International Classification of Headache Disorders

16 April 2020

So You Have a Coin-Shaped Headache that won’t go away…

As bizarre as it may sound to someone who has never had one, there is such a thing as a “coin-shaped” headache – very small and localized, but still painful.

Coin-shaped headache is actually an older term for what we now call nummular headache. Nummular is just one of those fancy medical terms – it comes from the Latin for “little coin”.

The “little coin” headache may actually be little, but it’s often larger than a coin – up to 6cm (about 2 1/3 inches). But it has a definite shape – either round or sometimes more of an oval. It can come and go, but it’s always a specific shape.

Nummular headaches are often on the top/upper back of the head (more rarely there may be more than one “coin” – but always a very localized area). The pain is usually somewhere between mild or moderate, although it can be severe.

But even though it’s usually not as severe as some other headaches, it finds other ways to make life difficult. Although the pain may last only for minutes or days, most often it becomes chronic, lasting for months. Worse pain may flare up at various times.

And it is often accompanied by other symptoms besides pain. For example, the skin may feel strange – numb, perhaps. Or may more sensitive than normal – a feeling of “pins and needles” or burning, or pressure, or just painful to a slight touch.

A new trial will be studying the connection of nummular headache to migraine. Do patients with nummular headache have migraine-like symptoms? If you have chronic nummular headache, you may want to keep an eye on this study: Observational Prospective Study on the Presence of Typical Migraine Features in Nummular Headache Patients: The Numamig Study

If you have a coin-like headache, it’s very important to get it checked out. As you might guess, there are other things that can cause similar kinds of pain. Rashes, such as shingles. Or other diseases, such as cancers.

If the pain is not severe, nummular headache may not be treated at all. It’s enough to know from your doctor that it’s nothing that’s likely to become more serious (such as cancer, of course).

The fact is that common headache treatments simply may not work in this case. However, some treatments have been tried – you can read a summary of some of them here. The most important thing is to rule out other causes, and then talk to your doctor about the best treatment for you.

For more information on nummular headache:

Nummular headache (The International Classification of Headache Disorders 3rd edition)
Nummular headache: diagnosis and treatment.

10 April 2020

“Just a Headache” – Even Less Common Than We Thought

James Discoveries & Stats 0

Of course most of us know by now that migraine is not “just a headache”. In fact, it’s not “just migraine” either – there are many different types of migraine, and knowing the type of migraine you have may help you with treatment.

A recent study out of Spain is suggesting that the problem of the “just a headache” diagnosis may be even worse that we thought.

Imagine getting a headache diagnosis in the emergency department of your local hospital. If a doctor has to “guess” about what kind of headache you have, a good guess would be tension-type headache, right? Very common. Or is it?

The study took 2132 patients who had visited emergency, who had all been diagnosed with tension-type headache (TTH) (which isn’t caused by tension, by the way – hence the addition of the word “type”). Then the researchers used the criteria in the International Classification of Headache Disorders (ICHD) – the standardized way to diagnose headaches.

Out of over 2000 patients who were told they had TTH, guess how many probably actually did have TTH? 2.4%!

Really? Yep. “Take an aspirin, and call me in the morning – it’s just a headache.” But – what kind of headache? And is aspirin the best treatment? And what is the underlying cause?

A few simple questions can be used to better diagnose headaches. Are doctors not educated? Is there some laziness here? Are some just assuming that “chances are” it’s TTH? But what if the statistics are skewed just because we’re assuming it’s so common?

These patients were actually suffering from quite a variety of headaches, all with different treatments.

You can check out the ICHD classifications for yourself, right here. If your doctor gives you a diagnosis, it can at least get you started (although it can be tricky if you don’t have a wider knowledge of why various headaches are diagnosed as they are). Don’t settle for an off-the-cuff diagnosis – it could mean that you will suffer much longer than you need to.

5 January 2019

MSG and Headache – A Myth?

James Discoveries & Stats, Information, News 1

Late last year, an article in Lifehacker caught my attention – Stop Being Afraid of MSG. People with headaches and migraine may either be relieved or shocked by the claims that follow:

If you’re still afraid of the seasoning MSG giving you headaches, you should know you’ve bought into a decades-old myth.

Words like “afraid”, “bought into” and “myth” certainly make one feel like they should change their opinion immediately, and order a bottle of MSG (affiliate link conveniently provided in the above article).

But on the other hand, many headache sufferers swear that, every time they eat MSG, they get a headache.

So what’s the truth? First, in spite of the fact that MSG has sometimes pretty much been blamed for the imminent fall of civilization, it doesn’t seem to have an obvious, immediate effect on most people. And long term effects of that kind are extremely difficult to measure.

So the real question is, does it bother some people, perhaps those predisposed to migraine?

Almost anything bothers somebody, so we’re actually looking for something more widespread than 6 people in Berlin who get sick if they eat MSG.

So here’s what many of you really want to know. Yes, there are many people who feel that MSG gives them headaches. You will hear lots of stories. That doesn’t make it a fact, but it’s widespread enough that it seems to be more than a coincidence.

However, the clinical trials have not been conclusive. So why is that? Are the “right” people simply not in the trial?

Part of the challenge is that MSG is noticeable. That means placebo effect. So a well designed study is difficult to do with MSG, and trials in the past have often been poorly designed from a scientific point of view.

In 2016, a useful review of the studies of MSG was published in the Journal of Headache and Pain (Does monosodium glutamate really cause headache? : a systematic review of human studies). The study pointed out some of the problems with previous studies.

Falling short of claiming that MSG headaches are “myth”, the researchers concluded that the evidence was not strong enough from clinical trials to prove a direct causal relationship:

Because of the absence of proper blinding, and the inconsistency of the findings, we conclude that further studies are required to evaluate whether or not a causal relationship exists between MSG ingestion and headache.

Interestingly, the study actually interacted with the beta edition of the International Classification of Headache Disorders 3rd edition (ICHD-3 beta), which listed monosodium glutamate (MSG)-induced headache as one type of “Headache attributed to a substance or its withdrawal”. The cited studies were investigated more closely, and again, the studies did not seem robust enough to prove the relationship between MSG and headache.

The editors of ICHD-3 seemed to agree, dropping the mention of MSG altogether when the document came out of beta.

If someone gets a headache after eating foods with MSG, what does that mean? Is it possible that other issues (such as high salt content in general) could be causing the headache? In some cases, yet. It is easy for individuals to assume that one thing is causing their headache, when it’s something else altogether – and that’s something that happens frequently.

On the other hand, it would seem difficult to use these studies to “prove” that there is no causal relationship. So that leaves us with two practical issues.

First, you are the only one who is going to “test” the relationship on yourself. Keep an open mind, and if you’re convinced that MSG is a problem for you, stay away from it. If you’ve read the evidence and would like to give it another try, go ahead.

We should probably be a little cautious before we start labelling the MSG headache as a con or myth. And laughing at the silly woman who still lives in the bronze age and thinks that MSG causes her headache would seem to be counter-productive. We really don’t have the evidence to know if MSG bothers her or not. And when new research comes out, who knows if our minds will change.

14 October 2010

1% Thursday: Get to know the ICHD-II

James Resources, Tips 1

The International Classification of Headache Disorders (ICHD-II) from the International Headache Society is an attempt to standardize the way we talk about various headache disorders.

Look at it this way – it’s a way for people all around the world to speak the "same language".

For example, let’s say I find a great treatment for retinal migraine. I want to share it with the world, so I tell everyone,"Eat jelly doughnuts! They’ll cure you of retinal migraine!"

Unfortunately, some people speak a different language. What I call migraine without aura they call retinal migraine. So everyone starts eating jelly doughnuts for migraine without aura, but it doesn’t help – it makes things worse.

We need a common language, so we can share treatments, understand diagnosis, talk about symptoms. Of course researchers can question these classifications – but they can’t discuss them intelligently unless they have a common base to work from.

When it comes to research, the ICHD II also helps us have clear, consistent, valuable results. Sadly, a recent study of the past few years found that studies only had about 64% compliance with the ICHD II standards. That makes the studies confusing at best and useless at worst.

So this week I challenge you to at least start to understand the International Classification of Headache Disorders (ICHD-II). Have your doctor show you which type of headache or migraine you have, and understand why you have that and nothing else.

This will:

Help promote the use of this tool worldwide
Help you understand your type of headache or migraine
Enable you to better discuss symptoms and treatments with others
Help you find people who really do have the same type of headache as you
It may help you discover that you have something different than what you thought, or perhaps more than one type of headache. Check the guide then talk to your doctor!

Start now. For the online version, see the International Classification of Headache Disorders II website. Currently, you can directly download the whole guide. Right click this link and download it to your desktop (pdf, 780KB)

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!