This is meant to be a companion of the Headache -OR- Migraine post. If you have not read that then please do so before continuing on below.

The International Headache Society (IHS) further breaks down primary headaches into three initial categories:

1) MIGRAINE

— two subtypes: ‘without aura’ and ‘with aura’

— without aura migraines are defined by the IHS as: “recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.”

— with aura migraines are classified as: “recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.”

2) TENSION HEADACHE or TENSION-TYPE HEADACHE (TTH)

— four subtypes: ‘infrequent episodic’, ‘frequent episodic’, ‘chronic’, and ‘probable’

— infrequent episodic TTH’s are defined by the IHS as: “infrequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, but photophobia or phonophobia may be present.”

— frequent episodic TTH’s are classified as: “frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, but photophobia or phonophobia may be present.”

— chronic TTH’s are defined as: “a disorder evolving from frequent episodic tension-type headache, with daily or very frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting hours to days, or unremitting. The pain does not worsen with routine physical activity, but may be associated with mild nausea, photophobia or phonophobia.”

— probable TTH’s are classified as: “tension-type-like headache missing one of the features required to fulfil all criteria for a subtype of tension-type headache coded above, and not fulfilling criteria for another headache disorder.”

3) TRIGEMINAL AUTONOMIC CEPHALALGIAS (TACs)

— subtypes: ‘cluster’, ‘paroxysmal hemicrania’, ‘Short-lasting unilateral neuralgiform headache attacks’, ‘hemicrania continua’, and ‘probable TAC’

— cluster headaches are defined as: “attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15–180 minutes and occurring from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation.”

— paroxysmal hemicrania are classified as: “attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 2–30 minutes and occurring several or many times a day. The attacks are associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema. They respond absolutely to indomethacin.”

— short-lasting unilateral neuralgiform headache attacks are defined as: “attacks of moderate or severe, strictly unilateral head pain lasting seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye.”

— hemicrania continua is classified as: “persistent, strictly unilateral headache, associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation. The headache is absolutely sensitive to indomethacin.”

— a probable TAC is defined as: “headache attacks which are believed to be a type of 3. Trigeminal autonomic cephalalgia, but which are missing one of the features required to fulfil all criteria for any of the subtypes coded above, and do not fulfil all criteria for another headache disorder.”

Each category and subtype also has their own set of diagnostic criteria. Knowing these separate criteria makes it much easier to distinguish between each category and (especially) sub-type. If you are interested, I highly recommend referring to the IHS’ current guidelines and classification criteria found here.

To return to the Headache -OR- Migraine post click here.