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Diagnostic criteria:

  1. Headache, no typical characteristics known, fulfilling criteria C-E
  2. Presence of post-traumatic stress disorder fulfilling DSM-IV criteria:
    1. the patient has been exposed to a traumatic event in which both of the following were present:
      1. the patient experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
      2. the patient's response involved intense fear, helplessness or horror
    2. the traumatic event is persistently re-experienced in at least one of the following ways:
      1. recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions
      2. recurrent distressing dreams of the event
      3. acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including any of these that occur on awakening or when intoxicated)
      4. intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event
      5. physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event
    3. persistent avoidance of stimuli associated with the trauma and a numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
      1. efforts to avoid thoughts, feelings or conversations associated with the trauma
      2. efforts to avoid activities, places or people that arouse recollections of the trauma
      3. inability to recall an important aspect of the trauma
      4. markedly diminished interest or participation in significant activities
      5. feeling of detachment or estrangement from others
      6. restricted range of affect (eg, unable to have loving feelings)
      7. sense of a foreshortened future (eg, not expecting to have a career, marriage, children or a normal life span)
    4. persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following):
      1. difficulty falling asleep or staying asleep
      2. irritability or outbursts of anger
      3. difficulty concentrating
      4. hypervigilance
      5. exaggerated startle response
    5. symptoms in B2, B3 and B4 have lasted >1 month
  3. Headache occurs exclusively during the course of the post-traumatic stress disorder
  4. Headache resolves after the post-traumatic stress disorder remits
  5. Headache is not attributed to another cause

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