Objective: To expose fatal flaws in the International Headache Society’s (IHS) International Classification of Headache Disorders (ICHD) in the diagnosis of migraine.
Background: The ICHD is universally accepted by researchers and clinicians. It is highly unlikely that specialist headache journals will accept submissions for publication if the cohorts have not been selected strictly according to the ICHD diagnostic criteria. Likewise, in the clinical setting, the appropriate treatment is prescribed according to how the patient’s headache is classified in the ICHD. If, however, the ICHD is not substantiated by scientific data, then it is not possible for research based on the ICHD to be regarded as “evidence-based”.
Methods: A detailed analysis of the bibliography and references in the “Migraine without Aura” section of the ICHD, and a determination of whether the ICHD is based on sound scientific data.
Results: There are 13 references in the “Migraine without Aura” section of the ICHD-3, the latest version of the ICHD, published in 2013. None of these contain data substantiating the choice of criteria for the diagnosis of migraine. The same applies to the ICHD-1 (1988) and the ICHD-2 (2004).
Conclusion: Although the references analyzed are only from the migraine without aura section of the ICHD, the same principles apply to all the other sections of the ICHD relating to primary headaches. Professor Jes Olesen, who was chairman of the CC from its inception in 1985 till the ICHD-3 was published in 2018, admitted that the IHS diagnostic criteria are “based on opinions” and are “not based on empiric data”. The only possible conclusion is that migraine research and treatment since 1988, based on the ICHD, has no scientific validity.