Handbook of Psychology

246 Headaches

TABLE 11.2 Classification of Headache

1. Migraine.
   1.1 Migraine without aura.
   1.2 Migraine with aura.
   1.3 Childhood periodic syndromes that may be precursors to or
   associated with migraine.


2. Tension-type headache.
   2.1 Episodic tension-type headache.
   2.1.1 Episodic tension-type headache associated with disorder of
   pericranial muscles.
   2.1.2 Episodic tension-type-headache unassociated with disorder
   of pericranial muscles.
   2.2 Chronic tension-type headache.
   2.2.1 Chronic tension-type headache associated with disorder of
   pericranial muscles.
   2.2.2 Chronic tension-type headache unassociated with disorder of
   pericranial muscles.


3. Cluster headache and chronic paroxysmal hemicrania.
   3.1 Cluster headache.
   3.1.1 Cluster headache periodicity undetermined.
   3.1.2 Episodic cluster headache.
   3.1.3 Chronic cluster headache.


4. Miscellaneous headaches unassociated with structural lesion.


5. Headache associated with head trauma.
   5.1 Acute posttraumatic headache.
   5.1.1 with signi“cant head trauma and /or con“rmatory signs.
   5.1.2 with minor head trauma and no con“rmatory signs.
   5.2 Chronic posttraumatic headache.
   5.2.1 with signi“cant head trauma and /or con“rmatory signs.
   5.2.2 with minor head trauma and/or con“rmatory signs.


6. Headache associated with vascular disorders.


7. Headache associated with nonvascular intracranial disorder.


8. Headache associated with substances or their withdrawal.
   8.1 Headache induced by acute substance use or exposure.
   8.1.1 Nitrate/nitrite-induced headache.
   8.1.2 Monosodium glutamate-induced headache.
   8.1.3 Carbon monoxide-induced headache.
   8.1.4 Alcohol-induced headache.
   8.1.5 Other substances.
   8.2 Headache induced by chronic substance use or exposure.
   8.2.1 Ergotamine induced headache.
   8.2.2 Analgesics abuse headache.
   8.2.3 Other substances.
   8.3 Headache from substance withdrawal (acute use).
   8.3.1 Alcohol withdrawal headache (hangover).
   8.3.2 Other substances.
   8.4 Headache from substance withdrawal (chronic use).
   8.4.1 Ergotamine withdrawal headache.
   8.4.2 Caffeine withdrawal headache.
   8.4.3 Narcotics abstinence headache.
   8.4.4 Other substances.
   8.5 Headache associated with substances but with uncertain
   mechanism.
   8.5.1 Birth control pills or estrogens.
   8.5.2 Other substances.


9. Headache associated with noncephalic infection.


10. Headache associated with metabolic disorder.


11. Headache or facial pain associated with disorder of cranium, neck,
    eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial
    structures.


12. Cranial neuralgias, nerve trunk pain, and deafferentation pain.


13. Headache nonclassi“able.
    Source:From the International Headache Society (IHS) Headache Classi“-
    cation Committee (1988), pp. 13...17.The Norwegian University Press.

prior system was inexplicit and outdated). Their recommen-
dations were published in 1988 (International Headache
Society Headache Classi“cation Committee), and have since
been endorsed by all national headache societies within
IHS, the World Federation of Neurology, and the World
Health Organization for inclusion in ICD-10(see Olesen,
2000, for further discussion). Thirteen different categories re-
sulted (see Table 11.2), with categories 1, 2, 3 (termed pri-
mary headache disorders), 5 and 8 (termed secondary
headaches) being the most likely to present for treatment to
behaviorally oriented pain specialists. Diagnostic criteria for
these “ve categories are listed in Table 11.3 (International
Headache Society Headache Classi“cation Committee,
1988). It is not uncommon for migraine and tension-type
headache to coexist within the same individual and to warrant
separate diagnoses (which in the past had been termed vari-
ously mixed headache, tension-vascular headache, or combi-
nation headache).
Migraine has been found to be much more complex and
multidetermined than previously thought. In addition to the

TABLE 11.1 “Danger Signs” in Headache Pain Patients That May
Suggest the Need for Immediate Referral to a Physician

1. Headache is a new symptom for the individual in the past three
   months, or the nature of the headache has changed markedly in the past
   three months.


2. Presence of any sensory or motor de“cits preceding or accompanying
   headache other than the typical visual prodromata of migraine with
   aura. Examples include weakness or numbness in an extremity,
   twitching of the hands or feet, aphasia, or slurred speech.


3. Headache is one sided and has always been on the same side of the
   head.


4. Headache is due to trauma, especially if it follows a period of
   unconsciousness (even if only momentary).


5. Headache is constant and unremitting.


6. For a patient reporting tension-type headache-like symptoms:
   a. Pain intensity has been steadily increasing over a period of weeks to
   months with little or no relief.
   b. Headache is worse in the morning and becomes less severe during
   the day.
   c. Headache is accompanied by vomiting.


7. Patient has been treated for any kind of cancer and now has a
   complaint of headache.


8. Patient or signi“cant other reports a noticeable change in personality or
   behavior or a notable decrease in memory or other intellectual
   functioning.


9. The patient is over 60 years of age, and the headache is a relatively
   new complaint.


10. Pain onset is sudden and occurs during conditions of exertion (such as
    lifting heavy objects), sexual intercourse, or •heatedŽ interpersonal
    situation.


11. Patient•s family has a history of cerebral aneurysm, other vascular
    anomalies, or polycystic kidneys.

Source:From Andrasik and Baskin (1987), page 327. Copyright 1987
Plenum Press. Reprinted by permission. List developed in consultation with
Lawrence D. Rodichok, M.D. Diagnoses have been modi“ed to be compati-
ble with the classi“cation system developed by the International Headache
Society (IHS) Headache Classi“cation Committee (1988).