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11.4 Headache attributed to disorder of the ears


Headache caused by an inflammatory, neoplastic or other disorder of one or both ears and associated with other symptoms and/or clinical signs of the disorder.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Clinical, laboratory and/or imaging evidence of an infectious, neoplastic or other irritative disorder or lesion of one or both ears, known to be able to cause headache
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the onset of the ear disorder or appearance of the ear lesion
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with worsening or progression of the ear disorder or lesion
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the ear disorder or lesion
    3. headache is exacerbated by pressure applied to the affected ear(s) or periauricular structures
    4. in the case of a unilateral ear disorder or lesion, headache is localized and ipsilateral to it
  4. Not better accounted for by another ICHD-3 diagnosis.

Because of nociceptive field overlap and convergence in the nociceptive pathways of the head and neck, it seems clear that a painful disorder or lesion of the ear may lead to headache. It is highly unlikely that headache in such conditions can occur in the absence of ear pain, the typical manifestation of otological pathology.