5.2 Persistent headache attributed to traumatic injury to the headHartmut Gobel2018-02-06T10:27:17+00:00

Coded elsewhere:

Trauma due to acceleration/deceleration movements of the head, with flexion/extension of the neck, is classified as whiplash. Persistent headache attributed to such trauma is coded as 5.4 Persistent headache attributed to whiplash. Persistent headache attributed to surgical craniotomy performed for reasons other than traumatic head injury is coded as 5.6 Persistent headache attributed to craniotomy.

Description:

Headache of more than 3 months’ duration caused by traumatic injury to the head.

Diagnostic criteria:

1. Any headache fulfilling criteria C and D
2. Traumatic injury to the head¹ has occurred
3. Headache is reported to have developed within 7 days after one of the following:
   1. the injury to the head
   2. regaining of consciousness following the injury to the head
   3. discontinuation of medication(s) impairing ability to sense or report headache following the injury to the head
4. Headache persists for >3 months after its onset
5. Not better accounted for by another ICHD-3 diagnosis².

Notes:

1. Traumatic injury to the head is defined as a structural or functional injury resulting from the action of external forces upon the head. These include impact between the head and an object, penetration of the head by a foreign body, forces generated from blasts or explosions, and other forces yet to be defined.
2. When headache following head injury becomes persistent, the possibility of 8.2 Medication-overuse headache needs to be considered.

Comments:

The stipulation that headache must be reported to have developed within 7 days is somewhat arbitrary (see Introduction above). Compared to longer intervals, a 7-day interval yields diagnostic criteria with higher specificity for 5.2 Persistent headache attributed to traumatic injury to the head (ie, stronger evidence of causation) but a correlative loss of sensitivity. Further research is needed into whether or not a different interval might be more appropriate. In the meantime, Appendix criteria for A5.2.1.1 Delayed-onset persistent headache attributed to moderate or severe traumatic injury to the head and A5.2.2.1 Delayed-onset persistent headache attributed to mild traumatic injury to the head may be used when the interval between injury and headache onset is greater than 7 days.

To be consistent with ICHD-II diagnostic criteria for chronic post-traumatic headache and with the time interval used in the diagnoses of other secondary headache disorders, 3 months is the time interval after which headache attributed to trauma or injury to the head is considered persistent. Further research is needed to investigate whether shorter or longer intervals may be more appropriately adopted.