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American Headache Society Members' Assessment of Headache Diagnostic Criteria


Address all correspondence to Dr. Justin M. Nash, Centers for Behavioral and Preventive Medicine, Brown Medical School, The Miriam Hospital, A Lifespan Affiliate, CORO Suite 500, One Hoppin Street, Providence, RI 02903.


Objective.—We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches.

Background.—The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension-type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the “transformed migraine” diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use.

Methods.—Members of the American Headache Society rated the importance of IHS and non-IHS diagnostic criteria for migraine and tension-type headache and for analgesic rebound headache. Respondents also described their use of the proposed transformed migraine diagnosis.

Results.—Two-thirds (67.3%) of the respondents reported use of the IHS criteria or the IHS criteria in conjunction with clinical judgment. For migraine and tension-type headache, IHS criteria were rated with high importance, but some respondents reported using additional non-IHS diagnostic criteria and de-emphasizing certain IHS criteria. For chronic headache, almost two-thirds (63%) of respondents reported using the transformed migraine diagnosis. For analgesic rebound headache, respondents preferred to make the diagnosis based on medication consumption that is lower than amounts stipulated in the IHS classification system.

Conclusions.—There remains a number of physicians interested in headache who do not use the IHS classification system, who modify the IHS criteria in practice, and who use the “transformed migraine” diagnosis for patients with chronic daily headache.