The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO

Chairperson

Section

Amendment

7(2)

Replace the existing definition in subsection 7(2) with the following:

For the purposes of this Statement of Principles, migraine:

(a)     means migraine without aura, migraine with aura (which includes basilar migraine, sporadic hemiplegic migraine and retinal migraine), chronic migraine and vestibular migraine; and

(b)     excludes familial hemiplegic migraine, abdominal migraine, migrainous infarction, amaurosis fugax, cluster headache, tension-type headache, headache attributable to structural abnormalities or inflammatory disorders of the head and neck, and headache attributable to systemic disease.

Note: chronic migraine, migraine with aura, migraine without aura and vestibular migraine are defined in the Schedule 1 – Dictionary.

Schedule 1 – Dictionary

Insert the following definitions of "chronic migraine", "ICHD-3", "migraine with aura", "migraine without aura" and "vestibular migraine" in alphabetical order:

chronic migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):

1. Headache on greater than 14 days per month for greater than three months, and fulfilling criteria B and C.
2. Occurring in a patient who has had at least five attacks of any combination of migraine without aura or migraine with aura.
3. On greater than seven days per month for more than three months, fulfilling any of the following:
   1. criteria C and D for migraine without aura;
   2. criteria B and C for migraine with aura; or
   3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative.
4. Not better accounted for by another ICHD-3 diagnosis.

Note: ICHD-3 is also defined in the Schedule 1 – Dictionary.

ICHD-3 means the International Headache Society: International Classification of Headache Disorders, Third Edition.

migraine with aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):

1. At least two attacks fulfilling criteria B and C.
2. One or more of the following fully reversible aura symptoms:

1. visual;
2. sensory;
3. speech and/or language;
4. motor;
5.      brainstem; or
6. retinal.

C.       At least three of the following six characteristics:

1. at least one aura symptom spreads gradually over ≥5 minutes;
2. two or more aura symptoms occur in succession;
3. each individual aura symptom lasts between five and 60 minutes.  When three symptoms occur during an aura, the acceptable maximal duration is 3 x 60 minutes. Motor symptoms last up to 72 hours;
4. at least one aura symptom is unilateral;
5. at least one aura symptom is positive; or
6. the aura is accompanied, or followed within 60 minutes, by headache.

D.       Not better accounted for by another ICHD-3 diagnosis.

Note 1: Migraine with aura is also known as classic or classical migraine and includes migraine with typical aura, migraine with brainstem aura (basilar migraine), sporadic hemiplegic migraine and retinal migraine.

Note 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.

migraine without aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):

1. At least five attacks fulfilling criteria B-D.
2. Headache attacks in adults lasting between four and 72 hours (untreated or unsuccessfully treated) and in persons aged under 18 years, attacks lasting between two and 72 hours.
3. Headache has at least two of the following four characteristics:
   1. unilateral location;
   2. pulsating quality;
   3. moderate or severe pain intensity; or
   4. aggravation by routine physical activity or causing avoidance of routine physical activity.
4. During headache at least one of the following:
   1. nausea and/or vomiting; or
   2. photophobia and phonophobia.
5. Not better accounted for by another ICHD-3 diagnosis.

Note 1: Migraine without aura is also known as common migraine.

Note 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.

vestibular migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):

1. At least five episodes fulfilling criteria C and D.
2. A current or past history of migraine without aura or migraine with aura.
3. Vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours with the vestibular symptoms including spontaneous vertigo, positional vertigo, visually-induced vertigo, head motion-induced vertigo, and head motion-induced dizziness with nausea.
4. At least half of episodes are associated with at least one of the following three migrainous features:
   1. headache with at least two of the following four characteristics:

a)        unilateral location;

b)        pulsating quality;

c)        moderate or severe intensity; or

d)        aggravation by routine physical activity.

2.        photophobia and phonophobia; or

3.        visual aura.

E.         Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.

Note: ICHD-3 is also defined in the Schedule 1 – Dictionary.