Headache types evaluated
Accurate classification changes treatment fundamentally. The International Classification of Headache Disorders (ICHD-3) provides standardized criteria for migraine with or without aura, chronic migraine (≥8 migrainous days among ≥15 headache days), tension-type headache, cluster headache and medication-overuse headache. Without classification, patients may receive ineffective acute therapy, miss preventive opportunities, or unknowingly worsen their headaches through medication overuse. A headache diary is the foundation — it captures frequency, severity, triggers, associated symptoms (nausea, photophobia, aura) and medication days.
Migraine typically presents as throbbing, often one-sided pain with nausea, photophobia and functional impairment — lasting 4–72 hours if untreated. Chronic headache involves ≥15 headache days per month for over 3 months, often with overlapping migraine and tension-type features plus medication overuse. Cluster headache causes severe brief attacks (15–180 minutes) around the eye with tearing, nasal congestion and restlessness, occurring in seasonal or annual clusters. Each type requires different management.
- Migraine — throbbing, one-sided, nausea, photophobia, 4–72 hours
- Chronic headache — ≥15 days/month for >3 months, variable features
- Cluster headache — severe orbital attacks, tearing, nasal congestion
- Medication-overuse headache — analgesic use ≥10–15 days/month
Related: Headache Medicine → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Evaluation and follow-up
Evaluation begins with structured history following ICHD-3 criteria, followed by neurological examination and red-flag screening. The diary guides classification and identifies medication-overuse when present — a reversible contributor to chronic daily headache. Acute treatment options are paired with frequency limits (typically ≤2–3 days/week for migraine medications) to prevent medication-overuse headache. Preventive options are considered when diary shows high burden, with explicit discussion of benefits, risks, alternatives and expected timeline for response.
Follow-up is scheduled to review diary, assess response, adjust treatment and address side effects. For patients from Lalitpur, initial in-person evaluation at Durbar Marg, Opposite of Yak & Yeti Hotel establishes the diagnosis and treatment plan; selected follow-up consultations may be possible remotely after initial assessment. The clinic reviews medication purpose and side effects to sustain long-term compliance. Bring a 4-week headache diary, current and past medication list, and any prior investigations to the first visit.
- ICHD-3 classification — accurate diagnosis guides treatment
- Diary-based review — frequency, severity, triggers, medication days
- Medication-overuse identification — reversible contributor assessment
- Preventive discussion — benefits, risks, alternatives and follow-up