​5.2 Persistent headache attributed to traumatic injury to the head

​Description:Headache of more than 3 months’ duration caused by traumatic injury to the head.
Diagnostic criteria:
  1. Any headache fulfilling criteria C and D
  2. Traumatic injury to the head1 has occurred
  3. 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) impairing ability to sense or report headache following the injury to the head
  4. Headache persists for >3 months after its onset
  5. Not better accounted for by another ICHD-3 diagnosis2.
Notes:
  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 impact between the head and an object, penetration of the head by a foreign body, forces generated from blasts or explosions, and other forces yet to be defined.
  2. When headache following head injury becomes persistent, the possibility of 8.2 Medication-overuse headache needs to be considered.
Comments:The stipulation that headache must be reported to have developed within 7 days is somewhat arbitrary (see Introduction above). Compared to longer intervals, a 7-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 A5.2.1.1 Delayed-onset persistent headache attributed to moderate or severe traumatic injury to the head and A5.2.2.1 Delayed-onset persistent headache attributed to mild traumatic injury to the head may be used when the interval between injury and headache onset is greater than 7 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, 3 months is the time interval after which headache attributed to trauma or injury to the head is considered persistent. Further research is needed to investigate whether shorter or longer intervals may be more appropriately adopted.

​5.2.2 Persistent headache attributed to mild traumatic injury to the head

Diagnostic criteria:​
  1. Headache fulfilling criteria for 5.2 Persistent headache attributed to traumatic injury to the head
  2. Head injury fulfilling both of the following:
    1. associated with none of the following:
      • – loss of consciousness for >30 minutes
      • – Glasgow Coma Scale (GCS) score <13
      • – post-traumatic amnesia lasting >24 hours1
      • – altered level of awareness for >24 hours
      • – imaging evidence of a traumatic head injury such as skull fracture, intracranial haemorrhage and/or brain contusion
    2. associated with one or more of the following symptoms and/or signs:
      • – transient confusion, disorientation or impaired consciousness
      • – loss of memory for events immediately before or after the head injury
      • – two or more of the following symptoms suggestive of mild traumatic brain injury:
        • – nausea
        • – vomiting
        • – visual disturbances
        • – dizziness and/or vertigo
        • – gait and/or postural imbalance
        • – impaired memory and/or concentration.
Note:The duration of post-traumatic amnesia is defined as the time between head injury and resumption of normal continuous recall of events.

​5.2.1 Persistent headache attributed to moderate or severe traumatic injury to the head

Diagnostic criteria:
  1. Headache fulfilling criteria for 5.2 Persistent headache attributed to traumatic injury to the head
  2. Injury to the head associated with at least one of the following:
    1. loss of consciousness for >30 minutes
    2. Glasgow Coma Scale (GCS) score <13
    3. post-traumatic amnesia lasting >24 hours
    4. alteration in level of awareness for >24 hours
    5. imaging evidence of a traumatic head injury such as skull fracture, intracranial haemorrhage and/or brain contusion.
Note:The duration of post-traumatic amnesia is defined as the time between head injury and resumption of normal continuous recall of events.

Glasgow Coma Scale  


Eye Opening Response
• Spontaneous--open with blinking at baseline 4 points
• To verbal stimuli, command, speech 3 points
• To pain only (not applied to face) 2 points
• No response 1 point

Verbal Response
• Oriented 5 points
• Confused conversation, but able to answer questions 4 points
• Inappropriate words 3 points
• Incomprehensible speech 2 points
• No response 1 point

Motor Response
• Obeys commands for movement 6 points
• Purposeful movement to painful stimulus 5 points
• Withdraws in response to pain 4 points
• Flexion in response to pain (decorticate posturing) 3 points
• Extension response in response to pain (decerebrate posturing) 2 points
• No response 1 point

Coma: No eye opening, no ability to follow commands, no word verbalizations (3-8)

Head Injury Classification:
Severe Head Injury----GCS score of 8 or less
Moderate Head Injury----GCS score of 9 to 12
Mild Head Injury----GCS score of 13 to 15