Abstract

Headache is a highly complex condition and cannot be explained by a single mechanism. There are no biomarkers for headache, and no effective diagnostic tests which are universally applicable. For instance, the International Classification of Headache Disorders (ICHD) criteria for conditions such as chronic migraine, hemicrania continua and Tolosa-Hunt syndrome require diagnosis to include a detailed medical history and notification of potential sensitivity to treatment drugs.

However, diagnosis is flawed in some of these patients using the normal treatment criteria and can lead to incorrect diagnoses and treatment responses. This paper reviews relevant studies pertaining to treatment response to headache and suggests that the ICHD should remove treatment response as a criterion. The accurate diagnosis of headache must precede treatment, and consideration of drug efficacy should not be required as a diagnostic criterion for headache. We suggest that treatment response could help to confirm the final diagnosis of headache in cases where diagnosis is undefined, and it is entirely reasonable to downgrade the role of treatment response in the ICHD diagnostic criteria for headache.

Keywords: Treatment response; International classification of headache disorders; Chronic migraine; Hemicranias continua; Tolosa-Hunt syndrome