Original Article
Field-testing of the ICHD-3 beta/proposed ICD-11 diagnostic criteria for migraine with aura
Cephalalgia 2015, Vol. 35(9) 748–756 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414559731 cep.sagepub.com
Dana Li, Anne F Christensen and Jes Olesen Abstract Introduction: In 2013 the International Headache Society published the third International Classification of Headache Disorders beta-version, ICHD-3 beta. Its structure is identical to that of the present proposed version of the International Classification of Diseases (ICD-11), although slightly abbreviated to fulfill the needs of ICD-11. In the following, only ICHD-3 beta is mentioned, but findings regarding the validity of ICHD-3 beta categories are equally relevant to the forthcoming ICD-11. Here we field-tested the criteria for 1.2 migraine with aura (MA), 1.2.1 migraine with typical aura (MTA), 1.2.3 hemiplegic migraine, 1.2.2 migraine with brainstem aura, and the alternative criteria A1.2 MA and A1.2.1 MTA. Methods: Clinical characteristics were systematically and prospectively collected from patients with 1.2.1 MTA, 1.2.4 familial hemiplegic migraine (FHM), 1.2.5 sporadic hemiplegic migraine (SHM) and 1.2.6 basilar-type migraine according to ICHD-2 in a cross-sectional study design. A database of 2464 patients with 1.1 migraine without aura and 1.2 migraine with non-hemiplegic aura and a database of 252 hemiplegic migraine patients (1.2.4 FHM or 1.2.5 SHM) was collected. We used SPSS 20 for Windows 8.0 for the statistical analysis. Results: All ICHD-2 patients fulfilled ICHD-3 beta criteria for 1.2 MA. The ICHD-3 beta criteria for 1.2.1 MTA were more sensitive than ICHD-2 and ICHD-3 beta alternative criteria; they resulted in fewer probable MA diagnoses. Too many patients fulfilled ICHD-2 and ICHD-3 beta criteria for 1.2.2 migraine with brainstem aura. ICHD-3 beta criteria for 1.2.4 FHM and 1.2.5 SHM both comply with ICHD-2. Conclusion: The new criteria in ICHD-3 beta/proposed ICD-11 for 1.2 MA, 1.2.1 MTA, 1.2.3.1 FHM and 1.2.3.2 SHM have more desirable properties than ICHD-2 and the ICHD-3 beta alternative criteria. The criteria for 1.2.2 migraine with brainstem aura should be more restrictive. Keywords Migraine with aura, ICHD-3 beta, field-test, Danish Headache Center, diagnostic criteria, primary migraine Date received: 7 April 2014; revised: 27 May 2014; 4 July 2014; 29 July 2014; accepted: 15 August 2014
Introduction In 2013 the International Headache Society (IHS) published the third International Classification of Headache Disorders beta-version, the ICHD-3 beta (1). It is the first time that the ICHD has been published in a beta version and the purpose was to field-test the criteria before publishing the final version. According to Oxford Advanced Learner’s Dictionary, to ‘‘fieldtest’’ is to ‘‘test something, such as a piece of equipment, in the place where it will be used.’’ In this context, field-testing means testing the criteria on actual patients with actual symptoms, often collected in a database, as is tradition within the field of headache research (1). The 11th edition of the World Health Organization’s
(WHO’s) International Classification of Diseases (ICD11) in a preliminary form uses the same linear structure of ICHD-3 beta and field-testing is therefore equally relevant to both classifications. In the following we mention for ease only ICHD-3 beta codes and criteria.
The Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark Corresponding author: Jes Olesen, Danish Headache Center, Department of Neurology, Glostrup Hospital, DK-2600 Glostrup, Denmark. Email: [email protected]
749
Li et al. The purpose of the present study was to field-test the ICHD-3 beta criteria for 1.2 migraine with aura (MA) and its sub-diagnoses: 1.2.1 migraine with typical aura (MTA), 1.2.3.1 familial hemiplegic migraine (FHM), 1.2.3.2 sporadic hemiplegic migraine (SHM) and 1.2.2 migraine with brainstem aura. The study population consisted of a large cohort of patients with extensive prospectively collected data on clinical characteristics and with diagnoses made by specialists in migraine and headache diseases according to ICHD-2 (2). The patients’ diagnosis according to ICHD-2 was compared to the diagnosis according to the ICHD-3 beta criteria. We discussed any mismatch between the ICHD-2 and ICHD-3 beta diagnosis. We also tested the alternative criteria for A1.2 MA and A1.2.1 MTA proposed in the appendix of ICHD-3 beta. The purpose was to see if the alternative criteria had more desirable qualities than the criteria for 1.2 MA in the main body of ICHD-3 beta.
Material and methods ICDH-2 did not have a set of criteria specific to 1.2 MA, but the 1.2 diagnosis was defined by fulfillment of criteria for one of the sub-diagnoses: 1.2.1 typical aura with migraine headache (Table 1); 1.2.2 typical aura with non-migraine headache; and 1.2.3 typical aura without headache. That was a problem because 1.2 MA is the preferred level of diagnosis in general practice.
Table 1. 1.2.1 Typical aura with migraine headache in ICHD-2. A At least two attacks fulfilling criteria B–D B Aura consisting of at least one of the following, but no motor weakness: 1. Fully reversible visual symptoms including positive features (e.g. flickering lights, spots or lines) and/or negative features (i.e. loss of vision) 2. Fully reversible sensory symptoms including positive features (i.e. pins and needles) and/or negative features (i.e. numbness) 3. Fully reversible dysphasic speech disturbance C At least two of the following: 1. Homonymous visual symptoms and/or unilateral sensory symptoms 2. at least one aura symptom develops gradually over 5 minutes and/or different aura symptoms occur in succession over 5 minutes 3. each symptom lasts 5 and 60 minutes D Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes E Not attributed to another disorder ICHD-2: International Classification of Headache Disorders, second edition.
ICHD-3 beta subdivides 1.2 MA (Table 2) at the third-digit level, into: 1.2.1, MTA; 1.2.2, migraine with brainstem aura; 1.2.3, hemiplegic migraine; and 1.2.4, retinal migraine. 1.2.1, MTA, is further divided into 1.2.1.1 typical aura with headache and 1.2.1.2 typical aura without headache (Table 3(a) and (b)). Table 4 shows the classification in ICHD-2 (2) and ICHD-3 beta (3) of MA. Table 2. 1.2 Migraine with aura, MA in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory, speech/language, motor, brainstem or retinal symptoms C At least two of the following four characteristics: 1. At least one aura symptom spreads gradually over 5 minutes or more and/ or two or more symptoms occur in succession 2. Each single aura symptom lasts 5–60 minutes 3. At least one aura symptom is one sided 4. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
Table 3. 1.2.1 Migraine with typical aura, MTA in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory or speech/language symptoms but no motor, brainstem or retinal symptoms C At least two of the following four characteristics 1. At least one aura symptom spreads gradually over at least 5 minutes, and/or, two or more symptoms occur in succession 2. Each individual aura symptom lasts 5–60 minutes 3. At least one aura symptom is one sided 4. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. Table 3(a): 1.2.1.1 Typical aura with headache in ICHD-3 beta A. Fulfills criteria for 1.2.1 Migraine with typical aura B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. Table 3(b): 1.2.1.2 Typical aura without headache in ICHD-3 beta A. Fulfills criteria for 1.2.1 Migraine with typical aura B. No headache accompanies or follows the aura within 60 minutes. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
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Cephalalgia 35(9) Table 4. Division of sub-diagnoses of migraine with aura (MA) in ICHD-2 and ICHD-3 beta. ICHD-2
ICHD-3 beta
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 1.2.5 Sporadic hemiplegic migraine 1.2.6 Basilar-type migraine
1.2 Migraine with aura 1.2.1 Migraine with typical aura 1.2.1.1 Migraine with typical aura with headache 1.2.1.2 Migraine with typical aura without headache 1.2.2 Migraine with brainstem aura 1.2.3 Hemiplegic migraine 1.2.3.1 Familial hemiplegic migraine 1.2.3.2 Sporadic hemiplegic migraine 1.2.4 Retinal migraine
ICHD-2: International Classification of Headache Disorders, second edition; ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
Table 5. A 1.2.1 Migraine with typical aura alternative criteria in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory or speech/language symptoms but no motor C At least three of the following six characteristics 1. At least one aura symptom spreads gradually over 5 minutes or more 2. Two or more symptoms occur in succession 3. At least one positive symptom (scintillations, pins and needles) 4. Each single aura symptom lasts 5–60 minutes 5. At least one aura symptom is one sided 6. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
The ICHD-3 also provides an alternative set of diagnostic criteria for A1.2 MA and A1.2.1 MTA in the appendix (Table 5). The present study was based on detailed patient information from our database that consisted of a total of 2464 patients with 1.1 migraine without aura (MO) and 1.2 migraine with non-hemiplegic aura, and a database of 252 hemiplegic migraine patients (1.2.4 FHM or 1.2.5 SHM). The patients were diagnosed with any type of 1.2 MA including 1.6.2 probable migraine with aura in ICHD-2. The first cohort was recruited 1997–1999 by a computerized search of the Danish National Patient Register and screening of 27,000 case files from neurological clinics. The recruitment has been described in detail in a previous publication (4–6). In brief, the patients were systematically questioned about headache symptoms by a trained physician or a trained senior
medical student using a validated, semi-structured interview. They were sent written information before contact by telephone. A total of 980 were included in our database and diagnosed with migraine with nonhemiplegic aura. They were initially diagnosed according to ICHD-1, based on the raw clinical data from the interview, but the operational characteristics of ICHD2 were later applied to the clinical data for the purpose of later studies. A large study from 2010–2011 recruited more patients using the same method. The diagnosis of the 1.2.4 FHM and 1.2.5 SHM patients (1.2.4 FHM and 1.2.5 SHM) was originally based on the criteria of ICHD-1 (5) and information about these patients was gathered during two study periods described in detail previously (7–9). In short, the patients were similarly recruited and diagnosed as above. They were screened by telephone and 252 patients were identified with hemiplegic migraine (1.2.4 or 1.2.5). In total, our database consisted of 147 1.2.4 FHM patients and 105 1.2.5 SHM patients. The extensive data allowed us to convert their diagnoses into ICHD-2 diagnoses. The study was approved by the Danish Standards Ethical Committees and the Danish Data Protection Agency (protocol no. KA91234, KA94076m and H-22010-122). Written informed consent was obtained from all participants.
Data processing and statistical analysis The statistical analysis used SPSS Base System 20 for Windows 8.0. Patients fulfilling ICHD-2 criteria for 1.2.1 MTA and 1.6.2 probable MA were submitted to testing of the criteria for 1.2 MA in ICHD-3 beta. They were also tested according to the criteria for 1.2.1 MTA and 1.5.2 probable MA in ICHD-3 beta. Patients diagnosed with 1.2.4 FHM or 1.2.5 SHM according to ICHD-2 were submitted to field-testing
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Li et al. Table 6. 1.2.3 Hemiplegic migraine in ICHD-3 beta.
Table 7. 1.2.2 Migraine with brainstem aura in ICHD-3 beta.
A At least two attacks fulfilling criteria B and C B Fully reversible motor weakness and one or more of the following fully reversible aura symptoms: visual, sensory or speech symptoms C At least two of the following four characteristics 1. At least one aura symptom spreads gradually over 5 minutes or more, or, two or more symptoms occur in succession 2. Each non-motor aura symptom lasts 5–60 minutes and motor symptoms
Field-testing of the ICHD-3 beta/proposed ICD-11 diagnostic criteria for migraine with aura
Cephalalgia 2015, Vol. 35(9) 748–756 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414559731 cep.sagepub.com
Dana Li, Anne F Christensen and Jes Olesen Abstract Introduction: In 2013 the International Headache Society published the third International Classification of Headache Disorders beta-version, ICHD-3 beta. Its structure is identical to that of the present proposed version of the International Classification of Diseases (ICD-11), although slightly abbreviated to fulfill the needs of ICD-11. In the following, only ICHD-3 beta is mentioned, but findings regarding the validity of ICHD-3 beta categories are equally relevant to the forthcoming ICD-11. Here we field-tested the criteria for 1.2 migraine with aura (MA), 1.2.1 migraine with typical aura (MTA), 1.2.3 hemiplegic migraine, 1.2.2 migraine with brainstem aura, and the alternative criteria A1.2 MA and A1.2.1 MTA. Methods: Clinical characteristics were systematically and prospectively collected from patients with 1.2.1 MTA, 1.2.4 familial hemiplegic migraine (FHM), 1.2.5 sporadic hemiplegic migraine (SHM) and 1.2.6 basilar-type migraine according to ICHD-2 in a cross-sectional study design. A database of 2464 patients with 1.1 migraine without aura and 1.2 migraine with non-hemiplegic aura and a database of 252 hemiplegic migraine patients (1.2.4 FHM or 1.2.5 SHM) was collected. We used SPSS 20 for Windows 8.0 for the statistical analysis. Results: All ICHD-2 patients fulfilled ICHD-3 beta criteria for 1.2 MA. The ICHD-3 beta criteria for 1.2.1 MTA were more sensitive than ICHD-2 and ICHD-3 beta alternative criteria; they resulted in fewer probable MA diagnoses. Too many patients fulfilled ICHD-2 and ICHD-3 beta criteria for 1.2.2 migraine with brainstem aura. ICHD-3 beta criteria for 1.2.4 FHM and 1.2.5 SHM both comply with ICHD-2. Conclusion: The new criteria in ICHD-3 beta/proposed ICD-11 for 1.2 MA, 1.2.1 MTA, 1.2.3.1 FHM and 1.2.3.2 SHM have more desirable properties than ICHD-2 and the ICHD-3 beta alternative criteria. The criteria for 1.2.2 migraine with brainstem aura should be more restrictive. Keywords Migraine with aura, ICHD-3 beta, field-test, Danish Headache Center, diagnostic criteria, primary migraine Date received: 7 April 2014; revised: 27 May 2014; 4 July 2014; 29 July 2014; accepted: 15 August 2014
Introduction In 2013 the International Headache Society (IHS) published the third International Classification of Headache Disorders beta-version, the ICHD-3 beta (1). It is the first time that the ICHD has been published in a beta version and the purpose was to field-test the criteria before publishing the final version. According to Oxford Advanced Learner’s Dictionary, to ‘‘fieldtest’’ is to ‘‘test something, such as a piece of equipment, in the place where it will be used.’’ In this context, field-testing means testing the criteria on actual patients with actual symptoms, often collected in a database, as is tradition within the field of headache research (1). The 11th edition of the World Health Organization’s
(WHO’s) International Classification of Diseases (ICD11) in a preliminary form uses the same linear structure of ICHD-3 beta and field-testing is therefore equally relevant to both classifications. In the following we mention for ease only ICHD-3 beta codes and criteria.
The Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark Corresponding author: Jes Olesen, Danish Headache Center, Department of Neurology, Glostrup Hospital, DK-2600 Glostrup, Denmark. Email: [email protected]
749
Li et al. The purpose of the present study was to field-test the ICHD-3 beta criteria for 1.2 migraine with aura (MA) and its sub-diagnoses: 1.2.1 migraine with typical aura (MTA), 1.2.3.1 familial hemiplegic migraine (FHM), 1.2.3.2 sporadic hemiplegic migraine (SHM) and 1.2.2 migraine with brainstem aura. The study population consisted of a large cohort of patients with extensive prospectively collected data on clinical characteristics and with diagnoses made by specialists in migraine and headache diseases according to ICHD-2 (2). The patients’ diagnosis according to ICHD-2 was compared to the diagnosis according to the ICHD-3 beta criteria. We discussed any mismatch between the ICHD-2 and ICHD-3 beta diagnosis. We also tested the alternative criteria for A1.2 MA and A1.2.1 MTA proposed in the appendix of ICHD-3 beta. The purpose was to see if the alternative criteria had more desirable qualities than the criteria for 1.2 MA in the main body of ICHD-3 beta.
Material and methods ICDH-2 did not have a set of criteria specific to 1.2 MA, but the 1.2 diagnosis was defined by fulfillment of criteria for one of the sub-diagnoses: 1.2.1 typical aura with migraine headache (Table 1); 1.2.2 typical aura with non-migraine headache; and 1.2.3 typical aura without headache. That was a problem because 1.2 MA is the preferred level of diagnosis in general practice.
Table 1. 1.2.1 Typical aura with migraine headache in ICHD-2. A At least two attacks fulfilling criteria B–D B Aura consisting of at least one of the following, but no motor weakness: 1. Fully reversible visual symptoms including positive features (e.g. flickering lights, spots or lines) and/or negative features (i.e. loss of vision) 2. Fully reversible sensory symptoms including positive features (i.e. pins and needles) and/or negative features (i.e. numbness) 3. Fully reversible dysphasic speech disturbance C At least two of the following: 1. Homonymous visual symptoms and/or unilateral sensory symptoms 2. at least one aura symptom develops gradually over 5 minutes and/or different aura symptoms occur in succession over 5 minutes 3. each symptom lasts 5 and 60 minutes D Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes E Not attributed to another disorder ICHD-2: International Classification of Headache Disorders, second edition.
ICHD-3 beta subdivides 1.2 MA (Table 2) at the third-digit level, into: 1.2.1, MTA; 1.2.2, migraine with brainstem aura; 1.2.3, hemiplegic migraine; and 1.2.4, retinal migraine. 1.2.1, MTA, is further divided into 1.2.1.1 typical aura with headache and 1.2.1.2 typical aura without headache (Table 3(a) and (b)). Table 4 shows the classification in ICHD-2 (2) and ICHD-3 beta (3) of MA. Table 2. 1.2 Migraine with aura, MA in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory, speech/language, motor, brainstem or retinal symptoms C At least two of the following four characteristics: 1. At least one aura symptom spreads gradually over 5 minutes or more and/ or two or more symptoms occur in succession 2. Each single aura symptom lasts 5–60 minutes 3. At least one aura symptom is one sided 4. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
Table 3. 1.2.1 Migraine with typical aura, MTA in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory or speech/language symptoms but no motor, brainstem or retinal symptoms C At least two of the following four characteristics 1. At least one aura symptom spreads gradually over at least 5 minutes, and/or, two or more symptoms occur in succession 2. Each individual aura symptom lasts 5–60 minutes 3. At least one aura symptom is one sided 4. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. Table 3(a): 1.2.1.1 Typical aura with headache in ICHD-3 beta A. Fulfills criteria for 1.2.1 Migraine with typical aura B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. Table 3(b): 1.2.1.2 Typical aura without headache in ICHD-3 beta A. Fulfills criteria for 1.2.1 Migraine with typical aura B. No headache accompanies or follows the aura within 60 minutes. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
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Cephalalgia 35(9) Table 4. Division of sub-diagnoses of migraine with aura (MA) in ICHD-2 and ICHD-3 beta. ICHD-2
ICHD-3 beta
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 1.2.5 Sporadic hemiplegic migraine 1.2.6 Basilar-type migraine
1.2 Migraine with aura 1.2.1 Migraine with typical aura 1.2.1.1 Migraine with typical aura with headache 1.2.1.2 Migraine with typical aura without headache 1.2.2 Migraine with brainstem aura 1.2.3 Hemiplegic migraine 1.2.3.1 Familial hemiplegic migraine 1.2.3.2 Sporadic hemiplegic migraine 1.2.4 Retinal migraine
ICHD-2: International Classification of Headache Disorders, second edition; ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
Table 5. A 1.2.1 Migraine with typical aura alternative criteria in ICHD-3 beta. A At least two attacks fulfilling criteria B and C B One or more of the following fully reversible aura symptoms: Visual, sensory or speech/language symptoms but no motor C At least three of the following six characteristics 1. At least one aura symptom spreads gradually over 5 minutes or more 2. Two or more symptoms occur in succession 3. At least one positive symptom (scintillations, pins and needles) 4. Each single aura symptom lasts 5–60 minutes 5. At least one aura symptom is one sided 6. The aura is accompanied or followed by headache. A possible lag phase lasts maximally 60 minutes D Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack has been excluded. ICHD-3 beta: International Classification of Headache Disorders, third edition beta.
The ICHD-3 also provides an alternative set of diagnostic criteria for A1.2 MA and A1.2.1 MTA in the appendix (Table 5). The present study was based on detailed patient information from our database that consisted of a total of 2464 patients with 1.1 migraine without aura (MO) and 1.2 migraine with non-hemiplegic aura, and a database of 252 hemiplegic migraine patients (1.2.4 FHM or 1.2.5 SHM). The patients were diagnosed with any type of 1.2 MA including 1.6.2 probable migraine with aura in ICHD-2. The first cohort was recruited 1997–1999 by a computerized search of the Danish National Patient Register and screening of 27,000 case files from neurological clinics. The recruitment has been described in detail in a previous publication (4–6). In brief, the patients were systematically questioned about headache symptoms by a trained physician or a trained senior
medical student using a validated, semi-structured interview. They were sent written information before contact by telephone. A total of 980 were included in our database and diagnosed with migraine with nonhemiplegic aura. They were initially diagnosed according to ICHD-1, based on the raw clinical data from the interview, but the operational characteristics of ICHD2 were later applied to the clinical data for the purpose of later studies. A large study from 2010–2011 recruited more patients using the same method. The diagnosis of the 1.2.4 FHM and 1.2.5 SHM patients (1.2.4 FHM and 1.2.5 SHM) was originally based on the criteria of ICHD-1 (5) and information about these patients was gathered during two study periods described in detail previously (7–9). In short, the patients were similarly recruited and diagnosed as above. They were screened by telephone and 252 patients were identified with hemiplegic migraine (1.2.4 or 1.2.5). In total, our database consisted of 147 1.2.4 FHM patients and 105 1.2.5 SHM patients. The extensive data allowed us to convert their diagnoses into ICHD-2 diagnoses. The study was approved by the Danish Standards Ethical Committees and the Danish Data Protection Agency (protocol no. KA91234, KA94076m and H-22010-122). Written informed consent was obtained from all participants.
Data processing and statistical analysis The statistical analysis used SPSS Base System 20 for Windows 8.0. Patients fulfilling ICHD-2 criteria for 1.2.1 MTA and 1.6.2 probable MA were submitted to testing of the criteria for 1.2 MA in ICHD-3 beta. They were also tested according to the criteria for 1.2.1 MTA and 1.5.2 probable MA in ICHD-3 beta. Patients diagnosed with 1.2.4 FHM or 1.2.5 SHM according to ICHD-2 were submitted to field-testing
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Li et al. Table 6. 1.2.3 Hemiplegic migraine in ICHD-3 beta.
Table 7. 1.2.2 Migraine with brainstem aura in ICHD-3 beta.
A At least two attacks fulfilling criteria B and C B Fully reversible motor weakness and one or more of the following fully reversible aura symptoms: visual, sensory or speech symptoms C At least two of the following four characteristics 1. At least one aura symptom spreads gradually over 5 minutes or more, or, two or more symptoms occur in succession 2. Each non-motor aura symptom lasts 5–60 minutes and motor symptoms
