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TABLE 1. IHS DIAGNOSTIC CRITERIA FOR MIGRAINE²⁰*

At least five attacks fulfilling B-D. Migraine days <15/month
Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
Headache has at least two of the following characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance from routine physical activity (ie, walking or climbing stairs)
During headache at least one of the following:
- Nausea and/or vomiting
- Photophobia or phonophobia
Not attributed to another disorder

* Proposed

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TABLE 2. IHS DIAGNOSTIC CRITERIA FOR ACUTE
RHINOSINUSITIS HEADACHE²⁰*

Pain perceived in one or more regions of the head, face, ears, or teeth
Clinical, laboratory, and/or imaging evidence of acute rhinosinusitis, eg, purulence in nasal cavity, nasal obstruction, fever, hyposmia/anosmia, CT imaging, MR imaging, or fiberoptic nasal endoscopy findings
Simultaneous onset of headache and rhinosinusitis
Headache disappears after remission of acute rhinosinusitis

* Proposed

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TABLE 3. IHS DIAGNOSTIC CRITERIA FOR EPISODIC
TENSION-TYPE HEADACHE⁹

At least ten previous headache episodes fulfilling criteria B through D listed below. Number of days with such headache <180/year (<15/month)
Headache lasting from 30 minutes to 7 days
At least two of the following pain characteristics:
- Pressing/tightening (nonpulsating) quality
- Mild or moderate intensity (may inhibit, but does not prohibit activities)
- Bilateral location
- No aggravation by walking stairs or similar routine physical activity
Both of the following:
- No nausea or vomiting (anorexia may occur)
- Photophobia and phonophobia are absent, or one but not the other is present
At least one of the following:
- History, physical, and/or neurological examinations do not suggest one of the disorders listed in groups 5 through 11*
- History, physical, and/or neurological examinations do suggest such disorder, but it is ruled out by appropriate investigations
- Such disorder is present, but tension-type headache attacks do not occur for the first time in close temporal relation to the disorder

*Groups 5 through 11 include headache associated with head trauma, vascular disorders, nonvascular intracranial disorder, substances or their withdrawal, noncephalic infection, or metabolic disorder; and headache or facial pain associated with disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures.

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Figure 1. The trigeminal nerve, consisting of the ophthalmic division (V1), the maxillary division (V2), and the mandibular division (V3), converging at the trigeminal nucleus caudalis (TNC).

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Figure 2. The migraine process.

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Figure 3. Activation of the TNC causes reflex activation of the cranial parasympathetic nervous system resulting in autonomic symptoms such as lacrimation, rhinorrhea, and nasal congestion.

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Figure 4. Sensory nerves of the neck are anatomically connected with the TNC; activation can result in posterior head and neck pain.

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Head and facial pain

Neck pain

Sinus symptoms

Figure 5. Activation of the trigeminal nerve network during a migraine can result in sinus and tension-type symptoms including neck pain commonly associated with sinus headache or tension headache.

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Figure 6. Percentage of patients who met IHS criteria for migraine reporting neck pain during the prodrome, headache phase, or postdrome of their migraine attacks.⁷

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Figure 7. Percentage of attacks in which head or neck pain responded to treatment of IHS-diagnosed migraineurs with a 5HT_1B/1D agonist.⁷

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