Chronic secondary headache or orofacial pain

Definition

Chronic secondary headache and orofacial pain comprises all headache and orofacial pain disorders that have underlying causes and occur on at least 50% of the days during at least three months. The duration of pain per day is at least 2 hours. If the etiology is vague, consider using codes in the section of chronic primary pain. For most purposes, patients receive a diagnosis according to the underlying causes, and some secondary headache and orofacial pain disorders present with typical headache and orofacial pain phenotypes. It can be difficult to separate between primary and secondary headache in some cases (e.g., chronic migraine with medication overuse). Each distinct type, subtype, or subform of headache or orofacial pain that the patient has must be separately diagnosed and coded. When a patient receives more than one diagnosis, these should be listed in the order of importance to the patient. To receive a particular chronic secondary headache or orofacial pain diagnosis the patient must, in many cases, experience a minimum number of attacks of (or days with) that headache or orofacial pain. This number is specified in the explicit diagnostic criteria for each headache type or type of orofacial pain. Further, the headache or orofacial pain must fulfill a number of further requirements for each specific subtype. For chronic secondary orofacial pain conditions, some of the disorders may be listed under musculoskeletal diseases or diseases of the digestive system. Diagnostic Criteria: Conditions A to D are fulfilled: A. Headache or orofacial pain for >2 hours on 15 days or more per month for longer than 3 months. B. Another disorder scientifically documented to be able to cause headache or orofacial pain has been diagnosed. C. Evidence of causation demonstrated by at least two of the following: C.1 Headache or orofacial pain has developed in temporal relation to the onset of the presumed causative disorder C.2 One or both of the following is fulfilled: a) Headache or orofacial pain has significantly worsened in parallel with worsening of the presumed causative disorder b) Headache or orofacial pain has significantly improved in parallel with improvement of the presumed causative disorder C.3 Headache or orofacial pain has characteristics typical for the causative disorder C.4 Other evidence exists of causation D. The pain is not better accounted for by another diagnosis.

Coding Note

Exclusions

• Acute pain in the face, not elsewhere classified
• Acute headache, not elsewhere classified

Subcategories (7)