Diagnostic Criteria for Migraine (ICHD-3)

The ICHD-3 provides diagnostic criteria for the three main categories of migraine: migraine without aura, migraine with aura, and chronic migraine.

Criteria Migraine without aura

At least five attacks that meet the following four criteria:

1. Headache lasting 4-72 hours (when untreated or unsuccessfully treated)
2. Headache with at least two of the following four characteristics:
   • Unilateral location
   • Pulsating quality
   • Moderate or severe pain intensity
   • Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
3. Headache accompanied by at least one of the following symptoms:
   • Nausea, vomiting, or both
   • Photophobia and phonophobia
4. Not better accounted for by another ICHD-3 diagnosis

Migraine with aura

At least two attacks that meet the following three criteria:

1. One or more of the following fully reversible aura symptoms:
   • Visual
   • Sensory
   • Speech, language, or both
   • Motor
   • Brain stem
   • Retinal
2. At least three of the following six characteristics:
   • At least one aura symptom spreading gradually over a period ≥5 minutes
   • Two or more aura symptoms occurring in succession
   • Each aura symptom lasting 5–60 minutes
   • At least one unilateral aura symptom
   • At least one positive aura symptom
   • Headache accompanying the aura or following the aura within 60 minutes
3. Not better accounted for by another ICHD-3 diagnosis

Chronic migraine

Headaches (suggestive of migraine or tension headaches) on ≥15 days/month for >3 months that fulfill the following criteria:

1. Occurring in a patient who has had at least five attacks meeting the criteria for migraine without aura or the criteria for migraine with aura or both
2. On ≥8 days/month for >3 months, features of migraine without aura or of migraine with aura or believed by the patient to be migraine at onset that is relieved by a triptan or ergot derivative
3. Not better accounted for by another ICHD-3 diagnosis

 

References:

1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. [Medline]
2. Ashina M. Migraine. N Engl J Med 2020; 383:1866-1876. [Medline]

 

Created Nov 12, 2020.