Abstract
In this issue of Cephalalgia we report the most recent efforts of the International Headache Classification Committee for ICHD-2. The paper presents a revision of the general criteria for secondary headaches. Present ICHD-2 criteria for secondary headaches request improvement of headache after treatment of the primary cause before a diagnosis can be made (1). This had to be changed because physicians need to diagnose patients as they come to their clinic and not after they have been treated. The purpose of the article is to present new general criteria that maintain the specificity of diagnosis without requesting improvement as an absolute requirement. One thing is to have a set of standard criteria; however, another is to translate them into criteria for each of the specific types of secondary headaches. This is a big task that will be carried out over the next couple of years. The committee that created ICHD-2 has done a lot of work over the last several years and the members have performed their duties well. Time has now come for a change of committee membership, partly to get fresh troops and partly to juvenate the membership with a view to the future. We want to train younger people in headache classification so that they are prepared when, in perhaps 10 years, it becomes necessary to make a totally revised headache classification, ICHD-3. However, in order not to loose the experience and wisdom of the present committee members, we have created an international scientific advisory board on headache classification. This committee will supervise the work of the classification committee and all documents will have to pass this committee before they go to print. Members of the advisory board are: Marie-Germaine Bousser, Hans-Christoph Diener, Hartmut Göbel, Miguel Lainez, Richard B. Lipton, Guiseppe Nappi, Fumihiko Sakai, Jean Schoenen, and Stephen D. Silberstein. Members of the new classification committee are: Jes Olesen (Chairman), Tim Steiner (Secretary), David Dodick, Anne Ducros, Michael B. First, Peter J. Goadsby, Zaza Katsarava, Morris Levin, Julio Pascual, Michael B. Russell, Tood Schwedt, Cristina Tassorelli, Gisela Terwindt, Maurice Vincent, and Shuu-Jiun Wang.
The new committee will convene for the first time during the IHC in Philadelphia and it is expected that it will finish its work within approximately 1 year. In addition to revised criteria for the secondary headaches, it will also include the revised criteria for chronic migraine and medication overuse headache and make other small adjustments throughout the document. This will then culminate in the printing of a new international headache classification, ICHD-2R, which should appear in the autumn of 2010 on the IHS website and replace the current versions. It will be printed as the first supplement of Cephalalgia in 2011. As soon as possible this new version of the classification should be translated and printed in the different languages of the world. This will bring an end to the uncertainty that now prevails because of the successive revisions of some of the chapters in ICHD-2.
The headache community has never been more active than now when it comes to research relating to headache classification. Many important papers have appeared on this issue and the results will be included in ICHD- 2R. I want particularly to focus on the April 2009 issue of Cephalalgia. In that issue Sun-Edelstein, Bigal and Rapoport (2) gave a thoughtful overview of the classification of chronic headaches. I share entirely their views and their request for a fast revision and printing of an official new classification. Above I have presented the road map to achieve this. A paper by the S-J Wang group (3) analysed exertional headache in adolescents and another paper from the group of Leone and Bussone (4) analysed the criteria for spontaneous intracranial hypotension. These two papers are excellent examples of high quality research into headache classification. They included large numbers of patients and analysed the sensitivity and specificity of current criteria. Most striking was the insufficiency of the criteria for spontaneous intracranial hypotension, but also the criteria for exertional headache obviously must be revised. These two papers can be used as a model for the study of the diagnostic criteria for all other secondary headaches. Most of the current diagnostic criteria are based on the opinion of experts and virtually every single entity needs a qualifying study. Obviously the results of the two published papers carry great weight when the classification is to be revised. Over the next 10 years papers with an equally good methodology will hopefully be published on most of the secondary headaches so that ICHD-3 in 10 years time can be based exclusively on published evidence. Until that happens, it is my hope that ICHD-2R will be a useful and clear guide to the diagnosis of primary as well as secondary headache disorders.