Table 1. International Headache Society Classification of Headache

 

1.             Migraine 1.1           Migraine without aura 1.2           Migraine with aura 1.3           Childhood periodic syndromes 1.4           Retinal migraine 1.5           Complications of migraine 1.6           Probable migraine   2.             Tension-type headache (TTH) 2.1           Infrequent Episodic tension-type headache 2.2           Frequent episodic tension-type headache 2.3.           Chronic tension-type headache 2.4           Probable tension-type headache   3.             Cluster headache and other trigeminal autonomic cephalalgias 3.1           Cluster headache 3.2           Paroxysmal hemicrania 3.3           Short-lasting unilateral neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) 3.4             Probable trigeminal autonomic cephalalgia   4.             Other primary headaches 4.1           Primary stabbing headache 4.2           Primary cough headache 4.3           Primary exertional headache 4.4           Primary headache associated with sexual activity 4.5           Hypnic headache 4.6           Primary thunderclap headache 4.7            Hemicrania continua 4.8            New daily-persistent headache (NDPH)   5.             Headache attributed to head and/or neck trauma 5.1           Acute post-traumatic headache 5.2           Chronic post-traumatic headache 5.3            Acute headache attributed to whiplash injury 5.4            Chronic headache attributed to whiplash injury 5.5            Headache attributed to traumatic intracranial haematoma 5.6            Headache attributed to other head and/or neck trauma 5.7            Post-craniotomy headache   6.             Headache attributed to cranial or cervical vascular disorder 6.1           Headache attributed to ischemic stroke or transient ischemic attack 6.2           Headache attributed to non-traumatic intracranial haemorrhage 6.3           Headache attributed to unruptured vascular malformation 6.4           Headache attributed to arteritis 6.5           Carotid or vertebral artery pain 6.6           Headache attributed to cerebral venous thrombosis 6.7           Headache attributed to other intracranial vascular disorder   7.             Headache attributed to non-vascular intracranial disorder 7.1           Headache attributed to high cerebrospinal fluid pressure 7.2           Headache attributed to low cerebrospinal fluid pressure 7.3           Headache attributed to non-infectious inflammatory disease 7.4           Headache attributed to intracranial neoplasm 7.5           Headache attributed to intrathecal injection 7.6           Headance attributed to epileptic seizure 7.7           Headache attributed to Chiari malformation type I 7.8            Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis 7.9            Headache attributed to other non-vascular intracranial disorder

8.             Headache associated to a substance2 or its withdrawal 8.1           Headache induced by acute substance use or exposure 8.2           Medication-overuse headache (MOH) 8.3           Headache as an adverse event attributed to chronic medication 8.4           Headache attributed to substance withdrawal   9.             Headache attributed to infection 9.1           Headache attributed to intracranial infection 9.2           Headache attributed to systemic infection 9.3           Headache attributed to HIV/AIDS 9.4            Chronic post-infection headache   10.           Headache attributed to disorder of homoestasis 10.1         Headache attributed to hypoxia 10.2         Dialysis headache 10.3         Headache attributed to arterial hypertension 10.4         Headache attributed to hypothyroidism 10.5         Headache attributed to fasting 10.6         Cardiac cephalalgia 10.7           Headache attributed to other disorder of homoestasis   11.           Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures 11.1         Headache attributed to disorder of cranial bone 11.2         Headache attributed to disorder of neck 11.3         Headache attributed to disorder of eyes 11.4         Headache attributed to disorder or ears 11.5         Headache attributed to rhinosinusitis 11.6         Headache attributed to disorder of teeth, jaws, or related structures 11.7         Headache or facial pain attributed to a temporomandibular joint (TMJ) disorder 11.8          Headache attributed to other disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structures   12.           Headache attributed to psychiatric disorder 12.1           Headache attributed to somatisation disorder 12.2           Headache attributed to psychotic disorder   13.            Cranial neuralgias and central causes of facial pain 13.1         Trigeminal neuralgia 13.2           Glossopharyngeal neuralgia 13.3         Nervus intermedius neuralgia 13.4         Superior laryngeal neuralgia 13.5         Nasociliary neuralgia 13.6         Supraorbital neuralgia 13.7         Other terminal branch neuralgias 13.8           Occipital neuralgia 13.9           Neck-tongue syndrome 13.10         External compression headache 13.11         Cold-stimulus headache 13.12         Constant pain caused by compression, irritation or distortion of cranial nerves or upper cervical roots by structural lesions 13.13        Optic neuritis 13.14        Ocular diabetic neuropathy 13.15         Head or facial pain attributed to herpes zoster 13.16         Tolosa Hunt syndrome 13.17         Ophthalmoplegic ‘migraine’ 13.18         Central causes of facial pain 13.19        Other cranial neuralgia or other centrally mediated facial pain   14.           Other headache, cranial neuralgia, central or primary    facial pain

In contemporary medicine, Dalessio,  Goadsby, Raskin, Sacks, Silberstein, Lipton, Stewart, Saper, and Welch,  are among those who could be singled out for their contributions to the study of migraine.  One central theme seems to decry the simplistic view that migraine is defined by a unilateral (hemicranial) headache.  As Sacks⁵ wrote, "It is necessary to state that headache is never the sole symptom of a migraine, nor indeed is it the necessary feature of migraine attacks."  Another quote emphasizes this belief:  "Migraine is diagnosed by the entire history, not by physical findings or by the presence of headache alone".⁷  It is unfortunate that many have limited their concept of migraine to a stereotyped syndrome of visual disturbance followed by unilateral throbbing headache, which is diagnosed by the response to ergot preparations.  Migraine gives rise to a number of well‑recognized syndromes, as well as a variety of "equivalents" less commonly considered as migraine.  The symptom‑complexes or syndromes of migraine include migraine without aura, migraine with aura, ophthalmoplegic migraine, retinal migraine, as well as the others listed in

Table 1.  The clinical features of migraine will be discussed according to the formal criteria published by the International Headache Society (IHS) in 2004.¹

Other conditions and syndromes discussed include cluster headache, trigeminal neuralgia, atypical facial pain, temporal arteritis, and the headaches produced by intracranial mass lesions, muscle contraction, trauma, vascular anomalies, and ocular lesions.

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