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107: HEADACHE, CERVICOGENIC

Eric Shamus, PhD, DPT, PT, CSCS; Mollie Venglar, Dsc, MSPT, NCS

CONDITION/DISORDER SYNONYMS

  • Cephalgia

  • Headache

ICD-9-CM CODES

  • 307.81 Tension headache

  • 339 Other headache syndromes

  • 339.1 Tension type headache

  • 339.2 Post-traumatic headache

  • 339.8 Other specified headache syndromes

FIGURE 107-1

Tension-type headache algorithm. (From Esherick JS, Clark DS, Slater ED. Current Practice Guidelines in Primary Care. 2013. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 107-2

Innervation of pain-sensitive intracranial compartments (A) and corresponding extracranial sites of pain radiation (B). The trigeminal (V) nerve, especially its ophthalmic (V1) division, innervates the anterior and middle cranial fossae; lesions in these areas can produce frontal headache. The upper-cervical nerve roots (especially C2) innervate the posterior fossa; lesions here can cause occipital headache. (From Greeenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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ICD-10-CM CODES

  • 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

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 studying long nights for college entrance examinations. She is not involved in any other activities, but rather spends all of her spare time on the computer reading or studying. She reports to physical therapy because she has a headache that won’t subside and she can no longer turn her head fully to the right. It has become painful even to sit at her computer or to sit through class. Now the pain is interfering with her sleep, which is causing even more anxiety about her upcoming examinations. On initial observation when the client arrives, the physical therapist notes that she has a forward head and rounded shoulders. She turns her whole body to look at the physical therapist when speaking. She is having spasms in her upper traps and scalene muscles.

KEY FEATURES

Description

  • Pain in the head or neck region

  • Dysfunction in the cervical spine

    • Suboccipital

    • C1 to C3 vertebral region

  • One of five National Institute of Health (NIH) headache classifications

    • Cervicogenic headache

FIGURE 107-3

Distribution of symptoms and signs in tension headache. (From Greeenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • International classification of headache disorders, 2nd ed. (ICHD-II) criteria

    • Secondary headaches are based on etiology

      • May be caused by ...

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