| IHS | Diagnosis | ICD-10 |
|---|---|---|
| 11 | HEADACHE OR FACIAL PAIN ATTRIBUTED TO DISORDER OF CRANIUM, NECK, EYES, EARS, NOSE, SINUSES, TEETH, MOUTH OR OTHER FACIAL OR CRANIAL STRUCTURES | G44.84 |
| Coded elsewhere | Headaches that are due to head or neck trauma are classified under 5. Headache attributed to head and/or neck trauma . Neuralgiform headaches are classified under 13. Cranial neuralgias and central causes of facial pain . | |
General comment
Primary or secondary headache or both?
When a new headache occurs for the first time in close temporal relation to a craniocervical disorder, it is coded as a secondary headache attributed to that disorder. This is also true if the headache has the characteristics of migraine, tension-type headache or cluster headache. When a pre-existing primary headache is made worse in close temporal relation to a craniocervical disorder, there are two possibilities, and judgment is required. The patient can either be given only the diagnosis of the pre-existing primary headache or be given both this diagnosis and the diagnosis of headache attributed to the craniocervical disorder. Factors that support adding the latter diagnosis are: a very close temporal relation to the craniocervical disorder, a marked worsening of the pre-existing headache, very good evidence that the craniocervical disorder can aggravate the primary headache and, finally, improvement or resolution of the headache after relief from the craniocervical disorder.
Definite, probable or chronic?
A diagnosis of Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures usually becomes definite only when the headache resolves or greatly improves after effective treatment or spontaneous remission of the craniocervical disorder. If this disorder cannot be treated effectively or does not remit spontaneously, or when there has been insufficient time for this to happen, a diagnosis of Headache probably attributed to the [specified] craniocervical disorder is usually applied.
If the craniocervical disorder is effectively treated or remits spontaneously but headache does not resolve or markedly improve after 1 month, the persisting headache has other mechanisms. Nevertheless, A11.9 Chronic post-craniocervical disorder headache is described in the appendix. Headaches meeting these criteria exist but have been poorly studied and the appendix entry is intended to stimulate further research into such headaches and their mechanisms.
Introduction
Disorders of the cervical spine and of other structures of the neck and head have not infrequently been regarded as the commonest causes of headache, since many headaches originate from the cervical, nuchal or occipital regions or are localised there. Moreover, degenerative changes in the cervical spine can be found in virtually all people over 40 years of age. The localisation of pain and the x-ray detection of degenerative changes have been plausible reasons for regarding the cervical spine as the most frequent cause of headaches. However, large-scale controlled studies have shown that such changes are just as widespread among individuals who do not suffer from headaches. Spondylosis or osteochondrosis cannot therefore be seen as the explanation of headaches. A similar situation applies to other widespread disorders: chronic sinusitis, temporomandibular joint disorders and refractive errors of the eyes.
Without specific criteria it would be possible for virtually any type of headache to be classified as Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures, and this problem existed in the past. It is not sufficient merely to list manifestations of headaches in order to define them, since these manifestations are not unique. The purpose of the criteria in this chapter is not to describe headaches in all their possible subforms, but rather to establish specific causal relationships between headaches and facial pain and the disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth and other facial or cranial structures where these exist. For this reason it has been necessary to identify strict specific operational criteria for cervicogenic headache and other causes of headache described in this chapter. It is not possible here to take account of diagnostic tests that are unconfirmed or for which quality criteria have not been investigated. Instead the aim of the revised criteria is to motivate as a future task the development of reliable and valid operational tests to establish specific causal relationships between headaches and craniocervical disorders that are currently available only to a very limited extent.
Headache disorders attributed to causes included here for the first time are 11.2.3 Headache attributed to craniocervical dystonia and 11.3.4 Headache attributed to ocular inflammatory disorders.
