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9.2.3 Headache attributed to other systemic infection


Headache caused by and occurring in association with other symptoms and/or clinical signs of a systemic fungal infection or infestation by protozoal or other parasites, in the absence of meningitis or meningoencephalitis.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Both of the following:
    1. systemic fungal infection, or infestation by protozoal or other parasites, has been diagnosed
    2. no evidence of meningitic or meningoencephalitic involvement
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to onset of the systemic infection or infestation
    2. headache has significantly worsened in parallel with worsening of the systemic infection or infestation
    3. headache has significantly improved in parallel with improvement in the systemic infection or infestation
    4. headache has either or both of the following characteristics:
      • a) diffuse pain
      • b) moderate or severe intensity
  4. Not better accounted for by another ICHD-3 diagnosis.

This is a heterogenous and ill-defined group of systemic infections, most frequently seen in immunosuppressed patients or in specific geographical areas.

The fungi most commonly involved are the pathogenic fungi (Cryptococcus neoformans, Histoplasma capsulatum and Coccidioides immitis) and the opportunistic fungi (Candida species, Aspergillus species and others). Among protozoa, Pneumocystis carinii and Toxoplasma gondii infestations may be associated with headache. Headache has also been reported with the nematode Strongyloides stercoralis.