Below you will thing the diagnostic criteria for different headaches (the most common clinical types) according to the International Headache Society.
SUMMARY (click to go straight to the topic):
1. Migraine
1.1. Migraine without aura
1.2. Migraine with aura
1.3. Chronic migraine
2. Tension-type headache
2.1. Infrequent episodic tension-type headache
2.2. Frequent episodic tension-type headache
2.3. Chronic tension-type headache
3. Classical trigeminal neuralgia
4. Sinus headache
4.1. Headache attributed to acute rhinosinusitis
4.2. Headache attributed to chronic or recurring rhinosinusitis
8. Short-lasting unilateral neuralgiform headache attacks
8.1. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
8.2. Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
12. Headache attributed to idiopathic intracranial hypertension (IIH)
13. Medication-overuse headache (MOH)
DIAGNOSTIC CRITERIA FOR EACH HEADACHE:
1. Migraine
1.1. Migraine without aura
Diagnostic criteria:
A. At least five attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated)
C. Headache has at least two of the following four characteristics:
1. unilateral location
2. pulsating quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
D. During headache at least one of the following:
1. nausea and/or vomiting
2. photophobia and phonophobia
E. Not better accounted for by another ICHD-3 diagnosis.
1.2. Migraine with aura
Diagnostic criteria:
A. At least two attacks fulfilling criteria B and C
B. One or more of the following fully reversible aura symptoms:
1. visual
2. sensory
3. speech and/or language
4. motor
5. brainstem
6. retinal
C. At least two of the following four characteristics:
1. at least one aura symptom spreads gradually over ≥5 min, and/or two or more symptoms occur in succession
2. each individual aura symptom lasts 5-60 min
3. at least one aura symptom is unilateral
4. the aura is accompanied, or followed within 60 min, by headache
D. Not better accounted for by another ICHD-3 diagnosis, and transient ischaemic attack has been excluded.
1.3. Chronic migraine
Diagnostic criteria:
A. Headache (tension-type-like and/or migraine-like) on ≥15 days per month for >3 months2 and fulfilling criteria B and C
B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura
C. On ≥8 days per month for >3 months, fulfilling any of the following:
1. criteria C and D for 1.1 Migraine without aura
2. criteria B and C for 1.2 Migraine with aura
3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative
D. Not better accounted for by another ICHD-3 diagnosis.
2. Tension-type headache
2.1. Infrequent episodic tension-type headache
Diagnostic criteria:
A. At least 10 episodes of headache occurring on <1 day per month on average (<12 days per year) and fulfilling criteria B-D
B. Lasting from 30 min to 7 days.
C. At least two of the following four characteristics:
1. bilateral location
2. pressing or tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as walking or climbing stairs
D. Both of the following:
1. no nausea or vomiting
2. no more than one of photophobia or phonophobia
E. Not better accounted for by another ICHD-3 diagnosis.
2.2. Frequent episodic tension-type headache
Diagnostic criteria:
A. At least 10 episodes of headache occurring on 1-14 days per month on average for >3 months (≥12 and <180 days per year) and fulfilling criteria B-D
B. Lasting from 30 min to 7 days
C. At least two of the following four characteristics:
1. bilateral location
2. pressing or tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as walking or climbing stairs
D. Both of the following:
1. no nausea or vomiting
2. no more than one of photophobia or phonophobia
E. Not better accounted for by another ICHD-3 diagnosis.
2.3. Chronic tension-type headache
Diagnostic criteria:
A. Headache occurring on ≥15 days per month on average for >3 months (≥180 days per year), fulfilling criteria B-D
B. Lasting hours to days, or unremitting
C. At least two of the following four characteristics:
1. bilateral location
2. pressing or tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as walking or climbing stairs
D. Both of the following:
1. no more than one of photophobia, phonophobia or mild nausea
2. neither moderate or severe nausea nor vomiting
E. Not better accounted for by another ICHD-3 diagnosis.
3. Classical trigeminal neuralgia
Diagnostic criteria:
A. At least three attacks of unilateral facial pain fulfilling criteria B and C
B. Occurring in one or more divisions of the trigeminal nerve, with no radiation beyond the trigeminal distribution
C. Pain has at least three of the following four characteristics:
1. recurring in paroxysmal attacks lasting from a fraction of a second to 2 min
2. severe intensity
3. electric shock-like, shooting, stabbing or sharp in quality
4. precipitated by innocuous stimuli to the affected side of the face
D. No clinically evident neurological deficit
E. Not better accounted for by another ICHD-3 diagnosis.
4. Sinus headache
4.1. Headache attributed to acute rhinosinusitis
Diagnostic criteria:
A. Any headache fulfilling criterion C
B. Clinical, nasal endoscopic and/or imaging evidence of acute rhinosinusitis
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed in temporal relation to the onset of the rhinosinusitis
2. either or both of the following:
a) headache has significantly worsened in parallel with worsening of the rhinosinusitis
b) headache has significantly improved or resolved in parallel with improvement in or resolution of the rhinosinusitis
3. headache is exacerbated by pressure applied over the paranasal sinuses
4. in the case of a unilateral rhinosinusitis, headache is localized ipsilateral to it
D. Not better accounted for by another ICHD-3 diagnosis.
4.2. Headache attributed to chronic or recurring rhinosinusitis
Diagnostic criteria:
A. Any headache fulfilling criterion C
B. Clinical, nasal endoscopic and/or imaging evidence of current or past infection or other inflammatory process within the paranasal sinuses
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed in temporal relation to the onset of chronic rhinosinusitis
2. headache waxes and wanes in parallel with the degree of sinus congestion, drainage and other symptoms of chronic rhinosinusitis
3. headache is exacerbated by pressure applied over the paranasal sinuses
4. in the case of a unilateral rhinosinusitis, headache is localized ipsilateral to it
D. Not better accounted for by another ICHD-3 diagnosis.
5. Cluster headache
Diagnostic criteria:
A. At least five attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 min (when untreated)1
C. Either or both of the following:
1. at least one of the following symptoms or signs, ipsilateral to the headache:
a) conjunctival injection and/or lacrimation
b) nasal congestion and/or rhinorrhoea
c) eyelid oedema
d) forehead and facial sweating
e) forehead and facial flushing
f) sensation of fullness in the ear
g) miosis and/or ptosis
2. a sense of restlessness or agitation
D. Attacks have a frequency between one every other day and 8 per day for more than half of the time when the disorder is active
E. Not better accounted for by another ICHD-3 diagnosis.
6. Paroxysmal hemicrania
Diagnostic criteria:
A. At least 20 attacks fulfilling criteria B-E
B. Severe unilateral orbital, supraorbital and/or temporal pain lasting 2-30 min
C. At least one of the following symptoms or signs, ipsilateral to the pain:
1. conjunctival injection and/or lacrimation
2. nasal congestion and/or rhinorrhoea
3. eyelid oedema
4. forehead and facial sweating
5. forehead and facial flushing
6. sensation of fullness in the ear
7. miosis and/or ptosis
D. Attacks have a frequency above five per day for more than half of the time
E. Attacks are prevented absolutely by therapeutic doses of indomethacin1
F. Not better accounted for by another ICHD-3 diagnosis.
7. Hemicrania continua
Diagnostic criteria:
A. Unilateral headache fulfilling criteria B-D
B. Present for >3 months, with exacerbations of moderate or greater intensity
C. Either or both of the following:
1. at least one of the following symptoms or signs, ipsilateral to the headache:
a) conjunctival injection and/or lacrimation
b) nasal congestion and/or rhinorrhoea
c) eyelid oedema
d) forehead and facial sweating
e) forehead and facial flushing
f) sensation of fullness in the ear
g) miosis and/or ptosis
2. a sense of restlessness or agitation, or aggravation of the pain by movement
D. Responds absolutely to therapeutic doses of indomethacin (should be used initially in a dose of at least 150 mg daily and increased if necessary up to 225 mg daily)
E. Not better accounted for by another ICHD-3 diagnosis.
8. Short-lasting unilateral neuralgiform headache attacks
Diagnostic criteria
A. At least 20 attacks fulfilling criteria B–D
B. Moderate or severe unilateral head pain, with orbital, supraorbital, temporal and/or other trigeminal distribution, lasting for 1–600 sec and occurring as single stabs, series of stabs or in a saw-tooth pattern
C. At least one of the following cranial autonomic symptoms or signs, ipsilateral to the pain:
1. conjunctival injection and/or lacrimation
2. nasal congestion and/or rhinorrhoea
3. eyelid oedema
4. forehead and facial sweating
5. forehead and facial flushing
6. sensation of fullness in the ear
7. miosis and/or ptosis
D. Attacks have a frequency of at least one a day for more than half of the time when the disorder is active
E. Not better accounted for by another ICHD-3 diagnosis.
It may be differentiated in:
8.1. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
Diagnostic criteria
A. Attacks fulfilling criteria for Short-lasting unilateral neuralgiform headache attacks
B. Both of conjunctival injection and lacrimation (tearing).
8.2. Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
Diagnostic criteria
A. Attacks fulfilling criteria for Short-lasting unilateral neuralgiform headache attacks, and criterion B below
B. Only one or neither of conjunctival injection and lacrimation (tearing).
9. Primary stabbing headache
Diagnostic criteria:
A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B-D
B. Each stab lasts for up to a few seconds
C. Stabs recur with irregular frequency, from one to many per day
D. No cranial autonomic symptoms
E. Not better accounted for by another ICHD-3 diagnosis.
10. Hypnic headache
Diagnostic criteria:
A. Recurrent headache attacks fulfilling criteria B-E
B. Developing only during sleep, and causing wakening
C. Occurring on ≥10 days per month for >3 months
D. Lasting ≥15 min and for up to 4 hr after waking
E. No cranial autonomic symptoms or restlessness
F. Not better accounted for by another ICHD-3 diagnosis.
11. Nummular headache
Diagnostic criteria:
A. Continuous or intermittent head pain fulfilling criterion B
B. Felt exclusively in an area of the scalp, with all of the following four characteristics:
1. sharply-contoured
2. fixed in size and shape
3. round or elliptical
4. 1-6 cm in diameter
C. Not better accounted for by another ICHD-3 diagnosis.
12. Headache attributed to idiopathic intracranial hypertension (IIH)
Diagnostic criteria:
A. Any headache fulfilling criterion C
B. Idiopathic intracranial hypertension (IIH) has been diagnosed, with CSF pressure >250 mm CSF (measured by lumbar puncture performed in the lateral decubitus position, without sedative medications or by epidural or intraventricular monitoring)
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed in temporal relation to IIH, or led to its discovery
2. headache is relieved by reducing intracranial hypertension
3. headache is aggravated in temporal relation to increase in intracranial pressure
D. Not better accounted for by another ICHD-3 diagnosis.
13. Medication-overuse headache (MOH)
Diagnostic criteria:
A. Headache occurring on ≥15 days per month in a patient with a pre-existing headache disorder
B. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
C. Not better accounted for by another ICHD-3 diagnosis.
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