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      Galeata: chronic migraine independently considered in a medieval headache classification

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          Chronic migraine is a quite recent concept. However, there are descriptions suggestive of episodic migraine since the beginning of scientific medicine. We aim to review main headache classifications during Classical antiquity and compared them with that proposed in the 11th century by Constantine the African in his Liber Pantegni, one of the most influential texts in medieval medicine.


          We have carried out a descriptive review of Henricum Petrum's Latin edition, year 1539.


          Headache classifications proposed by Aretaeus of Cappadocia, Galen of Pergamun and Alexander of Tralles, all of them classifying headaches into three main types, considered an entity (called Heterocrania or Hemicrania), comparable to contemporary episodic migraine.

          In ninth book of Liber Pantegni, headaches were also classified into three types and one of them, Galeata, consisted on a chronic pain of mild intensity with occasional superimposed exacerbations.


          In Liber Pantegni we have firstly identified, as a separate entity, a headache comparable to that we currently define as chronic migraine: Galeata.

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          Most cited references 31

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          New appendix criteria open for a broader concept of chronic migraine.

          After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.
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            Classification of daily and near-daily headaches: field trial of revised IHS criteria.

            Primary chronic daily headache can be subdivided into transformed migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. We proposed and tested criteria in 150 consecutive outpatients with chronic daily headache. Based on preliminary analysis, we revised the criteria for transformed migraine. Using the International Headache Society criteria, 43% of the patients could not be classified; using our old criteria, 25% could not be classified; however, using our new criteria, we were able to classify 100%. Seventy-eight percent had transformed migraine, 15.3% had chronic tension-type headache, and 6.7% had other headache disorders.
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              Transformed or evolutive migraine.


                Author and article information

                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                21 March 2014
                : 15
                : 1
                : 16
                [1 ]Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
                [2 ]G. I. R. Speculum medicinae, University of Valladolid, Valladolid, Spain
                Copyright © 2014 Guerrero-Peral et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

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