4.6.2 External-traction headache

Previously used term:

Ponytail headache.


Headache resulting from sustained traction on pericranial soft tissues, without damage to the scalp.

Diagnostic criteria:
  1. At least two episodes of headache fulfilling criteria B-D
  2. Brought on by and occurring only during sustained external traction on the scalp
  3. Maximal at the traction site
  4. Resolving within 1 hour after traction is relieved
  5. Not better accounted for by another ICHD-3 diagnosis.

The duration of headache varies with the severity and duration of the external traction. While headache is maximal at the site of traction, it often extends to other areas of the head.