73 Defining migraine days 3 with aura are accompanied by visual symptoms.20-22 Moreover, it is impossible to ask all possible aura symptomatology for each day as this is too time consuming, thus simplification of aura symptomatology for E-headache diaries is needed to lower the data entry burden for patients and thereby improve diary compliance.23 Secondly, when defining days of acute medication intake for migraine, only days with triptan intake were taken into account. Ergotamines, ditans, and gepants are currently not prescribed in clinical practice in the Netherlands. We expect no change in results when these acute migraine medications would have been included. Thirdly, although prodromal symptoms are part of the migraine attacks, these symptoms are difficult to quantify and not part of migraine definitions in the ICHD-3 and were therefore not included in this study. Finally, further research might be needed for larger numbers of patients with MOH, although those patients were also included in our study, as well as non-white populations. Our study was performed in an European country, whereas in those from western pacific with Asian ethnicity more often osmophobia is reported besides photo- and phonophobia. However, osmophobia was not added in the ICHD-3 and therefore not studied in this study.24 In this study we showed that headache duration is the main factor causing migraine days with triptan intake not to match the typical migraine characteristics. In addition, adjustment of the minimum required headache duration to ≥30 minutes led to a minor 5.4% increase in the total number of migraine days and the majority still had a duration of multiple hours. We propose to define a MD as follows: 1) (a) headache duration ≥30 minutes; (b) matching ≥2 out of 4 characteristics: unilateral, pulsating, moderate to severe pain, aggravation by or causing avoidance of routine physical activity; and (c) during headache ≥1 of the following: nausea and/or vomiting, photophobia and phonophobia or 2) (visual) aura duration 5-60 minutes or 3) a day with headache for which acute migraine-specific medication is used irrespective of its effect. For future releases of the ICHD criteria, we would recommend including consensus on the definition of migraine days to prevent the use of different definitions hindering the comparability of different studies. However, initial individual assessment will remain essential for accurate diagnosis and classification of patients. Article highlights • A migraine day should have a duration of ≥30 minutes instead of ≥4 hours. • All days with headache for which acute migraine-specific medication is used should be counted as migraine days, irrespective of its effect.
RkJQdWJsaXNoZXIy MjY0ODMw