engleski

About new classification of headaches

During the XI. Congress of International Headache Society held in September 2003 in Rome, Italy, Supplement 1, Volume 24, 2004 of the journal Cephalgia dedicated to the International Classification of Headache Disorders was distributed to the participants. Along with sincere congratulations to the authors for the difficult job they did, we have some objections concerning a few mistakes made in the rules of taxonomy and classification principles. In the introduction to the classification, the authors stress the hierarchical classification principle and consequently diagnosing headache in individual patients according to to their phenomenology. On creating definitions and terms one must take into account the basic rule, ie, avoiding negative qualification. The first classification unit (Migraine, 1/G43/, 0.24), that of migraine without aura, is a violation of the proclaimed principles. Namely, it is not logical for a diagnostic term to include a phenomenon that patients do not experience.In line with this, one sholud also expect to read "migraine without neurological focal signs". We think that it would be much better to name this kind of headache simply migraine, as a common denominator of all subunits (or to retain the previously used term common migraine). Furthermore, under "Childhood periodic syndromes", which commonly are precursors of migraine, the first unit of Migraine also includes cyclic vomiting, abdominal migraine, and benign paroxysmal vertigo of childhood (1.3., 1.3.1., 1.3.2., 1.3.3., pp. 30-31). None of the patients with these symptoms has migraine or headache of any other type.We think that physicians have no right to classify these patients as those with headache or migraine. Unit 3/G44.0 named "Cluster headache and other trigeminal autonomic cephalalgias" is logically quite questionable. A common denominator of all entities in this group is the presence of autonomic phenomena including pain resembling causalgic pain. Because of this, cephalalgia appears to be a better term for this group as a whole. With a present title the authors obviously refer also to cluster headache as autonomic cephalalgia. In the subgroup of cluster headache, not all units have cluster dynamics. Therefore, it would be much more appropriate to rename this group as autonomic cephalalgia. In this case, other forms would consequently form a subgroup of individual units. We think that with the corrections suggested the classification would be more precise.

headache ; classification ; migraine

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