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10.4 Headache attributed to hypothyroidism

Coded elsewhere:

In the presence of hypothyroidism, headache can also be a manifestation of pituitary adenoma, coded as 7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion.


Headache, usually bilateral and non-pulsatile, in patients with hypothyroidism and remitting after normalization of thyroid hormone levels.

Diagnostic criteria:
  1. Headache fulfilling criterion C
  2. Hypothyroidism has been demonstrated
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the onset of the hypothyroidism, or led to its discovery
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with worsening of the hypothyroidism
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the hypothyroidism
    3. headache has either or both of the following characteristics:
      • a) bilateral location
      • b) constant over time
  4. Not better accounted for by another ICHD-3 diagnosis.

It has been estimated that approximately 30% of patients with hypothyroidism suffer from 10.4 Headache attributed to hypothyroidism. Its mechanism is unclear. There is a female preponderance and often a history of migraine.

While 10.4 Headache attributed to hypothyroidism is not understood to be associated with nausea or vomiting, a recent study found that patients with hypothyrodism may present with unilateral, episodic, pulsating headache accompanied by nausea and/or vomiting. Half of the patients studied had a history of 1. Migraine, so the significance of these results is unclear and they require confirmation in future studies.