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Background According to the new ICHD 3 diagnostic criteria a de novo headache occurring with another disorder recognized to be capable of causing it is always diagnosed as secondary. For example, when a new headache occurs for the first time in close temporal relation to trauma or injury to the head and/or neck, it is coded as a “secondary headache attributed to the trauma or injury”. However, it may be possible, that this headache phenomenologically appears to be a primary headache. But, when a pre-existing headache with the characteristics of a primary headache disorder becomes chronic or is made significantly worse in close temporal relation to such trauma or injury, both the initial (primary) headache diagnosis and a diagnosis of “Headache attributed to trauma or injury to the head and/or neck (or one of its types or subtypes)” should be given. In other words, since headache is very prevalent, it can occur simultaneously with another disorder with and without a causal relation. Primary or secondary headache or both – clinically/scientifically spoken a dead end? These entities are a challenging diagnostic problem as can be primary or secondary and the etiologies for secondary cases differ depending on the headache type. Secondary headache can be definitely diagnosed only when solid evidence exists from published scientific studies that the disorder is capable of causing headache. Scientific evidence can come from large clinical studies observing close temporal relationships between the disorder and headache outcomes after treatment of the

12th European Headache Federation Congress jointly with 32nd National Congress of the Italian Society for the Study of Headaches