The ICHD III Secondary Headaches
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1 The ICHD III Secondary Headaches ICHD II Morris Levin, MD Professor of Neurology Professor of Psychiatry Dartmouth Medical School Co-Director, Dartmouth Headache Center Hanover, New Hampshire, USA ICHD III
2 The International Classification of Headache Disorders 3 rd edition - Beta version (January, 2013) Third Headache Classification Committee Members Jes Olesen, Denmark (Chairman) Lars Bendtsen, Denmark David Dodick, United States of America Anne Ducros, France Stefan Evers, Germany Michael First, United States of America Peter J Goadsby, United States of America Andrew Hershey, United States of America Zaza Katsarava, Germany Morris Levin, United States of America Julio Pascual, Spain Michael B Russell, Norway Todd Schwedt, United States of America Timothy J Steiner, United Kingdom (Secretary) Cristina Tassorelli, Italy Gisela M Terwindt, The Netherlands Maurice Vincent, Brazil Shuu-Jiun Wang, Taiwan
3 ICHD III Basic Organization Part 1: Primary headaches Part 2: Secondary headaches Part 3: Cranial Neuralgias, etc. The Appendix
4 ICHD III Part 1: Primary headaches (no other causative disorder) 1. Migraine 2. Tension-type Headache 3. Cluster and its relatives (TACs) 4. Other primary headaches exertional, hemicrania continua, hypnic headache, et al
5 ICHD III Part 2: Secondary headaches (caused by another disorder) 5. Posttraumatic (Head, neck) 6. Vascular disease (Head, neck) 7. Nonvascular intracranial pathology 8. Substances or withdrawal 9. Infection 10. Homeostatic disorder 11. Cranial, face, neck, EENT, sinuses, teeth 12. Psychiatric
6 ICHD III Part 3: Cranial Neuralgias, Central and primary facial pain, other headaches 13. Neuralgias and neuropathy 14. Other Headaches (Empty for now)
7 ICHD III The Appendix: 1. Suggested criteria for possible new entities 2. Alternative diagnostic criteria for certain categories (pending evidence) 3. Some previously accepted disorders which have not been supported by evidence
8 ICHD II primary v. secondary headaches Primary or secondary headache or both: When a new headache occurs for the first time in close temporal relation to another disorder that is known to cause headache, or fulfils other criteria for causation by that disorder, the new headache is coded as a secondary headache attributed to the causative disorder. When a pre-existing primary headache becomes chronic in close temporal relation to such a causative disorder, both the primary and the secondary diagnoses should be given. When a pre-existing primary headache is made significantly worse (usually meaning a two-fold or greater increase in frequency and/or severity) in close temporal relation to such a causative disorder, both the primary and the secondary headache diagnoses should be given, provided that there is good evidence that the disorder can cause headache.
9 ICHD III New 2 o HA 1) If a headache is morphologically like migraine but arises as a result of a secondary cause code as the secondary HA 2) ICHD III criteria require two separate evidential features to be present in all cases, and allow up to four types of evidence 3) diagnostic criteria restrict themselves to information reasonably available to the diagnosing physician in a typical clinical situation. 4) No Probable secondary headaches
10 ICHD II Secondary HA Chapter 5 Headache attributed to trauma 1. Require headache following head or neck trauma within 7 d 2. Acute or Chronic < or > 3 months 3. After mild or severe trauma 4. Whiplash induced headaches
11 ICHD II Secondary HA 5. Posttraumatic 6. Vascular disease 7. Other intracranial pathology 8. Substances 9. Infection 10. Homeostatic disorders 11. Cervicogenic, Eyes, ENT, Sinuses, Mouth, Teeth, TMJ 12. Psychiatric 13. Neuralgias
12 Post-traumatic headache 5.1 Acute post-traumatic headache acute post-traumatic headache attributed to moderate or severe head injury acute post-traumatic headache attributed to mild head injury 5.2 Chronic post-traumatic headache mod or severe head injury mild head injury 5.3 Acute headache attributed to whiplash injury 5.4 Chronic headache attributed to whiplash injury
13 Post-traumatic headaches ICHD II PTHA had to begin within 7 days of trauma ICHD III - within 7 days after head trauma, or after regaining consciousness following head trauma or after discontinuation of medications that impair the ability of the patient to report or sense headache following head trauma
14 ICHD II Secondary HA Chapter 6 - Headache attrib to cranial or cervical vascular disorder Stroke Hemorrhages (ICH, SAH) Aneurysm, AVM Arteritis (GCA or intracerebral) Carotid or vertebral artery pain Cerebral venous thrombosis RCVS CADASIL
15 ICHD II Secondary HA Chapter 7 - Headache due to non vascular intracranial pathology CSF pressure Hydrocephalus Sarcoidosis Neoplasm Carcinomatous meningitis HaNDL Epileptic seizure Chiari malformation
16 ICHD II Secondary HA Chapter 8 - Medication and substances Nitric oxide donors like nitroglycerine Carbon Monoxide Alcohol Food additives like MSG Cocaine, marijuana Medication overuse Substance withdrawal including caffeine, opioids, estrogen
17 8.2 Medication-overuse headache A. Headache present on 15 d/mo B. Regular overuse for >3 mo of one or more drugs that can be taken for acute and/or symptomatic treatment of headache ergotamine, triptan, opioid, combination >10d/mo simple analgesic or a comb of analgesics >15 d/mo C. Headache has developed or markedly worsened during medication overuse
18 ICHD II III - Medication Overuse HA No particular HA features (ICHD II specified type) Frequency of HA > 15 d/month (like ICHD II) Requirement for usage frequency (like ICHD II): ergotamine, triptan, opioid, comb meds >10d/mo simple analgesic or a combination of analgesics >15 d/mo No requirement for resolution after discontinuation of the causal medication
19 Chronic daily headache v. MOH In chronic headaches, as headache frequency increases, analgesic medication frequency increases Then analgesic rebound may occur So how do distinguish between CM and MOH? See if headaches disappear when acute medication is discontinued not always a reliable clue
20 ICHD II Secondary HA Chapter 9 Headache attributed to infection - Meningitis, encephalitis - Brain abscess - Systemic infection - HIV
21 ICHD II Secondary HA Chapter 10 HA attributed to disorder of homeostasis Formerly - HA associated with metabolic disorder - High altitude, sleep apnea - Dialysis - Pheochromocytoma - HTN significant, with or without encephalopathy - Hypothyroidism - Fasting - Cardiac cephalalgia
22 ICHD II Secondary HA Chapter 11 HA attributed to skull, neck, eyes, ears, nose, sinuses, teeth, mouth etc Cervocogenic HA Ocular causes Nose and Sinuses Teeth or Jaw Temporomandibular dysfunction
23 Cervicogenic Headache ICHD III A. Headache of any kind fulfilling criteria C and D B. Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of headache, including tumors, fractures, infections, and significant upper cervical arthritic disease such as symptomatic spondylosis.
24 ICHD II Secondary HA Chapter 12 HA attributed to psychiatric disorder Evidence supporting psychiatric causes of headache remains scarce Chapter 13 Neuralgias Trigeminal, glossopharyngeal, occipital Optic neuritis Recurrent painful ophthalmoplegic neuropathy (Ophthalmoplegic migraine)
25 12. Headache attributed to psychiatric disorder 12.1 Headache attributed to somatization disorder 12.2 Headache attributed to psychotic disorder
26 What s New in the Appendix? A1.3.1 Chronic migraine with pain free periods A1.3.2 Chronic migraine with continuous pain A1.4.5 Migraine aura status A Infantile Colic A Vestibular migraine A 4.11 Epicrania fugax zig-zag HA A5.1, 5.2 Delayed PTH A7.11 Post-electroconvulsive therapy (ECT) headache A7.12 Persistent post-intracranial disorder headache A 7.13 Ictal Epileptic Headache
27 What s New in the Appendix? A9.3 Headache attributed to HIV infection Headache attributed to aeroplane travel A10.9 Headache attributed to travel to space A10.10 Coat hanger pain attributed to orthostatic (postural) hypotension A Headache attributed to upper cervical radiculopathy A Headache attributed to myofascial pain in the cervical muscles A Headache attributed to pathology of the nasal mucosa, turbinates or septum Airplane Headache
28 ICHD III Appendix psych disorders A12.3 Headache attributed to Depressive Disorders A12.4 Headache attributed to Separation Anxiety Disorder A12.5 Headache attributed to Panic Disorder A12.6 Headache attributed to Specific Phobia A12.7 Headache attributed to Social Anxiety Disorder (Social Phobia) A12.8 Headache attributed to Generalized Anxiety Disorder A12.9 Headache attributed to Post-traumatic Stress Disorder A12.10 Headache attributed to Acute Stress Disorder
29 ICHD III The Beta Version Field testing begins NOW with the aim of finalizing the ICHD by 2015 Participate in assessing and commenting: Simultaneously, ICD 11 is being created and interested neuro professionals are being asked to participate in the WHO Global Neurology Network: VAyeQB
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