A12.9 Headache attributed to post-traumatic stress disorder (PTSD)

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Post-traumatic stress disorder (PTSD) has been diagnosed according to DSM-5 criteria
  3. The headache first developed after exposure to the trauma stressor and occurs exclusively in the context of other symptoms of PTSD1
  4. Not better accounted for by another ICHD-3 diagnosis2.
Notes:
  1. For example, headache occurs upon exposure to reminders of the trauma.
  2. In particular, A12.3 Headache attributed to depressive disorder.
Comments:

Exposure to actual or threatened death, serious injury or sexual violation may occur directly by experiencing the event, or it may occur indirectly: by witnessing the event; by learning that the event occurred to a close family member or friend; by experiencing repeated or extreme exposure to aversive details of the event (eg, first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This is not true of exposure through electronic media, television, movies or pictures, unless this exposure is work-related.

Given the high rate of comorbid depression with post-traumatic stress disorder (PTSD), the diagnosis of A12.9 Headache attributed to post-traumatic stress disorder should be reserved for patients whose headache is not explained by comorbid depression (ie, cases of headache attributed to PTSD in patients without comorbid depression).