Abstract Details

Title Expert Consensus on the Benefits and Limitations of the Diagnostic Criteria for Post-Traumatic Headache as Defined by the International Classification of Headache Disorders-3rd Edition: A Qualitative Study

Topic Headache

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 15-003

Objective To obtain expert opinion regarding the utility of the diagnostic criteria for post-traumatic headache outlined in the International Classification of Headache Disorders-3^rd Edition.

Background An accurate, consistent definition for post-traumatic headache is essential to guarantee that accumulating data can be meaningfully interpreted and used for advancements in its diagnosis and treatment. The International Classification of Headache Disorders-3rd Edition criteria for post-traumatic headache are the best definition presently, and while there are definite benefits, significant limitations in the current criteria also exist.

Design/Methods We comprised a set of qualitative semi-structured interviews, with a sample of 43 Veteran’s Affairs-based providers and 13 community-based providers specializing in headache management from 24 sites across 18 US states. We queried all providers on the benefits and limitations of the ICHD-3 criteria for PTH and conducted case comparisons using matrix analyses on coded transcripts.

Results Four common themes emerged among providers regarding the benefit of the current ICHD-3 criteria: (1) it’s beneficial from a research perspective, (2) improves diagnostic accuracy, (3) legitimizes the disorder, and (4) is important for reimbursement. Six themes arose regarding the limitations of the ICHD-3 criteria: (1) the time frame outlined is too restrictive, (2) PTH phenotypes are not incorporated, (3) the criteria are minimally useful clinically, (4) other traumatic brain injury co-morbidities are important factors not addressed, (5) diagnosing PTH as outlined by the criteria limits therapies providers can offer patients, and (6) the mechanism of injury of the cardinal TBI is an important factor not accounted for.

Conclusions Experts agree that there is value in the current ICHD-3 definition of PTH but also a significant need to update it. Headache phenotype, mechanism of TBI, and comorbid TBI symptoms need to be incorporated into the new ICHD-3 definition, in order to better characterize the disorder. Additionally, consideration should be made to expanding the time frame.

Authors/Disclosures
Emily Lane L. Schlitz Fortenberry, MD (University of Alabama At Birmingham) PRESENTER	Dr. Schlitz Fortenberry has nothing to disclose.
Jason J. Sico, MD, FAAN	Dr. Sico has nothing to disclose.

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