Operational Diagnostic Criteria for Chronic Migraine: Expert Opinion


  • Conflict of Interest: Dr. Dodick has served on advisory boards and has consulted for Allergan, Amgen, Alder, Arteaus, Pfizer, Merck, ENeura, NuPathe, Eli Lilly & Company, Autonomic Technologies, WL Gore, Ethicon J&J, Zogenix, Supernus, Labrys, and Bristol Myers Squibb. Dr. Dodick has received funding for travel, speaking, or editorial activities from the following: CogniMed, Scientiae, IntraMed, SAGE Publishing, Sun Pharma, Allergan, Lippincott Williams & Wilkins, Oxford University Press, Cambridge University Press, Miller Medical, SAGE, and Annenberg Center for Health Sciences; he serves as Editor-in-Chief and on the editorial boards of The Neurologist, Lancet Neurology, and Postgraduate Medicine, and has served as Editor-in-Chief of Cephalalgia. He receives publishing royalties for Wolff's Headache, 8th edition (Oxford University Press, 2009) and Handbook of Headache (Cambridge University Press, 2010). Dr. Silberstein is on the advisory panel of and receives honoraria from Allergan, Artaeus, Electrocore, and Neuralieve. He serves as a consultant for and receives honoraria from Amgen, Labrys Biologics, MAP, and Zogenix. His employer receives research support from AGA, Allergan, Amgen, Cumberland, ElectroCore, Labrys, Merz, OptiNose, and Troy Healthcare. Dr. Lipton receives research support from the NIH – PO1 AG03949 (Program Director), PO1AG027734 (Project Leader), RO1AG025119 (Investigator), K23AGO30857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor), the National Headache Foundation and the Migraine Research Fund; serves on the editorial boards of Neurology and Cephalalgia and as senior advisor to Headache, has reviewed for the NIA and NINDS, holds stock options in Neuralieve, Inc., and Minster, Inc.; and serves as a consultant or has received honoraria from: Allergan, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Eli Lilly, Endo, GlaxoSmithKline, Minster, Merck, Nautilus Neuroscience, Neuralieve, Novartis, and Pfizer.



The prevalence, disability, progression, and treatment needs associated with chronic migraine (CM) mandate epidemiological, clinical, and basic research to better understand the clinical course of this disorder and to facilitate development of more effective therapies. Such efforts have been significantly impeded by lack of agreement within the headache specialist community of the most appropriate diagnostic criteria for CM.


This paper reviews the pertinent nosological literature and extensive field testing already performed.


We recommend that the International Classification of Headache Disorders-3β criteria for CM be modified. We would remove the need for 5 prior migraine attacks and would replace “Headache considered by patient to be onset migraine and relieved by a triptan or an ergotamine derivative” with “criteria A and B for 1.5 probable migraine.”


The proposed criteria are guided by the aims of accurately characterizing patients with migraine who develop primary chronic daily headache, reflecting the large numbers of patients with CM in clinical practice, and facilitating research into a disorder that is an academic and clinical priority.