10.4 Headache attributed to hypothyroidism

Headache, usually bilateral and non-pulsatile, in patients with hypothyroidism and remitting after normalization of thyroid hormone levels.

Diagnostic criteria:
A. Headache fulfilling criterion C
B. Hypothyroidism has been demonstrated
C. Evidence of causation demonstrated by at least two of the following:

    1. headache has developed in temporal relation to the onset of hypothyroidism, or led to its discovery
    2. either or both of the following:

      a) headache has significantly worsened in parallel with worsening of the hypothyroidism
      b) headache has significantly improved or resolved in parallel with improvement in or resolution of the hypothyroidism

    3. headache has at least one of the following three characteristics:

      a) bilateral location
      b) non-pulsatile quality
      c) constant over time

D. Not better accounted for by another ICHD-3 diagnosis.

It has been estimated that approximately 30% of patients with hypothyroidism suffer from 10.4 Headache attributed to hypothyroidism. Its mechanism is unclear. There is a female preponderance and often a history of migraine in childhood. The headache is not associated with nausea or vomiting.

In the presence of hypothyroidism, headache can also be a manifestation of pituitary adenoma (coded 7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion).