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  • Cephalgia

  • Headache

  • Tension headache


  • 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 108-1

Algorithm for headache. CNS, central nervous system; GCA, giant cell arteritis; TMJ, temporomandibular joint. (From Henderson MC, Tierney LM, Smetana GW. The Patient History: An Evidence-Based Approach to Differential Diagnosis. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)


  • 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


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

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders


A 17-year-old female is studying long nights for college entrance examinations. She is not involved in any other activities presently, but rather spends all of her spare time on the computer reading or studying. After about 2 hours of studying she notices a tight feeling at the base of her skull and a dull headache pain. Over the next 30 to 45 minutes the pain intensifies and she has to lie down to get any relief. The frequency of these headaches has increased over the past 2 months making it increasingly more difficult to study for her examinations. This is causing her a great deal of anxiety. During the interview with this client, the physical therapist notes that she has a forward head and rounded shoulders.



  • Pain in the head or neck region

  • Muscular in origin

  • Squeezing feeling in the head

  • Referred pattern depending on Travell trigger points

  • International Classification of Headache Disorders-2 (ICDH-2), 2004

    • 13 headache groups

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

    • Muscular tension/myogenic headache

Essentials of Diagnosis

  • ICDH-2

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

  • NIH

    • Muscular tension/myogenic headache

    • Tension headache

General Considerations

  • 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.

TABLE 108-1Classification of TTH and Migraine

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