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INTERNATIONAL HEADACHE SOCIETY
Company limited by guarantee, registered in England no.2988368 The International Classification
of Headache Disorders
2nd Edition
(1st revision, May 2005)
Abbreviated pocket version
for reference by professional users only,
prepared by
the Headache Classification Subcommittee of the
International Headache Society
Hans-Christoph Diener, David Dodick, Michael First,Peter J Goadsby, Hartmut Göbel, Miguel JA Lainez,James W Lance, Richard B Lipton, Giuseppe Nappi,Fumihiko Sakai, Jean Schoenen, Stephen D Silberstein,Timothy J Steiner.
International Headache Society 2004/5
Introduction to Abbreviated Pocket Version
The International Classification of Headache Disorders, 2nd
edition, is published by International Headache Society
(Cephalalgia 2004; 24 (suppl 1): 1-160, revised Cephalalgia
2005; 25: 460-465) and is accessible at www.i-h-s.org.
This abbreviated version, including the most common orimportant headache disorders, is an aide memoire for thosefamiliar with the classification principles and experienced intheir application. It lists the diagnostic criteria but omitsexplanatory introductions, descriptions, notes and commentswhich in many cases are key to proper and accurate usage.
Classification
ICHD-II ICD-10NA Diagnosis [aetiological ICD-10
code
Migraine
Childhood periodic syndromes thatare commonly precursors ofmigraine Migraine-triggered seizures[+ G40.x or G41.x to specify thetype of seizure] Tension-type headache (TTH)
Infrequent episodic TTH associ-ated with pericranial tenderness Infrequent episodic TTH notassociated with pericranialtenderness Frequent episodic TTH associatedwith pericranial tenderness Frequent episodic TTH not asso-ciated with pericranial tenderness Chronic TTH associated withpericranial tenderness Chronic TTH not associated withpericranial tenderness Cluster headache and other
trigeminal autonomic
cephalalgias (TAC)
Short-lasting unilateral neuralgiformheadache attacks with con-junctivalinjection and tearing (SUNCT) Other primary headaches
Primary headache associated withsexual activity Headache attributed to head
and/or neck trauma
Acute post-traumatic headacheattributed to moderate or severehead injury [S06] Acute post-traumatic headacheattributed to mild head injury[S09.9] Chronic post-traumatic headacheattributed to moderate or severehead injury [S06] Chronic post-traumatic headacheattributed to mild head injury[S09.9] Acute headache attributed towhiplash injury [S13.4] Chronic headache attributed towhiplash injury [S13.4] Headache attributed to traumaticintracranial haematoma Headache attributed to epiduralhaematoma [S06.4] Headache attributed to subduralhaematoma [S06.5] Headache attributed to other headand/or neck trauma [S06] Acute headache attributed toother head/neck trauma [S06] Chronic headache attributed toother head/neck trauma [S06] Headache attributed to cranial or
cervical vascular disorder
Headache attributed to ischaemicstroke or TIA Headache attributed to ischaemicstroke [I63] Headache attributed to non-traumatic intracranial haemorrhage[I62] Headache attributed to intra-cerebral haemorrhage [I61] Headache attributed tosubarachnoid haemorrhage [I60] Headache attributed to unrupturedvascular malformation [Q28] Headache attributed to saccularaneurysm [Q28.3] Headache attributed to arterio-venous malformation [Q28.2] Headache attributed to duralarteriovenous fistula [I67.1] Headache attributed to cavernousangioma [D18.0] Headache attributed to encephalo-trigeminal or leptomeningealangiomatosis (Sturge Webersyndrome) [Q85.8] Headache attributed to giant cellarteritis [M31.6] Headache attributed to primaryCNS angiitis [I67.7] Headache attributed to secondaryCNS angiitis [I68.2] Carotid or vertebral artery pain[I63.0, I63.2, I65.0, I65.2 or I67.0] Headache or facial or neck painattributed to arterial dissection[I67.0] Headache attributed to intra-cranial endovascular procedures Headache attributed to cerebralvenous thrombosis [I63.6] Headache attributed to other intra-cranial vascular disorder Cerebral autosomal dominantarteriopathy with subcorticalinfarcts and leukoencephalopathy(CADASIL) [I67.8] Mitochondrial encephalopathy,lactic acidosis and stroke-likeepisodes (MELAS) [G31.81] Headache attributed to benignangiopathy of the CNS [I99] Headache attributed to pituitaryapoplexy [E23.6] Headache attributed to non-
vascular intracranial disorder
Headache attributed to highcerebrospinal fluid (CSF) pressure Headache attributed to idiopathicintracranial hypertension [G93.2] Headache attributed to intra-cranial hypertension secondary tometabolic/toxic/hormonal causes Headache attributed to intra-cranial hypertension secondary tohydrocephalus [G91.8] Headache attributed to low cerebro-spinal fluid (CSF) pressure Headache attributed to spontaneous(or idiopathic) low CSF pressure Headache attributed to non-infectious inflammatory disease Headache attributed to neuro-sarcoidosis [D86.8] Headache attributed to aseptic(non-infectious) meningitis [codefor aetiology] Headache attributed to other non-infectious inflammatory disease[code for aetiology] Headache attributed to lympho-cytic hypophysitis [E23.6] Headache attributed to intracranialneoplasm [C00-D48] Headache attributed to increasedintracranial pressure or hydro-cephalus caused by neoplasm[code for neoplasm] Headache attributed directly toneoplasm [code for neoplasm] Headache attributed to carcino-matous meningitis [C79.3] Headache attributed tohypothalamic or pituitary hyper-or hyposecretion [E23.0] Headache attributed to intrathecalinjection [G97.8] Headache attributed to epilepticseizure [G40.x or G41.x] Headache attributed to Chiari mal-formation type I [Q07.0] Syndrome of transient headacheand neurological deficits with CSFlymphocytosis (HaNDL) Headache attributed to other non-vascular intracranial disorder Headache attributed to a
substance or its withdrawal
Headache induced by acutesubstance use or exposure Nitric oxide (NO) donor-inducedheadache [X44] Phosphodiesterase inhibitor-induced headache [X44] Carbon monoxide (CO)-inducedheadache [X47] Headache induced by food com-ponents and additives Monosodium glutamate-inducedheadache [X44] Immediate histamine-inducedheadache [X44] Calcitonin gene-related peptide(CGRP)-induced headache [X44] Headache as an acute adverseevent attributed to medicationused for other indications [codefor substance] substance use or exposure [codefor substance] Combination analgesic-overuseheadache [F55.2] Headache attributed to othermedication overuse [code forsubstance] Headache as an adverse eventattributed to chronic medication[code for substance] Exogenous hormone-inducedheadache [Y42.4] Headache attributed to substancewithdrawal Headache attributed to with-drawal from chronic use of othersubstances [code for substance] Headache attributed to infection
Headache attributed to intracranialinfection [G00-G09] Headache attributed to bacterialmeningitis [G00.9] Headache attributed to lympho-cytic meningitis [G03.9] Headache attributed to encephali-tis [G04.9] Headache attributed to brainabscess [G06.0] Headache attributed to subduralempyema [G06.2] Headache attributed to systemicinfection [A00-B97] Headache attributed to systemicbacterial infection [code foraetiology] Headache attributed to systemicviral infection [code for aetiology] Headache attributed to other sys-temic infection [code for aetiology] Chronic post-bacterial meningitisheadache [G00.9] Headache attributed to disorder
of homoeostasis
Headache attributed to hypoxiaand/or hypercapnia Headache attributed to arterialhypertension [I10] Headache attributed to phaeo-chromocytoma [D35.0 (benign)or C74.1 (malignant)] Headache attributed to hyperten-sive crisis without hypertensiveencephalopathy [I10] Headache attributed to hyperten-sive encephalopathy [I67.4] Headache attributed to pre-eclampsia [O13-O14] Headache attributed to acutepressor response to an exogenousagent [code for aetiology] Headache attributed to hypothy-roidism [E03.9] Headache attributed to otherdisorder of homoeostasis [code foraetiology] Headache or facial pain attribu-
ted to disorder of cranium, neck,
eyes, ears, nose, sinuses, teeth,
mouth or other facial or cranial
structures
Headache attributed to disorder ofcranial bone [M80-M89.8] Headache attributed to disorder ofneck [M99] Headache attributed to retro-pharyngeal tendonitis [M79.8] Headache attributed to cranio-cervical dystonia [G24] Headache attributed to acuteglaucoma [H40] Headache attributed to refractiveerrors [H52] Headache attributed to hetero-phoria or heterotropia (manifestor latent squint) [H50.3-H50.5] Headache attributed to ocularinflammatory disorder [code foraetiology] Headache attributed to disorder ofears [H60-H95] Headache attributed to rhino-sinusitis [J01] Headache attributed to disorder ofteeth, jaws or related structures[K00-K14] Headache or facial pain attributedto temporomandibular joint (TMJ)disorder [K07.6] Headache attributed to otherdisorder of cranium, neck, eyes,ears, nose, sinuses, teeth, mouth orother facial or cervical structures[code for aetiology] Headache attributed to
psychiatric disorder
Headache attributed to somatisationdisorder [F45.0] Headache attributed to psychoticdisorder [code for aetiology] G44.847,
Cranial neuralgias and central
G44.848 or causes of facial pain
G44.85
Symptomatic trigeminal neuralgia[G53.80 + code for aetiology] Classical glossopharyngealneuralgia [G52.10] Symptomatic glossopharyngealneuralgia [G53.830 + code foraetiology] Headache attributed to externalapplication of a cold stimulus Headache attributed to ingestionor inhalation of a cold stimulus Constant pain caused by compres-sion, irritation or distortion ofcranial nerves or upper cervicalroots by structural lesions [G53.8 +code for aetiology] Head or facial pain attributed toacute herpes zoster [B02.2] Anaesthesia dolorosa [G52.800 +code for aetiology] Facial pain attributed to multiplesclerosis [G35] Burning mouth syndrome [codefor aetiology] Other cranial neuralgia or othercentrally mediated facial pain [codefor aetiology] Other headache, cranial
neuralgia, central or primary
facial pain
PART 1. THE PRIMARY HEADACHES
1. [G43] Migraine
1.1 [G43.0] Migraine without aura
At least 5 attacks fulfilling criteria B–D Headache attacks lasting 4-72 hours (untreated orunsuccessfully treated) Headache has at least 2 of the following characteristics:1. unilateral location2. pulsating quality3. moderate or severe pain intensity4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) During headache at least 1 of the following:1. nausea and/or vomiting2. photophobia and phonophobia 1.2 [G43.1] Migraine with aura
At least 2 attacks fulfilling criterion B Migraine aura fulfilling criteria B–C for one of thesubforms 1.2.1-1.2.6 1.2.1 [G43.10] Typical aura with migraine headache
At least 2 attacks fulfilling criteria B–D Aura consisting of at least 1 of the following, but nomotor weakness:1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/ornegative features (ie, loss of vision) 2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/ornegative features (ie, numbness) 3. fully reversible dysphasic speech disturbance At least two of the following:1. homonymous visual symptoms and/or unilateral 2. at least one aura symptom develops gradually over 5 minutes and/or different aura symptoms occur insuccession over 5 minutes 3. each symptom lasts 5 and 60 minutes Headache fulfilling criteria B–D for 1.1 Migrainewithout aura begins during the aura or follows aurawithin 60 minutes 1.2.3 [G43.104] Typical aura without headache
Aura consisting of at least 1 of the following, with orwithout speech disturbance but no motor weakness:1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/ornegative features (ie, loss of vision) 2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/ornegative features (ie, numbness) Headache does not occur during aura nor follow aurawithin 60 minutes 2. [G44.2] Tension-type headache (TTH)
2.1 [G44.2] Infrequent episodic tension-type headache
At least 10 episodes occurring on <1 day/month onaverage (<12 days/year) and fulfilling criteria B–D Headache lasting from 30 minutes to 7 days Headache has at least 2 of the following characteristics:1. bilateral location2. pressing/tightening (non-pulsating) quality3. mild or moderate intensity4. not aggravated by routine physical activity such as Both of the following:1. no nausea or vomiting (anorexia may occur)2. no more than one of photophobia or phonophobia 2.2 [G44.2] Frequent episodic tension-type headache
At least 10 episodes occurring on 1 but <15days/month for ≥3 months (12 and <180 days/year)and fulfilling criteria B–D 2.3 [G44.2] Chronic tension-type headache
Headache occurring on 15 days/month on average for>3 months (180 days/year) and fulfilling criteria B–D Headache lasts hours or may be continuous Both of the following:1. no more than one of photophobia, phonophobia or 2. neither moderate or severe nausea nor vomiting 3. [G44.0] Cluster headache and other trigeminal
autonomic cephalalgias
3.1 [G44.0] Cluster headache
At least 5 attacks fulfilling criteria B–D Severe or very severe unilateral orbital, supraorbitaland/or temporal pain lasting 15-180 minutes if untreated Headache is accompanied by at least 1 of the following:1. ipsilateral conjunctival injection and/or lacrimation2. ipsilateral nasal congestion and/or rhinorrhoea3. ipsilateral eyelid oedema4. ipsilateral forehead and facial sweating5. ipsilateral miosis and/or ptosis6. a sense of restlessness or agitation Attacks have a frequency from 1 every other day to 8/day 3.1.1 [G44.01] Episodic cluster headache
Attacks fulfilling criteria A–E for 3.1 Cluster headache At least two cluster periods lasting 7-365 days andseparated by pain-free remission periods of 1 month 3.1.2 [G44.02] Chronic cluster headache
Attacks fulfilling criteria A–E for 3.1 Cluster headache Attacks recur over >1 year without remission periods orwith remission periods lasting <1 month PART 2. THE SECONDARY HEADACHES
A de novo headache occurring with another disorder recog-nised to be capable of causing it is diagnosed as secondary.
A patient who has previously had a primary headache thatbecomes worse in close temporal relation to the occurrenceof another disorder can receive two diagnoses: the primaryheadache diagnosis and the secondary headache diagnosis.
The following factors support the use of two diagnoses: avery close temporal relation, marked worsening of theprimary headache, the existence of other evidence that theother disorder can aggravate primary headache in the mannerobserved, and remission of the headache after cure orremission of the other disorder.
5. [G44.88] Headache attributed to head and/or
neck trauma
5.2.1 [G44.30] Chronic post-traumatic headache attributed
to moderate or severe head injury [S06]
Headache, no typical characteristics known, fulfillingcriteria C–D Head trauma with at least 1 of the following:1. loss of consciousness for >30 minutes2. Glasgow Coma Scale (GCS) <133. post-traumatic amnesia for >48 hours4. imaging demonstration of a traumatic brain lesion (cerebral haematoma, intracerebral/subarachnoidhaemorrhage, brain contusion, skull fracture) Headache develops within 7 days after head trauma orafter regaining consciousness following head trauma Headache persists for >3 months after head trauma 6. [G44.81] Headache attributed to cranial or
cervical vascular disorder
6.4.1 [G44.812] Headache attributed to giant cell arteritis
(GCA) [M31.6]
Any new persisting headache fulfilling criteria C–D At least one of the following:1. swollen tender scalp artery with elevated erythro- cyte sedimentation rate and/or C reactive protein 2. temporal artery biopsy demonstrating giant cell Headache develops in close temporal relation to othersymptoms and signs of giant cell arteritis Headache resolves or greatly improves within 3 days ofhigh-dose steroid treatment 7. [G44.82] Headache attributed to non-vascular
intracranial disorder
7.1.1 [G44.820] Headache attributed to idiopathic
intracranial hypertension (IIH) [G93.2]
Progressive headache with at least 1 of the followingcharacteristics and fulfilling criteria C–D:1. daily occurrence2. diffuse and/or constant (non-pulsating) pain3. aggravated by coughing or straining Intracranial hypertension fulfilling the following criteria:1. alert patient with neurological examination that either is normal or demonstrates any of the a) papilloedemab) enlarged blind spotc) visual field defect (progressive if untreated)d) sixth nerve palsy 2. increased CSF pressure (>200 mm H2O in the non- obese, >250 mm H2O in the obese) measured bylumbar puncture in the recumbent position or byepidural or intraventricular pressure monitoring 3. normal CSF chemistry (low CSF protein is 4. intracranial diseases (including venous sinus thrombosis) ruled out by appropriate investigations 5. no metabolic, toxic or hormonal cause of Headache develops in close temporal relation toincreased intracranial pressure Headache improves after withdrawal of CSF to reducepressure to 120-170 mm H2O and resolves within 72hours of persistent normalisation of intracranialpressure 7.4.1 [G44.822] Headache attributed to increased
intracranial pressure or hydrocephalus caused by
neoplasm [C00-D48]
Diffuse non-pulsating headache with at least 1 of thefollowing characteristics and fulfilling criteria C–D:1. associated with nausea and/or vomiting2. worsened by physical activity and/or manoeuvres known to increase intracranial pressure (such asValsalva manoeuvre, coughing or sneezing) Space-occupying intracranial tumour* demonstrated byCT or MRI and causing hydrocephalus Headache develops and/or deteriorates in close temporalrelation to the hydrocephalus Headache improves within 7 days after surgical removalor volume-reduction of tumour *including colloid cyst of the IIIrd ventricle.
7.4.2 [G44.822] Headache attributed directly to neoplasm
[C00-D48]
Headache with at least 1 of the following characteristicsand fulfilling criteria C–D:1. progressive2. localised3. worse in the morning4. aggravated by coughing or bending forward Headache develops in temporal (and usually spatial)relation to the neoplasm Headache resolves within 7 days after surgical removal orvolume-reduction of neoplasm or treatment withcorticosteroids 8. [G44.4 or G44.83] Headache attributed to a
substance or its withdrawal
8.1.3 [G44.402] Carbon monoxide (CO)-induced headache
[X47]
Bilateral and/or continuous headache, with quality andintensity that may be related to the severity of COintoxication, fulfilling criteria C–D Headache develops within 12 hours of exposure Headache resolves within 72 hours after elimination ofCO 8.2 [G44.41 or G44.83] Medication-overuse headache†
Headache present on ≥15 days/month fulfilling criteriaC and D Regular overuse for >3 months of one or more drugsthat can be taken for acute and/or symptomatictreatment of headache Headache has developed or markedly worsened duringmedication overuse Headache resolves or reverts to its previous patternwithin 2 months after discontinuation of overusedmedication 8.2.1 [G44.411] Ergotamine-overuse headache [Y52.5]
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Ergotamine intake on 10 days/month on a regularbasis for >3 months 8.2.2 [G44.41] Triptan-overuse headache
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Triptan intake (any formulation) on 10 days/month on aregular basis for >3 months † The changes to ICHD-II in this first revision are confinedto this group of disorders. 8.2.6 MOH attributed tocombination of acute medications is newly described.
8.2.3 [G44.410] Analgesic-overuse headache [F55.2]
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Intake of simple analgesics on 15 days/month on aregular basis for >3 months 8.2.4 [G44.83] Opioid-overuse headache [F11.2]
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Opioid intake on 10 days/month on a regular basis for >3months 8.2.5 [G44.410] Combination analgesic-overuse headache
[F55.2]
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Intake of combination analgesic medications on 10days/month on a regular basis for >3 months 8.2.6 [G44.41  G44.83] MOH attributed to combination of
acute medications
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Intake of any combination of ergotamine, triptans,analgesics and/or opioids on 10 days/month on a regularbasis for >3 months without overuse of any single classalone 8.2.7 [G44.410] Headache attributed to other medication-
overuse
Headache fulfilling criteria A, C and D for 8.2Medication-overuse headache Regular overuse for >3 months of a medication other thanthose described above 8.2.8 [G44.41 or G44.83] Probable medication-overuse
headache*
Headache fulfilling criteria A and C for 8.2 Medication-overuse headache Medication-overuse fulfilling criterion B for any one ofthe subforms 8.2.1-8.2.7 One or other of the following:1. overused medication has not yet been withdrawn2. medication overuse has ceased within the last 2 months but headache has not so far resolved orreverted to its previous pattern 8.4 [G44.83] Headache attributed to substance
withdrawal
8.4.3 [G44.83] Oestrogen-withdrawal headache [Y42.4]
Headache or migraine fulfilling criteria C–D Daily use of exogenous oestrogen for 3 weeks, which isinterrupted Headache or migraine develops within 5 days after lastuse of oestrogen Headache or migraine resolves within 3 days 11. [G44.84] Headache or facial pain attributed to
disorder of cranium, neck, eyes, ears, nose,
sinuses, teeth, mouth or other facial or cranial
structures
11.2.1 [G44.841] Cervicogenic headache [M99]
Pain, referred from a source in the neck and perceivedin one or more regions of the head and/or face, fulfillingcriteria C–D Clinical, laboratory and/or imaging evidence of adisorder or lesion within the cervical spine or softtissues of the neck known to be, or generally acceptedas, a valid cause of headache Evidence that the pain can be attributed to the neckdisorder or lesion based on at least 1 of the following:1. demonstration of clinical signs that implicate a source 2. abolition of headache following diagnostic blockade of a cervical structure or its nerve supply usingplacebo- or other adequate controls Pain resolves within 3 months after successful treatmentof the causative disorder or lesion PART 3. CRANIAL NEURALGIAS, CENTRAL AND
PRIMARY FACIAL PAIN AND OTHER HEADACHES
13. [G44.847, G44.848 or G44.85] Cranial
neuralgias and central causes of facial pain
13.1.1 [G44.847] Classical trigeminal neuralgia [G50.00]
Paroxysmal attacks of pain lasting from a fraction of asecond to 2 minutes, affecting one or more divisions of thetrigeminal nerve and fulfilling criteria B–C Pain has at least 1 of the following characteristics:1. intense, sharp, superficial or stabbing2. precipitated from trigger areas or by trigger factors Attacks are stereotyped in the individual patient There is no clinically evident neurological deficit 13.8 [G44.847] Occipital neuralgia [G52.80]
Paroxysmal stabbing pain, with or without persistentaching between paroxysms, in the distribution(s) of thegreater, lesser and/or third occipital nerves Pain is eased temporarily by local anaesthetic block of thenerve 13.18 [G44.810 or G44.847] Central causes of facial pain
13.18.4 [G44.847] Persistent idiopathic facial pain [G50.1]
Pain in the face, present daily and persisting for all ormost of the day, fulfilling criteria B–C Pain is confined at onset to a limited area on one side ofthe face, and is deep and poorly localised Pain is not associated with sensory loss or other physicalsigns Investigations including X-ray of face and jaws do notdemonstrate any relevant abnormality

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