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Condition/Disorder Synonyms

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  • Cephalagia

  • Headache

  • Tension headache

  • Myogenic 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

  • G44.81 Hypnic headache

  • G44.82 Headache associated with sexual activity

  • G44.83 Primary cough headache

  • G44.84 Primary exertional headache

  • G44.85 Primary stabbing headache

  • G44.89 Other headache syndrome

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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

  • Muscular in origin

  • Squeezing feeling in the head

  • Referred pattern depending on Travell trigger points

  • Categorized as tension-type headache by the International Classification of Headache Disorders-II (ICDH-II)2

    • Migraines, tension headaches, cluster headaches and trigeminal headaches are classified as the four primary headaches

  • National Institutes of Health (NIH) 1 of 4 classifications of headaches3

    • Muscular contraction (tension) headaches

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General Considerations

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  • Headaches can be harmless or disabling

  • Headaches can be a sign of something more severe in the head/brain region

  • Vision and sinus problems can cause headaches

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Demographics

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  • Can be any age group

  • Individuals that are under excess stress

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Clinical Findings

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Signs and Symptoms

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  • Squeezing or tightening on head

  • Mild to moderate pain

  • Okay with routine activity

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Functional Implications

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  • Difficulty maintaining sustained sitting postures secondary to neck pain

  • Inability to sleep

  • Weakness with upper extremity lifting

  • Inability to drive or work secondary to the inability to tolerate light or sound

  • Difficulty with neck movements secondary to pain; driving

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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

  • Nutritional deficiency

  • Vascular insufficiency

  • Muscular tightness

  • Stress

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Differential Diagnoses

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  • Tumor

  • Glaucoma

  • Sinusitis

  • Myofascial pain syndrome

  • Rhomboid/trapezius spasms

  • Degenerative disk disease

  • Lyme disease

  • Temporomandibular joint dysfunction

  • Arnold Chiari malformation

  • Migraine

  • Cluster headaches

  • Toxic headaches

  • Cervicogenic headache

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Means of Confirmation of Diagnosis

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Imaging

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  • MRI to visualize the head/brain region

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

  • CT scan

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Findings and Interpretation

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  • Physical exam cluster to rule in cervical radiculopathy1

    • Spurling's test

    • Rotation limited to ipsilateral side

    • Upper limb neural tension test

    • Diminished brachioradialis reflex

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Referrals/Admittance

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  • To hospital for imaging of the brain and sinuses

  • To nutritionist for ...

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