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Diagnostic criteria:
  1. Headache fulfilling criteria for 9.1.2 Headache attributed to viral meningitis or encephalitis
  2. Either or both of the following:
    1. neuroimaging shows diffuse or multifocal brain oedema1
    2. at least one of the following:
      • a) altered mental state
      • b) focal neurological deficits
      • c) seizures.

There may also be associated leptomeningeal enhancement


Pain is usually diffuse, with the focus in frontal and/or retro-orbital areas, severe or extremely severe and throbbing or pressing in nature. Headache attributed to viral encephalitis should be suspected whenever headache is associated with altered mental state (including impaired vigilance), focal neurological deficits and/or seizures. Other commonly associated neurological deficits are disturbances of speech or hearing, double vision, loss of sensation in some parts of the body, muscle weakness, partial paralysis in the arms and legs, ataxia, hallucinations, personality changes, loss of consciousness and/or memory loss.