9.2 Headache attributed to systemic infection

Coded elsewhere:

Headache attributed to meningitis or encephalitis accompanying systemic infection should be coded accordingly under 9.1 Headache attributed to intracranial infection.

Description:

Headache of variable duration caused by systemic infection, usually accompanied by other symptoms and/or clinical signs of the infection.

Comments:

Headache in systemic infections is usually a relatively inconspicuous symptom, and diagnostically unhelpful. These conditions are mostly dominated by fever, general malaise and other systemic symptoms. Nevertheless, some systemic infections, particularly influenza, have headache as a prominent symptom along with fever and others. When systemic infection is accompanied by meningitis or encephalitis, any headache attributed to the infection should be coded to these disorders as a subtype or subform of 9.1 Headache attributed to intracranial infection.

In infectious disease, headache commonly coexists with fever and may be dependent on it, but headache can also occur in the absence of fever. The exact nature of these mechanisms remains to be investigated. Meanwhile, the great variability in their propensity for causing headache indicates that systemic infections do not have this effect simply through fever and exogenous or endogenous pyrogens. The mechanisms causing headache include direct effects of the microorganisms themselves. Several cells are likely to be involved (activated microglia and monocytic macrophages, activated astrocytes and blood-brain barrier and endothelial cells), along with several immunoinflammatory mediators (cytokines, glutamate, COX-2/PGE2 system, NO–iNOS system and reactive oxygen species system).