Abstract
Dear Sir It has been said, the camel is so peculiar that it must have been designed by a committee. The same can be said for the recent attempt to classify frequent/chronic primary headaches, starting with the infelicitous title: ‘New appendix criteria open for a broader concept of chronic migraine’.
Why call it ‘chronic migraine’ when the majority of headaches are usually tension-type?
Why is item B (requiring five attacks of migraine) necessary when item C requires more than eight attacks?
Why add item C2 when response to treatment is not a criterion for migraine?
Why limit migraine to attacks without aura; if some of the more than eight attacks per month were migraine with aura, would that change the diagnosis?
Why not the simple term ‘chronic daily headache’, i.e. headache (tension-type and/or migraine) on more than 15 days per month for at least 3 months in the absence of medication overuse.
Subclassifications:
Chronic migraine (migraine > 15 days per month)
Chronic migraine with tension-type headache
Chronic migraine without tension-type headache
Chronic tension-type headache (TTH > 15 days per month)
Chronic tension-type headache with migraine
Chronic tension-type headache without migraine.