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106: HEADACHES

Eric Shamus, PhD, DPT, PT, CSCS; Jennifer Shamus, PhD, DPT, COMT, CSCS

CONDITION/DISORDER SYNONYMS

  • Cephalgia

  • Vascular headache

  • Muscular tension/myogenic headache

  • Cervicogenic headache

  • Traction/inflammatory headaches

FIGURE 106-1

Diagnostic approach: headache. DJD, degenerative joint disease; LP, lumbar puncture; SAH, subarachnoid hemorrhage. (From Stern SDC, Cifu AS, Altkorn D. Symptom to Diagnosis: An Evidence-Based Guide. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 106-2

Management of complaints of headache. (From Stone CK, Humphries RL. Current Diagnosis & Treatment: Emergency Medicine. 7th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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ICD-9-CM CODES

  • 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

ICD-10-CM CODES

  • G43 Migraine

  • G44 Cluster headache and other trigeminal autonomic cephalgias

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

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

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

  • G44.41 Drug-induced headache, not elsewhere classified, intractable

  • G44.51 Hemicrania continua

  • G44.80 Other primary headaches

  • G44.81 Hypnic headache

  • G44.82 Headache associated with sexual activity

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

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

PATIENT PRESENTATION

A 17-year-old female is complaining of headaches. She states she is not sure why she gets headaches. She has gone to the doctor for a workup and is scheduled for a brain CT examination. She reports to physical therapy because she has headaches that are interfering with her functional activities. She started taking a log of her headaches and has not noted any pattern with food or with her menstrual cycle.

KEY FEATURES
Description

  • Pain in the head or neck region

  • International Classification of Headache Disorders-II (ICDH-II), 2004

    • 13 headache classification groups

  • National Institute of Health (NIH) has five classifications of headaches

    • Vascular headache

    • Muscular tension/myogenic headache

    • Cervicogenic headache

    • Traction headaches

    • Inflammatory headaches

Essentials of Diagnosis

  • ICDH-II classifications

    • First four are primary headaches: Migraines, tension headaches, cluster headaches, trigeminal headaches

  • Headaches caused by cough, exertion, sexual activity, and stabbing are primary headaches

  • Groups 5 through 12 are secondary headaches, based upon their etiology: Whiplash injury, intracranial headaches, neck injury, vascular disorders

  • NIH: Vascular headache

    • Migraine2

    • Cluster headaches2

  • NIH: Muscular tension/myogenic headache

    • Tension headache

  • NIH: Cervicogenic headache

    • Disorder of the cervical spine

  • NIH: Traction headaches

    • Can be caused by stroke

  • NIH: Inflammatory headaches

    • Can be caused by sinus infection with inflammation

    • Increased intracranial pressure

FIGURE 106-3
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