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10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy

Coded elsewhere:

10.3.1 Headache attributed to phaeochromocytoma.


Headache, usually bilateral and pulsating, caused by a paroxysmal rise of arterial hypertension (systolic ≥180 mm Hg and/or diastolic ≥120 mm Hg). It remits after normalization of blood pressure.

Diagnostic criteria:
  1. Headache fulfilling criterion C
  2. Both of the following:
    1. a hypertensive crisis1 is occurring
    2. no clinical features or other evidence of hypertensive encephalopathy
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed during the hypertensive crisis
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with increasing hypertension
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the hypertensive crisis
    3. headache has at least one of the following three characteristics:
      • a) bilateral location
      • b) pulsating quality
      • c) precipitated by physical activity
  4. Not better accounted for by another ICHD-3 diagnosis.

A hypertensive crisis is defined as a paroxysmal rise in systolic (to ≥180 mm Hg) and/or diastolic (to ≥120 mm Hg) blood pressure.


Paroxysmal hypertension may occur in association with failure of baroreceptor reflexes (after carotid endarterectomy or subsequent to irradiation of the neck) or in patients with enterochromaffin cell tumours.