What are the other Names for this Condition? (Also known as/Synonyms)

• Ponytail Headache

What is External-Pressure Headache? (Definition/Background Information)

• External-Pressure Headache is a form of primary headache disorder that develops from sustained external pressure on the soft tissues of the head (pericranial soft tissues). The pressure may be in the form of compression or traction (from a pushing or pulling force respectively)
• The headache location, severity, and duration is based on the external force parameters such as its intensity and application time. The affected head region depends on the surface of contact with the external force, but the pain may extend to other regions in the head too
• The condition commonly develops from the use of tight headwear, safety helmets, or certain hairstyles that tug at the hair. Even the use of swimming goggles with tight strap band may result in External-Pressure Headaches. Per definition, there should be no scalp injury or other external trauma observed at the site (in the head)
• Based on the type of pressure application, External-Pressure Headaches are classified into the following subtypes:
  • External-Compression Headache - when the headache develops from a sustained compression force that may be caused by the use of a tight headgear, cap, or hairband
  • External-Traction Headache - when the headache develops from a sustained pulling force (or traction) that may be caused by a tight braid or ponytail
  • Probable External-Pressure Headache - here, the signs and symptoms does not fulfill all the diagnostic criteria outlined for External-Pressure Headache and its other subtypes, as recognized by the International Classification of Headache Disorders (ICHD)
• Individuals of any age group, gender, race, or ethnicity may be at risk for External-Pressure Headache. The condition is common among the general population

The criteria for diagnosis of External-Pressure Headache as outlined by the International Headache Society (IHS) is given below:

For External-Compression Headache:

• At least two episodes of headache fulfilling the criteria below
• Brought on by and occurring within 1 hour during sustained external compression of the forehead or scalp
• Maximal at the site of external compression
• Resolving within 1 hour after external compression is relieved
• Not better accounted for by another ICHD-3 diagnosis

For External-Traction Headache:

• At least two episodes of headache fulfilling the criteria below
• Brought on by and occurring only during sustained external traction on the scalp
• Maximal at the traction site
• Resolving within 1 hour after traction is relieved
• Not better accounted for by another ICHD-3 diagnosis

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)