International Headache Society

8 October 2018

The International Classification of Headache Disorders 3rd edition

This is a bit of news that went under the radar this past January, so it’s about time we gave it some attention. The International Classification of Headache Disorders 3rd edition finally came out of beta, and is publicly available online.

ICHD-3 ICHD-3 is a classification of headache disorders. The first edition was published over 30 years ago. As the years have gone by, new research has changed our understanding of migraine, and the ICHD itself is much more “evidence driven” and much less “opinion driven”, according to Jes Olesen, chairman of the Headache Classification Committee.

Of course, people will complain – “I don’t agree with that definition of migraine”, or “I know lots of people who have these symptoms, but not those symptoms”, and so on. And, of course, the discussion needs to continue.

However, whether or not one agrees with every detail is not the point. The ICHD-3 gives us a common framework, a common language. When I say “migraine with aura”, you can compare what I’m saying with a standard definition of migraine with aura and its sub-types. Agree or disagree, we have something to use to compare.

More fine-tuning has been done since the beta version came out in 2013, and you can compare the two versions online.

Thanks to the many people around the world who have brought this edition to the public!

You can use this tool yourself. It’s can be especially useful when talking about your diagnosis with your doctor.

Just go to the main ICHD-3 site, and check the major categories on the left sidebar. Click on one, and from there you’ll see a hierarchy of conditions that you can click through to see.

The site also has video explanations of certain things, especially intended for doctors.

9 July 2014

Getting a Headache right after Drinking Alcohol?

James Information 11

You’ve had a little to drink – or maybe more than a little – and while you’re still having a good time, the headache strikes. What’s happening? Should you be concerned?

Yes, you should be. If you have a headache within two or three hours of drinking alcohol, you’re experiencing something different from the familiar “hangover”. In fact, the International Headache Society has classified these as two different types of headache.

The headache that arrives early is known as an immediate alcohol-induced headache. That doesn’t mean it happens right away, but if it happens within 2-3 hours, it qualifies. This has sometimes been called the “cocktail headache”.

If these symptoms are new to you, you need to go to your doctor and explain your symptoms and medical history, in order to be sure something serious isn’t behind the headache.

Be sure you tell your doctor about any other headache conditions you have. It could be that people with tension-type headache, or migraine attacks, may be more susceptible to this rare alcohol induced headache. It could also be that the alcohol is triggering an attack.

If you have another headache condition, your best first step will be to treat (or continue to treat) that condition. Getting migraine attacks under control, for example, should improve the situation.

Unfortunately, immediate alcohol-induced headache is notoriously changeable. You may drink a little one day and get a headache, and drink a lot another day with no problem. The only way to certainly avoid the headache is to avoid the alcohol.

Do keep a headache diary, paying special attention to any alcohol you’re drinking. This will help your doctor diagnose you correctly and find a treatment plan which works for you.

13 December 2013

Painkillers – How Much is Too Much?

James Information, Medications 0

It’s easy to say “It’s just a headache – take a pill”. But what if you’re doing that over and over?

We hear over and over that overuse of medications is bad for us – and it is. Medication-overuse headache (MOH) is a serious issue.

So we don’t want to “overuse” medications – but how much is too much?

It’s a very controversial question. And it’s true that it will vary depending on your condition and medical history. Many doctors simply won’t give you an answer – they prefer to take things on a case by case basis, and evaluate how things are going as time goes by.

And they’re probably right.

The problem is, many people aren’t going to a doctor at all. Many are just relying on “painkillers” when there are better treatments available.

The International Headache Society has tried to classify MOH and give some suggestions regarding how much is too much. Generally, they’ve set the danger level at 10-15 days a month, depending on the medication. Medications such as triptans, opioids, and combination drugs should be taken less often than aspirin or ibuprofen, for example.

But the need to simplify once again means that certain people may be following the guidelines, and yet they’re still taking too much. For example, the person who takes a medication every day for a period of time, and then stops for a while. Or someone who’s taking something every other day. Some doctors will tell you that you should be concerned if you’re taking something more than 2-3 times a month.

If you are taking painkillers more than 2 or 3 times a month, at the very least you should be having a serious talk with your doctor. You do not want to see things get worse, and they could very easily. Tell your doctor what medication(s) you’re taking, how often, and what your symptoms are.

Some people may be able to take more medications than others – but once it goes beyond a very occasional dose, everyone should find a doctor who will listen and get some good advice. They should also do their own research. There are probably much better options for you that will be better for you.

Also see: How many headaches are too many in a week?

13 October 2012

Botox: Benefits vs Cost vs Other Treatments

James Treatments 0

We’ve talked more than once about the complexities of using Botox for the treatment of chronic migraine disease. Whether or not Botox (onabotulinumtoxinA) will be helpful seems to depend on many factors – how experienced is the doctor? Where is Botox being injected? How often? And, of course, even if everything else is equal, every patient is still very different.

(Also see Botox for Migraine â€“ how does it actually work?)

Neurologist Dr. Stuart B. Black, member of the International Headache Society and founding member and director of the Dallas Headache Clinic, recently wrote about Botox. His article reminds us how much things have changed and how far we have to go.

Here are some of the challenges that he mentions (with some addition thoughts of my own):

The Cost: One treatment alone is $1,300-$1,500 in the United States. Worse, some doctors are charging significantly more than that.
Complete Treatment: Botox works best when it’s part of more comprehensive treatment for migraine, and not alone. That means you should be seeing a doctor who not only knows the details of your medical history, but also has training in a range of migraine treatments. If you go to a doctor who just knows Botox injection, you may not get the benefit you really need.
Insurance: I probably don’t need to explain this – many of you know how complicated it can be to get insurance coverage. An insurance company makes general rules for what it will cover – not rules that will be best for you. For example, take a look at Aetna’s policy. On the one hand, you could point out (as Dr. Black does) that none of the other treatments you’re supposed to try first are actually approved [by the FDA] for migraine. On the other hand, some would argue that there’s better evidence for a host of other treatments not even listed, and that there are many more you should try before spending so much on Botox.

Dr. Black also mentioned the changes that are being made in which injection sites should be used. I would add that this is still a huge issue for Botox. Although we continue to change how injections are done, based (hopefully) on the best evidence, we still know very little about how different types of migraine and different people may react to different injection sites. The time and cost involved in such research is staggering. But it leaves a lot of questions about how well Botox will work for you.

Read Dr. Black’s full article from Clinical Neurology: Weighing Botox’s Migraine Benefits Against Costs

21 June 2012

10 Critical Mistakes First Time Migraine Patients Make

James Tips 6

You’ve just been diagnosed with MIGRAINE. It’s natural to be confused, maybe even nervous or scared.

I’ve spent many years listening to and helping migraineurs. I’ve found that there are some common mistakes that people make when they’re first diagnosed with migraine. Here are my top 10 – maybe one of them will help you to avoid the same mistake!

Expect fast results. No, actually, don’t expect fast results! It’s true that some migraine patients find a solution right away. But a decent trial period for a new treatment is often 3 months – and that’s just trying one treatment. It’s not just migraine – many neurological diseases require this kind of patience (for example epilepsy or muscular distrophy).
Don’t see the doctor again. After all, it’s "just" migraine. I just need some "painkillers" and a rest and I’ll be fine. No – you should go back to the doctor for follow-up. This especially applies when your symptoms change. But really, because migraine takes time to treat and because it’s a disease with complex symptoms and causes, you should be going back for more help.
Be satisfied with a diagnosis of "Migraine". In 1988, the Headache Classification Committee from the International Headache Society came out with a document intended to classify headache disorders, including many different types of migraine. The latest edition is from 2004. Knowing what type of migraine you have means you can find better treatment faster. When you get a diagnosis, check to see if it’s in the document and if your symptoms match. If not, find another doctor and get a second opinion. (A simplified version of the International Classification of Headache Disorders (migraine section) here)
Rely on popular news reports and commercials for information on migraine treatment. News reports and commercials are important ways to get information out to the public. However, they will almost never give you a balanced view of migraine treatment. That’s why crowds of people go after a "miracle" treatment before trying things that are much more likely to actually work for them. Please take news bites with a grain of salt.
Blame it on "stress". "Oh, it’s just stress – I just need to wait until life calms down a bit." Using stress as a scapegoat has kept many, many migraine patients from proper treatment. Stress does not cause migraine, and there’s some debate about whether it even triggers migraine attacks. It’s a factor in the overall picture, but there are likely other issues that you need to deal with in order to properly treat migraine. It’s not "just stress".
Rely on over-the-counter "painkillers". Instead of making use of medications and treatments that can specifically help migraine, patients often take the "shotgun" approach, and take a general purpose painkiller. This often leads to more symptoms and more pain in the long run.
Think you’ve tried "everything" after three different treatments. No one has tried "everything", because in this day and age there are so many treatments (yes, valid ones) for migraine that it could take a lifetime to give them all a try. Sure, it’s discouraging when you’ve tried 5, 10, 15 treatments over many years. Take a break – but don’t give up.
Rely one one kind of treatment. Only try yoga, or just drugs. Only try vitamins, and ignore the rest. Guess what? Many migraineurs have had great success with a variety of treatments. Medications and a change of diet, or the chiropractor and exercise, or magnesium and biofeedback… Don’t be quick to rule out other types of treatment.
Ignore other symptoms. What other symptoms? Well, a very common symptom of migraine is headache. It’s easy to focus on head pain, and ignore other symptoms. But your doctor can treat you better if she knows about other symptoms you’re having, even if they’re not migraine related. Dizziness? Nausea? Sensitive to light? Neck pain? Depression? And guess what? Many migraine symptoms are experienced between actual migraine attacks. The more you can describe your symptoms, the better treatment you’ll get.
What would you add? Oops – I don’t have a #10 mistake! You have some experience – what would you add as a mistake that people make when they’re first diagnosed with migraine? Leave a comment!