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Condition/Disorder Synonyms

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  • Cephalalgia

  • Headache

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ICD-9-CM Codes

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  • 307.81 Tension headache

  • 339 Other headache syndromes

  • 339.0 Cluster headaches and other trigeminal autonomic cephalgias

  • 339.1 Tension type headache

  • 339.2 Post-traumatic headache

  • 339.3 Drug-induced headache, not elsewhere classified

  • 339.4 Complicated headache syndromes

  • 339.8 Other specified headache syndromes

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ICD-10-CM Codes

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  • G43 Migraine

  • G44 Other headache syndromes

  • G44.009 Cluster headache syndrome, unspecified, not intractable

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Preferred Practice Pattern1

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Key Features

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Description

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  • Pain in the head or neck region

  • Severe episodes of intense pain

  • Hypersensitivity to light and sound

  • Many triggers

  • National Institute of Health (NIH): vascular headache is 1 of 4 classifications of headaches2

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Essentials of Diagnosis

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  • ICDH-II (International Classification of Headache Disorders-II)3

    • Considered a secondary headache

  • NIH: vascular headaches include

    • Migraine

    • Cluster headaches

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General Considerations

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  • Headaches can be harmless, disabling, or life-threatening.

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

  • Vision problems and sinuses can cause headaches.

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Demographics

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  • Cluster headaches are more common in men

  • Migraine headaches are more common in women

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Clinical Findings

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Signs and Symptoms

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  • Differential features of headaches in children

  • Migraine

    • Pulsating pain

    • Nausea

    • Sensitivity to light

    • Sensitivity to sound

    • One or both sides of the head

    • Aggravated with routine activity

  • Cluster headaches

    • Severe headaches

    • Short lasting

    • Symptoms around the eye

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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 (UE) lifting

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

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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 towards impaired nerve or prolonged extension

  • Facet hypertrophy

  • Trauma

  • Light

  • Sounds

  • Hydration

  • Nutrition deficiency

  • Vascular insufficiency

  • 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

  • Toxic headaches

  • Muscular tension/myogenic headache

  • Cervicogenic headache

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Means of Confirmation or Diagnosis

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Imaging

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

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

  • Doppler blood flow test

  • CT

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Findings and Interpretation

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  • Physical exam cluster to rule in cervical radiculopathy4

    • Spurlings test

    • Rotation limited to ipsilateral side

    • Upper limb nerve tension test

    • Diminished brachioradialis reflex

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