1. Combination medications typically implicated are those containing simple analgesics combined with
8.2.6 Headache attributed to other medication overuse
A. Headache present on >15 days/month fulfilling criteria C and D
B. Regular overuse1 for >3 months of a medication other than those described above
C. Headache has developed or markedly worsened during medication overuse
D. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused
Note:1. The definition of overuse in terms of treatment days per month is likely to vary with the nature of the
8.2.7 Probable medication-overuse headache
A. Headache fulfilling criteria A-C for any one of the subforms 8.2.1 to 8.2.6 above
1. overused medication has not yet been with-drawn
2. medication overuse has ceased within the last 2 months but headache has not so far resolved or
Codable subforms of 8.2.7 Probable medication-overuse headache are 8.2.7.1 Probable ergotamine-overuseheadache, 8.2.7.2 Probable triptan-overuse headache, 8.2.7.3 Probable analgesicoveruse headache, 8.2.7.4
Probable opioid-overuse headache, 8.2.7.5 Probable combination medication-overuse headache and 8.2.7.6
Headache probably attributed to other medication overuse.
Many patients fulfilling the criteria for 8.2.7 Probable medica- tion-overuse headache also fulfil criteria for
either 1.6.5 Probable chronic migraine or 2.4.3 Probable chronic tension-type headache. They should be coded
for both until causation is established after withdrawal of the overused medication. Patients with 1.6.5 Probablechronic migraine should additionally be coded for the antecedent migraine subtype (usually 1.1 Migraine without8.3 Headache as an adverse event attributed to chronic medication
A. Headache present on >15 days/month fulfilling criteria C and D
B. Chronic medication 1 for any therapeutic indication
D. Headache resolves after discontinuation of medication 2
International Classification of Headache Disorders, 2nd Ed.(ICHD-II)
1. The definition of dose and duration will vary with the medication.
2. Time for resolution will vary with the medication but may be months.
Headache can be due to a direct pharmacological effect of medication, such as vasoconstriction pro-ducing
malignant hypertension and headache, or to a secondary effect such as drug-induced intracranial hypertension.
The latter is a recognized complication of long-term use of anabolic steroids, amiodarone, lithium carbonate,
nalidixic acid, thyroid hormone replacement, tetracycline or minocycline. 8.3.1 Exogenous hormone-induced headache
A. Headache or migraine fulfilling criteria C and D
C. Headache or migraine develops or markedly worsens within 3 months of commencing exogenous hor-
D. Headache or migraine resolves or reverts to its previous pattern within 3 months after total disontinuation
Regular use of exogenous hormones, typically for contraception or hormone replacement therapy, can be
associated with increase in frequency or new development of headache or migraine. When a woman also expe-
riences headache or migraine associated with exogenous oestrogen-withdrawal, both codes 8.3.1 Exogenoushormone-induced headache and 8.4.3 Oestrogen-withdrawal headache should be used. 8.4 Headache attributed to substance withdrawal 8.4.1 Caffeine-withdrawal headache
A. Bilateral and/or pulsating headache fulfilling criteria C and D
200 mg/day for >2 weeks, which is interrupted or delayed
C. Headache develops within 24 hours after last caffeine intake and is relieved within 1 hour by 100 mg
D. Headache resolves within 7 days after total caffeine withdrawal
8.4.2 Opioid-withdrawal headache
A. Bilateral and/or pulsating headache fulfilling criteria C and D
B. Opioid intake daily for >3 months, which is interrupted
C. Headache develops within 24 hours after last opioid intake
D. Headache resolves within 7 days after total opioid withdrawal
8.4.3 Oestrogen-withdrawal headache
A. Headache or migraine fulfilling criteria C and D
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1. Combination medications typically implicated are those containing simple analgesics combined with
8.2.6 Headache attributed to other medication overuse
International Classification of Headache Disorders, 2nd Ed.(ICHD-II)
1. The definition of dose and duration will vary with the medication.