Migraine without Aura -Towards a New Definition

Objective: To quickly diagnose migraine without aura in a busy practice clinical in India and other developing countries. Background: Differentiating migraine from episodic tension type headaches is difficult if one strictly follows International classification of headache disorders- 3rd edition beta version (ICHD 3 Beta), as there are many overlapping statements. Another problem is applying criterion E, not better accounted for by another ICHD 3 beta diagnosis. Duration, presence of head pain and associated migraine diagnostic symptoms except vomiting and nausea are not mandatory to diagnose Episodic syndromes that may be associated with migraine (ICHD 3 Beta code 1.6) or Periodic syndromes (ICHD2) that are commonly precursors of migraine. Methods: A retrospective chart review was done on 6,200patients. All were diagnosed as Migraine without aura, Probable migraine or Benign secondary headaches, and the following four common features were identified- recurrent headaches / activity affected / absolutely normal in between episodes/ no red flags present. History of two more additional helpful diagnostic features was also noted - Common migraine triggers precipitating these headaches and family history of migraine or its synonyms. Exclusion criteria include aura, autonomic manifestations, headaches lasting more than 3 days, headaches with migraine features that are not activity dependent, post dromal symptoms, fever and other systemic disorders. Results: 92% of patients fulfilled the four simple migraine diagnostic features. 88% had one of the common migraine triggers precipitating their headaches and 91% had family history of migraine. Conclusion: Recurrent activity affected headaches with absolute normality in between episodes and without any red flags, should lead one to consider the diagnosis of migraine without aura.