Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  


Indian Pediatr 2014;51: 123-124

International Classification of Headache Disorders, 3rd Edition: What the Pediatrician Needs to Know!

Neetu Sharma and *Devendra Mishra

From the Departments of Pediatrics, Gajra Raja Medical College, Gwalior, and Maulana Azad Medical College, Delhi, India.

Correspondence to: Dr Neetu Sharma, C-36 Jawahar Colony, Lashkar, Gwalior, MP 474 009, India.
Email: drneetuagarwal@gmail.com


Headache is a common problem in children and causes significant disability [1]. Robust diagnostic criteria are essential due to its high prevalence and the absence of any diagnostic investigations. The International Classification of Headache Disorders, 3
rdedition (ICHD-3) has been released by the ‘International Headache Society’ in May 2013 [2]. As this version is based on a large body of research on headache, in contrast to previous editions that were mostly based on opinion of experts, it is being considered as a major step forward in the diagnosis and management of headache [3]. We herein present the salient features of the new classification, which are likely to be of interest to the pediatricians. The important ones include change in some terminologies, addition of new categories and changes in diagnostic criteria, and have been summarized in Table I.


The most important change has been in the diagnosis of ‘Secondary’ headaches, which will be of interest to those in developing countries because of the high numbers of such headaches [4,5]. When a new headache occurs in close temporal relation to another disorder that is known to cause headache (or fulfills other criteria for causation by that disorder), it is coded as Secondary headache, attributed to the causative disorder even if the headache has the characteristics of a Primary headache (migraine, tension-type headache, etc.) [3]. ICHD-2 required ‘remission or substantial improvement of the underlying causative disorder’ before the diagnosis of Secondary headache could be made [6]. The new diagnostic criteria can thus be applied at presentation, or as soon after as the underlying disorder is confirmed. In acute conditions, a close temporal relation between onset of headache and onset of the presumed causative disorder is often sufficient to establish causation, whereas less acute conditions usually require more evidence of causation.

The other important change is in the category ‘Childhood periodic syndromes that are commonly precursors of migraine’ (benign paroxysmal vertigo of childhood, cyclical vomiting and abdominal migraine) [6] that have now been renamed as ‘Episodic syndromes that may be associated with migraine’, and have an additional condition Benign paroxysmal torticollis. Cyclical vomiting and Abdominal migraine have been clubbed together as ‘Recurrent gastrointestinal disturbance’ [2].

The changes in ICHD-3 have been presented here in an abridged form. Those interested in a more detailed study of these guidelines may see the full document or visit the International Headache Society website for further information (www.ihs-headache.org).

Contributors: Both authors were involved in literature search, the drafting the manuscript and its approval.

Funding: None; Competing interests: None stated.


1. Mishra D, Sharma A, Juneja M, Singh K. Recurrent headache in pediatric outpatients at a public hospital in Delhi. Indian Pediatr. 2013;50:775-9.

2. Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition. Cephalalgia. 2013;33: 629-808.

3. Olesen J. ICHD-3 beta is published. Use it immediately. Cephalalgia. 33:627-8.

4. Mishra D. Cysticercosis headache: an important differential of childhood headache disorder in endemic countries. Headache. 2007;47:301-2.

5. Kumar V, Gulati A, Mehra B. Cysticercosis of the temporalis muscle causing temporal headache in a pregnant woman. Int J Gynaecol Obstet. 2011;114:79.

6. Headache Classification Committee of the International Headache Society. The International classification of headache disorders, 2nd edition. Cephalalgia 2004;24: 1-160.


Copyright © 1999-2014  Indian Pediatrics