Centro Cefalee, Istituto di Neurologia, Dipartimento di Neuroscienze, University of Parma, c/o Azienda Ospedaliero-Universitaria (Padiglione Barbieri, 3 degrees piano), Via Gramsci, 14, 43100, Parma, Italy.
Neurol Sci. 2010 Jun;31 Suppl 1:S9-13. doi: 10.1007/s10072-010-0265-x.
Since the publication of the second edition of the International Classification of Headache Disorders (ICHD-2) in 2004, a fiery debate has been raging about chronic daily headache in general and about chronic migraine and medication overuse headache in particular. Based on a number of considerations and observations on the current state of knowledge, a proposal is advanced that suggests a few changes to ICHD-2, namely: (1) differentiation of migraine without aura at the second-digit level into infrequent, frequent and very frequent, based on frequency of attacks. (2) Inclusion of transformed migraine among the complications of migraine; this entry should be coded to 1.5.1 replacing chronic migraine and the only diagnostic criterion that needs to be changed over those already listed in the revised ICHD-2 (ICHD-2R) is its temporal pattern (more than 20 days/month for 1 year or more and never with more than 5 headache-free consecutive days). (3) Differentiation of transformed migraine at the fourth-digit level depending on the presence or absence of symptomatic medication overuse (i.e. use for more than 20 days/month) regardless of whether overuse played any role in the worsening of the headache. (4) Switching of medication overuse headache to the Appendix with other diagnostic criteria to be defined.
自 2004 年第二版《国际头痛疾病分类》（ICHD-2）出版以来，针对慢性每日头痛，尤其是慢性偏头痛和药物过度使用性头痛，一直存在激烈的争论。基于对当前知识状况的一些考虑和观察，提出了对 ICHD-2 的一些修改建议，即：（1）根据发作频率，将无先兆偏头痛在第二位数级进行区分，分为偶发性、频发性和非常频发性。（2）将转换性偏头痛纳入偏头痛的并发症中；该条目应编码为 1.5.1，取代慢性偏头痛，并且只需更改已在修订后的 ICHD-2（ICHD-2R）中列出的诊断标准之一，即其时间模式（每月超过 20 天/超过 1 年，且从不超过 5 天连续无头痛）。（3）根据是否存在症状性药物过度使用（即每月使用超过 20 天），在第四位数级对转换性偏头痛进行区分，而不管过度使用是否在头痛恶化中起作用。（4）将药物过度使用性头痛切换到附录，并定义其他诊断标准。
