Cascade Headache
Clinical references
Migraine and headache classification
Each logged day is classified against the diagnostic criteria in the International Classification of Headache Disorders, 3rd edition (ICHD‑3). Ember reports what the criteria say; it does not propose a diagnosis.
Source: International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1):1–211. Available at ichd-3.org.
Disability scoring (MIDAS)
Disability is summarized using the Migraine Disability Assessment (MIDAS) questionnaire. Ember calculates the MIDAS score from the days the patient has reported, then reports the corresponding grade (I–IV).
Source: Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001; 56(suppl 1):S20–S28.
Medication-overuse thresholds
Acute medication use is tracked against the criteria in ICHD‑3 Section 8.2 (Medication-overuse headache). Ember surfaces non-judgmental nudges as patients approach the thresholds. Patients can turn these nudges off.
The thresholds Ember uses follow ICHD‑3 directly: triptans, ergots, opioids, and combination analgesics on ≥10 days/month for ≥3 months; simple analgesics (e.g., NSAIDs, acetaminophen) on ≥15 days/month for ≥3 months.
Gepants (e.g., ubrogepant, rimegepant) are not currently included in ICHD‑3 medication-overuse criteria and Ember does not count them toward an overuse threshold.
OnabotulinumtoxinA (Botox) for chronic migraine
Ember reports Botox interval, onset, and wear-off relative to the PREEMPT 1 and 2 protocol (155 units across 31 sites every 12 weeks, with up to 40 additional units allowed).
Sources: Aurora SK, Dodick DW, Turkel CC, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010; 30(7):793–803. Diener HC, Dodick DW, Aurora SK, et al. PREEMPT 2. Cephalalgia. 2010; 30(7):804–814.
CGRP-targeted preventives
For monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and oral CGRP antagonists, Ember reports the patient-reported response and tracks the timing of starts and switches. Indications and place-in-therapy follow current guidance from the American Headache Society.
Source: American Headache Society. The American Headache Society Position Statement on Integrating New Migraine Treatments into Clinical Practice (current update). See americanheadachesociety.org.
Hormonal pattern flag
Ember flags the percentage of migraines that occur during or within two days of a logged menstrual period. The definition follows ICHD‑3 Appendix A1.1.1 (Pure menstrual migraine without aura) and A1.1.2 (Menstrually-related migraine without aura).
Treatment-response separation
When a patient is on overlapping preventives, Ember calculates each medication’s individual contribution to the response, and the combined effect, using a chained-attribution method developed by Cascade Headache. The calculation compares each medication-on/medication-off window directly, rather than crediting all improvement to whatever was started most recently.
The methodology is internal and is not yet published. We invite specialists to review it. To examine it with bundled demo data, open the app and tap the version line in Profile seven times to flip between your data and a demo dataset.
What Ember does not do
- Make treatment recommendations
- Flag drug interactions
- Decide what counts as a rebound headache
- Replace clinical judgment
Audit invitation
We are a small team and we want this to be right. If you spot an inconsistency, an inaccuracy, or a citation that needs updating, email hello@cascadeheadache.com. Specialists who want to look closely are welcome to use the bundled demo data via the version-tap in Profile.