Abstract

Migraine is characterized by severe unilateral throbbing headache, aura, nausea and vomiting. Inter- national Headache Society has made clear diagnostic criteria for migraine and other headache disorders based on these clinical characteristics. However, differentiation and diagnosis of migraine is not clear when we encounter the patients with chronic recurrent headaches. A lot of patients with migraine have tension-type headache concomitantly. Migraine without aura and episodic tension-type headache share the nature of headache and associated symptoms. Episodic headaches including tension-type headache and migraine have tendency to transform to chronic daily headache. The transformed migraine and chronic tension-type headache have little difference in clinical features. The responsiveness to sumatriptan, which has been developed for migraine specific drug, can not differentiate migraine headache from tension type headache. Given the abundant similarities between clinical features and treatment response, new concepts and hypothesis have been raised such as migraine and tension type headache be considered opposite ends of a clinical spectrum of headache activity, and these headaches as sharing common pathophysiology (convergence hypothesis). Convergence hypothesis for primary headache can also explain the clinical manifestations of sinus headache and temporomandibular headache as well as migraine and tension type headache. Korean Journal of Headache 4(1):22-29, 2003