Headache classification 2007

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1 : Headache Classification 2007 Stephen D. Silberstein, M.D., F.A.C.P. Director, Jefferson Headache Center, Professor of Neurology Thomas Jefferson University Hospital Philadelphia, Pennsylvania Past President American Headache Society
2 : Old Ad-hoc Headache Classification 1. Migraine Migraine variants, vascular headaches, atypical facial neuralgia 2. Tension headache (muscular contraction headache) 3. Headache associated with intracranial disturbances Arteriosclerotic brain diseases, vascular anomalies, aneurysms, tumor, infections 4. Headache associated with extracranial disturbances Eye, ear, nose, bones of the skull and neck 5. Headache associated with cranial trauma 6. Hypertension, allergy, arteritis (temporal), fevers, infection 7. Psychogenic headaches Conversion, tension headaches
3 : International Classification of Headache Disorders 2nd edition (ICHD-2)
4 : ICHD-2 Classification Part 1: Primary headache disorders Part 2: Secondary headache disorders Part 3: Cranial neuralgias, central and primary facial pain and other headaches
5 : ICD-9: Problems Outmoded Terminology Based on ad-hoc criteria Classic and common migraine no longer used Did not allow characterization of disorders based on epidemiology and new science Many disorders misclassified or not classified Many new disorders described No relationship to ICHD-2 Tension headache misclassified as psychiatric disorder Occurs in over 50% of population
6 : ICD-9: New Categories 339 Other Headache Syndromes 346 Migraine Secondary Headaches
7 : ICD-9 Revisions: Tension-type headache not psychological 307 Special symptoms or syndromes, not elsewhere classified 307.8 Pain disorders related to psychological factors 307.81 Tension headache Excludes: headache: Add syndromes (339.00-339.89) Add tension-type (339.10-339.12)
8 : 339 Subcategories: Other Headache Syndromes 339.0 Cluster headaches and other TACS 339.1 Tension-type Headache (TTH) 339.2 Post-traumatic Headache (PTH) 339.3 Drug induced headache 339.4 Complicated headache syndromes 339.8 Other headache syndromes
9 : ‘Episodic versus Chronic’ In pain, chronic denotes persistence > 3 months In headache, it has this meaning for secondary headache disorders For primary episodic headache disorders (eg, migraine), chronic is used whenever headache occurs on more days than not > 3 months Episodic means <15days/month Trigeminal autonomic cephalalgias exception Chronic not used until unremitting >1 year
10 : New subcategory 339.0 Cluster headaches and other trigeminal autonomic cephalgias (TACS) New code 339.00 Cluster headache syndrome, unspecified (Cluster headache NOS, Ciliary neuralgia, Histamine cephalgia, Lower half migraine, Migrainous Neuralgia) New code 339.01 Episodic cluster headache New code 339.02 Chronic cluster headache New code 339.03 Episodic paroxysmal hemicrania Paroxysmal hemicrania NOS New code 339.04 Chronic paroxysmal hemicrania New code 339.05 SUNCT New code 339.09 Other TACS
11 : New Subcategory 339.1 Tension-type Headache (TTH) Excludes: tension headache due to psychological factors (307.81) New code 339.10 TTH, unspecified New code 339.11 Episodic TTH New code 339.12 Chronic TTH
12 : New Subcategory 339.2 Post-traumatic Headache (PTH) New code 339.20 PTH, unspecified New code 339.21 Acute PTH New code 339.22 Chronic PTH PTH can be part of post-concussion syndrome But does not have to be
13 : New Subcategory 339.3 Drug induced headache, not elsewhere classified Medication overuse headache Rebound headache
14 : New Subcategory 339.4 Complicated Headache Syndromes New code 339.41 Hemicrania continua (HC) Unilateral CDH New code 339.42 New daily persistent headache (NDPH) New onset CDH New code 339.43 Primary thunderclap headache New code 339.44 Other complicated headache syndrome
15 : New Subcategory 339.8 Other headache syndromes New code 339.81 Hypnic headache New code 339.82 Headache associated with sexual activity Orgasmic headache Preorgasmic headache New code 339.83 Primary cough headache New code 339.84 Primary exertional headache New code 339.85 Primary stabbing headache New code 339.89 Other headache syndromes
16 : 346 Migraine Following fifth-digit subclassification used with category 346: Revise 0 without mention of intractable migraine without mention of status migrainosus Revise 1 with intractable migraine, so stated, without mention of status migrainosus Add 2 without mention of intractable migraine with status migrainosus Add 3 with intractable migraine, so stated, with status migrainosus
17 : Revise 346.0 Migraine with aura Add Classic migraine Add Basilar migraine Add Migraine triggered seizures (can use sz codes) Add Migraine with acute-onset aura Add Migraine with aura without headache (Migraine equivalents) Add Migraine with prolonged aura Add Migraine with typical aura Add Retinal migraine
18 : Revise 346.1 Migraine without Aura Add Common Migraine
19 : 346.2 Variants of migraine, Not Elsewhere Classified Add Cyclical vomiting Add Ophthalmoplegic migraine Add Periodic headache syndromes in child or adolescent
20 : New Codes 346.3 Hemiplegic migraine Familial Sporadic 346.4 Menstrual migraine Menstrually related migraine Pure menstrual migraine
21 : New Codes 346.5 Persistent migraine aura without cerebral infarction Persistent migraine aura NOS 346.6 Persistent migraine aura with cerebral infarction Can use stroke codes
22 : New Codes 346.7 Chronic migraine Transformed migraine


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