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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Headache and Neurogenic Pain
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1526037

Network Analysis of Headache Diagnoses Using International Classification of Headache Disorders, 3rd Edition

Provisionally accepted
Pengfei Zhang Pengfei Zhang 1*Thomas Berk, MD FAHS Thomas Berk, MD FAHS 2
  • 1 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
  • 2 Neura Health, New York, United States

The final, formatted version of the article will be published soon.

    The International Classification of Headache Disorders (ICHD3) influences clinicans' understanding of headache disorders. In this paper we seek to elucidate how the hierarchical structure of ICHD3 shapes the understanding of the interconnectedness among headache disorders.A network is defined by a set of objects, called "nodes", and the connections between them, called "edges". We define a node as a headache diagnosis identified by at least one ICHD3 diagnosis criterion. We developed two network models for the ICHD3: a non-hierarchical model where only cross-references in the text of diagnoses qualified as edges and a hierarchical model where the structure of the ICHD3 is taken into account by establishing additional edges between sections and their subsections. We obtained the top 10 disorders based on their importance (or "centrality" in network analysis parlance) as ranked by their "popularity", their importance in acting as "bridges" between disorders, and their "proximity" to other disorders in the network.These can be described by calculating the network's degree, between-ness, and closeness centrality, respectively.There are 387 nodes in both of our models. The choice of non-hierarchical or hierarchical model affects which diagnoses occupy the top 10 centrality nodes.In both models, migraine and medication-overuse headache are in the top 10 diagnoses according to the three centrality measurements. There are more secondary headache diagnoses in the top 10 position in the hierarchical model compared to the non-hierarchical model.Migraine and medication overuse headache are the most well-connected nodes in ICHD3. The addition of diagnostic hierarchy allows for unification of secondary headaches that would otherwise be considered isolated, miscellaneous diagnoses. Once connected in a hierarchical fashion, secondary headache diagnoses form a majority of the most well-connected nodes in our field.

    Keywords: Headache classification, Network analysis, Migraine, Centrality measure, Disease classifi cation

    Received: 11 Nov 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Zhang and Berk, MD FAHS. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Pengfei Zhang, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, Massachusetts, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.