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Condition/Disorder Synonyms

  • Cephalagia

  • Headache

  • Tension headache

  • Myogenic 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

ICD-10-CM Codes

  • 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

Preferred Practice Pattern

Key Features

Description

  • 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

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

Demographics

  • Can be any age group

  • Individuals that are under excess stress

Clinical Findings

Signs and Symptoms

  • Squeezing or tightening on head

  • Mild to moderate pain

  • Okay with routine activity

Functional Implications

  • 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

Possible Contributing Causes

  • 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

Differential Diagnoses

  • 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

Means of Confirmation of Diagnosis

Imaging

  • MRI to visualize the head/brain region

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

  • CT scan

Findings and Interpretation

  • Physical exam cluster to rule in cervical radiculopathy1

    • Spurling's test

    • Rotation limited to ipsilateral side

    • Upper limb neural tension test

    • Diminished brachioradialis reflex

Referrals/Admittance

  • To hospital for imaging of the brain and sinuses

  • To nutritionist for ...

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