Impairment ratings for posttraumatic headache. Russell C. Packard, MD, FACP, and Lesley P. Ham, MA (Headache, 33:7;359–364).

For the past four years I have had a copy of Packard and Ham's “Impairment Ratings for Posttraumatic Headache” tucked inside the front cover of my copy of the Guides. This article is a useful reminder that a better approach is needed to determine impairment associated with headache. The fourth edition of the Guides provides limited guidance for the rating of impairment related to headache (please see The Guides Newsletter, March/April 1997, 7).

The rating of impairment related to headache is particularly difficult because, generally, there are no objective findings associated with the condition. Packard and Ham note that it is impossible to give an acceptable impairment rating based exclusively on physical findings in the evaluation of painful conditions and...

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