Trauma due to acceleration/deceleration movements of the head, with flexion/extension of the neck, is classified as whiplash. Persistent headache attributed to such trauma is coded as 5.4 Persistent headache attributed to whiplash. Persistent headache attributed to surgical craniotomy performed for reasons other than traumatic head injury is coded as 5.6 Persistent headache attributed to craniotomy.
Headache of greater than three months’ duration caused by traumatic injury to the head.
A. Any headache fulfilling criteria C and D
B. Traumatic injury to the head1 has occurred
C. Headache is reported to have developed within 7 days after one of the following:
1. the injury to the head
2. regaining of consciousness following the injury to the head
3. discontinuation of medication(s) that impair ability to sense or report headache following the injury to the head
D. Headache persists for >3 months after the injury to the head
E. Not better accounted for by another ICHD-3 diagnosis.
1. Traumatic injury to the head is defined as a structural or functional injury resulting from the action of external forces upon the head. These include striking the head with or the head striking an object, penetration of the head by a foreign body, forces generated from blasts or explosions, and other forces yet to be defined.
The stipulation that headache must be reported to have developed within seven days is somewhat arbitrary (see Introduction above). Compared to longer intervals, a seven-day interval yields diagnostic criteria with higher specificity for 5.2 Persistent headache attributed to traumatic injury to the head (ie, stronger evidence of causation) but a correlative loss of sensitivity. Further research is needed into whether or not a different interval might be more appropriate. In the meantime, Appendix criteria for A18.104.22.168 Delayed-onset persistent headache attributed to moderate or severe traumatic injury to the head and A22.214.171.124 Delayed-onset persistent headache attributed to mild traumatic injury to the head (qv) may be used when the interval between injury and headache onset is greater than seven days.
To be consistent with ICHD-II diagnostic criteria for chronic post-traumatic headache and with the time interval used in the diagnoses of other secondary headache disorders, three months is the time interval after which headache attributed to head injury is considered persistent. Further research is needed to investigate whether shorter or longer intervals may be more appropriately adopted.