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Condition/Disorder Synonyms

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  • Cephalagia

  • Headache

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ICD-9-CM Codes

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  • 307.81 Tension headache

  • 339 Other headache syndromes

  • 339.1 Tension type headache

  • 339.2 Post-traumatic headache

  • 339.8 Other specified headache syndromes

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ICD-10-CM Codes

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  • G44.209 Tension-type headache, unspecified, not intractable

  • G44.309 Post-traumatic headache, unspecified, not intractable

  • G44.88 Headache attributed to head and or neck trauma

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Preferred Practice Pattern

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Key Features

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Description

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  • Pain in the head or neck region

  • Dysfunction in the cervical spine

    • Suboccipital

    • C1-C3 vertebral region

  • One of 5 National Institutes of Health (NIH) headache classifications

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Essentials of Diagnosis

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  • International Classification of Headache Disorders-II (ICHD-II) criteria2

    • Secondary headaches are based on etiology

      • May be caused by whiplash injury, intracranial headaches, neck injury, vascular disorders

  • NIH definition for cervicogenic headache

    • Disorder of the cervical spine

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General Considerations

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  • Headaches can be harmless or disabling

  • May be a sign of more severe pathology in head or brain region

  • Sinuses and vision problems can cause headaches

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Demographics

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  • Cervical spine injury can affect any age group

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Clinical Findings

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Signs and Symptoms

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  • Stiff neck

  • Limited mobility

  • One-sided

  • Pain may radiate to arm

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Functional Implications

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  • Difficulty maintaining sitting postures secondary to neck pain

  • Inability to sleep

  • Weakness with upper extremity lifting

  • Inability to drive or work secondary to intolerance for light or sound

  • Difficulty with neck movements (driving) secondary to pain

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Possible Contributing Causes

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  • Forward-head, rounded-shoulders posture due to tight pectoralis, weak periscapular, and deep neck flexor muscles

  • Prolonged position of cervical side-bending toward impaired nerve or prolonged extension

  • Facet hypertrophy

  • Trauma

  • Hydration

  • Nutrition deficiency

  • Muscular tightness

  • Stress

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Differential Diagnosis

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  • Tumor

  • Glaucoma

  • Sinusitis

  • Myofascial pain syndrome

  • Rhomboid/trapezius spams

  • Degenerative disk disease

  • Lyme disease

  • Temporomandibular joint dysfunction

  • Arnold Chiari malformation

  • Migraine headaches

  • Cluster headaches

  • Toxic headaches

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps to visualize the head/brain region in diagnosis

  • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen of cervical spine

  • CT

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Findings and Interpretation

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  • Physical examination cluster to rule in cervical radiculopathy3

    • Spurling's test

    • Rotation limited to ipsilateral side

    • Upper limb nerve tension test

    • Diminished brachioradialis reflex

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Referrals/Admittance

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  • To hospital for imaging

  • To nutritionist for dietary/nutritional counseling, evaluate for nutritional deficiency

  • To optometrist for eye examination

  • To neurologist for imaging

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Impairments

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  • Restricted mobility of the upper-/mid-thoracic spine and subcranial spine

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