The Guides addresses impairment evaluation of headaches in section 15.9 of the chapter on pain (4th ed., 311). Rating impairment related to various chronic painful conditions including headaches is challenging. Primary headache disorders must be differentiated from secondary headache disorders. More than 90% of headaches requiring medical attention are primary headache disorders such as migraines, tension-type headaches, and, less commonly, cluster headaches. These primary headaches are due to disturbances in the central nervous system. Migraine is a complex, neurophysiologic disorder. There may be overlap in clinical syndromes between migraine and tension-type headaches.

Headaches occur with varying intensities and frequencies. The Guides distinguishes the following three broad headache patterns:

The impairment evaluator classifies headaches using these characteristics. Some headache conditions can acquire the attributes of a chronic pain syndrome as discussed in chapter 15. The Guides emphasizes the need...

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