Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 202 [3]

ICD Coding

• ICD-9-CM Codes: 307.81
• ICD-10-AM Codes: G44.2

Brief description

A tension-type headache is a headache that is mild to moderate in intensity, bilateral, non-throbbing, and without other associated features.  Infrequent, episodic tension-type headache occurs in almost the entire population and is not a disease. Tension-type headaches only warrant designation as a disease if they have an underlying basis, are of sufficient frequency and severity, and cause significant distress or impairment, warranting medical management.

Confirming the diagnosis

For the diagnosis to be made the criteria in the SOP definition concerning: frequency and duration; clinical features; and level of distress or impairment must be met.  Additionally, if the headaches are isolated episodes triggered by physiological stress (e.g. eye strain from too much close work, dehydration, acute psychological stress, fatigue) or extraneous agents (e.g. alcohol, odours/scents, food) then they are excluded and do not count towards meeting the diagnostic criteria.  Evidence of an underlying headache disorder (and not just episodic headaches with identifiable acute triggers) should be available in order for the diagnosis to be confirmed. Specialist opinion will generally not be required.

The relevant medical specialist is a neurologist.

Additional diagnoses covered by SOP

• Muscle contraction headaches
• Stress headaches
• "Post-traumatic headache" (see comments)

Conditions not covered by SOP

• Cluster headache*
• Migraine*
• Headaches due to acute physiological or extraneous triggers – not a disease or injury
• Headaches due to a structural abnormality (ascribe to abnormality)
• Headaches due to an inflammatory disorder of the head or neck (ascribe to disorder)
• Headaches due to systemic disease (ascribe to systemic disease)

* another SOP applies

Comments

Tension-type headaches that are claimed to have commenced or worsened in association with head or neck trauma come under the tension-type headache SOP.  A factor for concussion or moderate to severe head injury has been added to the current RH SOP. 

A diagnosis of "post-traumatic headaches" should not be made.

The RMA has formally investigated whether head or neck trauma is a cause of headache. They have not issued separate SOPs for "post-traumatic headache".  They have concluded that head trauma is not a cause of migraine but is a cause of cluster headache and tension-type headache at the RH standard of proof.

Any claims for "post-traumatic headaches" should be determined using the tension-type headache, migraine or cluster headache SOP, depending on the clinical presentation. The exception is if the headaches are due to a demonstrable structural abnormality (eg. subdural haematoma), in which case that abnormality should be diagnosed.

Clinical onset

Episodic tension-type headaches are likely to have been occurring since childhood.  A change to the pattern of headaches relating to frequency, occurrence without acute triggers, or onset of some underlying cause, may indicate a clinical onset of tension-type headaches as a disease.

Clinical worsening

Clinical worsening would generally be evidenced by a sustained increase in the frequency or severity of headaches.