Classification of headache disorders

Published on December 31, 2023   48 min
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Thank you for joining me on this talk about the classification of headache disorders. I'm Dr. Sara Sacco. I'm a neurologist and headache specialist in Charlotte, North Carolina.
If you want to appropriately treat a patient, you really need to know what it is you're treating. That goes for chest pain, abdominal pain, as well as for headache disorders, because you treat different ones differently. It's important that we understand what kind of headache it is that we're trying to treat or diagnose. The International Headache Society came up with the classification of headache disorders, so that we'd be all treating the same headache. The first one was published back in 1988, and a group of headache specialists got together and came up with what they thought was the best definition for headaches. After that, they reviewed those definitions and they looked at validation, and they got another committee. This second iteration, or version, of the International Classification of Headache Disorders was published in 2004. Working with the second version, it led to more questions about the diagnosis and a need for more validation, so they got another whole committee together, and they came up with a third version, which was published in 2018. That's the classification I'm going to be using, and I'm going to be primarily talking about that ICHD-3.
It's important to understand the organization of how the ICHD-3 works. They're divided into different groupings of headaches, - whether it's primary or secondary - within those they have different groupings, migraine, and then subgroupings. That's why you see that numbering system. It can go into actually three or even four digits. When you look at the individual ones, there is typically something like the number of headache attacks as part of the diagnosis. In addition, there's going to be certain criteria that they all need to meet. What you see on this slide is the general organization of it. Probably the most important one is the final one on this one. It's E - "not better accounted for by another ICHD-3 diagnosis". When you're thinking about these headache diagnoses, always keep the differential in mind so you're not missing some other diagnosis.