Headache Classification 2007

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

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

International Classification of Headache Disorders 2nd edition

• (ICHD-2)

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

ICD-9: New Categories

• 339 Other Headache Syndromes

• 346 Migraine

• Secondary Headaches

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)

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

‘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

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

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

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

New Subcategory 339.3

• Drug induced headache, not elsewhere classified

• Medication overuse headache
• Rebound headache

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

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

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

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

Revise 346.1 Migraine without Aura

• Add Common Migraine

346.2 Variants of migraine, Not Elsewhere Classified

• Add Cyclical vomiting

• Add Ophthalmoplegic migraine

• Add Periodic headache syndromes in child or adolescent

New Codes

• 346.3 Hemiplegic migraine Familial Sporadic

• 346.4 Menstrual migraine Menstrually related migraine

• Pure menstrual migraine

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

New Codes

• 346.7 Chronic migraine Transformed migraine