7.1 Headache attributed to increased cerebrospinal fluid (CSF) pressure

Coded elsewhere:

Headache attributed to increased intracranial pressure or hydrocephalus secondary to an intracranial neoplasm is coded as 7.4.1 Headache attributed to intracranial neoplasm.

Description:

Headache caused by increased cerebrospinal fluid (CSF) pressure, usually accompanied by other symptoms and/or clinical signs of intracranial hypertension.

Diagnostic criteria:
  1. New headache, or a significant worsening1 of a pre-existing headache, fulfilling criterion C
  2. Intracranial hypertension has been diagnosed, with both of the following:
    1. cerebrospinal fluid (CSF) pressure exceeds 250 mm CSF (or 280 mm CSF in obese children)2
    2. normal CSF composition
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the intracranial hypertension, or led to its discovery
    2. headache is relieved by reducing the intracranial hypertension
    3. papilloedema
  4. Not better accounted for by another ICHD-3 diagnosis3<.
Notes:
  1. ”Significant worsening” implies a two-fold or greater increase in frequency and/or severity in accordance with the general rule on distinguishing secondary from primary headache.
  2. For diagnostic purposes, CSF pressure should be measured in the absence of treatment to lower intracranial pressure. CSF pressure may be measured by lumbar puncture performed in the lateral decubitus position without sedative medications or by epidural or intraventricular monitoring. Because CSF pressure varies during the course of a day, a single measurement may not be indicative of the average CSF pressure over 24 hours: prolonged lumbar or intraventricular pressure monitoring may be required in cases of diagnostic uncertainty.
  3. Intracranial neoplasm has been excluded.
Comment:

7.1 Headache attributed to increased cerebrospinal fluid (CSF) pressure is a headache type. The diagnosis, when made, should be temporary only, pending determination of the cause of raised CSF pressure; the headache should then be recoded to the appropriate subtype.