A12.9 Headache attributed to post-traumatic stress disorder (PTSD)Hartmut Gobel2018-02-06T12:59:56+00:00

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).