International Headache Society Migraine Classification

Following is the IHS classification of migraine subtypes published in 2004:

1.2. Migraine with aura

1.2.1. Typical aura with migraine headache

1.2.2. Typical aura with non-migraine headache

1.2.3. Typical aura without headache

1.2.4. Familial hemiplegic migraine (FHM)

1.2.5. Sporadic hemiplegic migraine

1.2.6. Basilar-type migraine

1.3. Childhood periodic syndromes that are commonly precursors of migraine

1.3.1. Cyclical vomiting

1.3.2. Abdominal migraine

1.3.3. Benign paroxysmal vertigo of childhood

1.4. Retinal migraine

1.5. Complications of migraine

1.5.1. Chronic migraine

1.5.2. Status migrainosus

1.5.3. Persistent aura without infarction

1.5.4. Migrainous infarction

1.5.5. Migraine-triggered seizure

1.6. Probable migraine

1.6.1. Probable migraine without aura

1.6.2. Probable migraine with aura

1.6.5.[sic] Probable chronic migraine

The most important IHS subtypes of migraine are migraine without aura (formerly called common migraine) and migraine with aura (formerly classic migraine).11 Approximately 20–30% of migraineurs have migraine with aura.12 The same patient may have headache without aura, headache with aura, and aura without headache.

Migraine without aura (common migraine)

To establish a diagnosis of IHS migraine without aura Table: Migraine Without Aura,five attacks lasting from 4 to 72 hours are required. The attacks must have two of the following four pain characteristics:

  • unilateral location
  • pulsating quality
  • moderate to severe intensity
  • aggravation by routine physical activity

In addition, the attacks must be associated with either nausea, vomiting, or both, or photophobia and phonophobia.

No single characteristic is mandatory for a diagnosis of migraine. A patient who has photophobia, phonophobia, and severe pain aggravated by routine activity meets these criteria, as does the more typical patient with unilateral throbbing pain and nausea.36

Attacks that persist for more than 3 days are known as status migrainosus. Although the frequency of attacks varies widely, the average migraineur experiences one to three headaches a month. Like epilepsy, migraine is, by definition, a recurrent phenomenon. The requirement for at least five attacks is imposed because headaches simulating migraine may be caused by such organic diseases as brain tumors, sinusitis, or glaucoma.36

Migraine with aura (classic migraine)

The diagnosis of migraine with aura requires at least two attacks that are not attributable to another disorder and meet the criteria for a migraine aura of one of several subtypes. These criteria describe types of visual and sensory symptoms, their timing, duration, and relationship to a headache.

Fewer attacks are required to make a diagnosis of migraine with aura because a typical aura is highly specific for migraine. However, organic causes of headache must still be excluded, at least by history and physical examination.3,36

The headache and associated symptoms of migraine with aura are similar to those of migraine without aura but may be less severe, of shorter duration, or both. Most people who have migraine with aura also have migraine without aura. The aura usually lasts 20–30 minutes and typically precedes the headache, but occasionally it occurs only during the headache.

Text adapted from: Silberstein, SD, and Lipton RB. Headache and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;239–254.
With permission from Elsevier (www.elsevier.com).
Classification from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1:8-151. 

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Reviewed By: 
Steven C. Schachter, MD
on: 
Thursday, April 1, 2004