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The International Headache Society (IHS) classification and diagnostic criteria

These criteria were developed by a committee of experts and have been widely accepted. The criteria provide a hierarchical classification of all headache disorders (9) and have been translated into more than 15 languages. They also provide explicit diagnostic criteria for all headache disorders. Most headaches can be classified using this system. Since the development of the IHS classification and diagnostic criteria, many studies have shown that they are a valid, reliable, and comprehensive diagnostic tool (81, 82)


Table (3) International Headache Society Diagnostic Criteria for Migraine With Aura(9)

  1. At least 2 attacks fulfilling B
  2. At least 3 of the following characteristics:
    1. One or more fully reversible aura symptoms indicating focal brain dysfunction
    2. At least 1 aura symptom develops gradually over more than 4 minutes or 2 or more symptoms occur in succession
    3. No single aura symptom lasts more than 60 minutes
    4. Headache follows aura with a free interval of less than 60 minutes (it may also begin before or simultaneously with the aura)
  3. History, physical examination, and, where appropriate, diagnostic tests exclude a secondary cause .




Table (3) International Headache Society Diagnostic Criteria for Migraine without Aura (9)

At least 5 attacks fulfilling BD

  1. Headache lasting 472 hours (untreated or unsuccessfully treated)
  2. Headache has at least 2 of the following characteristics:
    1. Unilateral location
    2. Pulsating quality
    3. Moderate or severe intensity (inhibits or prohibits daily activities)
    4. Aggravation by walking stairs or similar routine physical activity
  3. During headache at least 1 of the following:
    1. Nausea, vomiting, or both
    2. Photophobia and phonophobia
  4. At least 1 of the following:
    1. History, physical, and neurologic examinations do not suggest one of the disorders listed in groups 511 (headaches secondary to organic or systemic metabolic disease)
    2. History, physical, and neurological examinations do suggest such disorder, but it is ruled out by appropriate investigations
    3. Such disorder is present, but migraine attacks do not occur for the first time in close temporal relation to the disorder.