10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy

Coded elsewhere:

10.3.1 Headache attributed to phaeochromocytoma.

Description:

Headache, usually bilateral and pulsating, caused by a paroxysmal rise of arterial hypertension (systolic ≥180 mm Hg and/or diastolic ≥120 mm Hg). It remits after normalization of blood pressure.

Diagnostic criteria:
  1. Headache fulfilling criterion C
  2. Both of the following:
    1. a hypertensive crisis1 is occurring
    2. no clinical features or other evidence of hypertensive encephalopathy
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed during the hypertensive crisis
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with increasing hypertension
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the hypertensive crisis
    3. headache has at least one of the following three characteristics:
      • a) bilateral location
      • b) pulsating quality
      • c) precipitated by physical activity
  4. Not better accounted for by another ICHD-3 diagnosis.
Note:

A hypertensive crisis is defined as a paroxysmal rise in systolic (to ≥180 mm Hg) and/or diastolic (to ≥120 mm Hg) blood pressure.

Comment:

Paroxysmal hypertension may occur in association with failure of baroreceptor reflexes (after carotid endarterectomy or subsequent to irradiation of the neck) or in patients with enterochromaffin cell tumours.