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Condition/Disorder Synonyms

  • Cephalalgia

  • Headache

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 Other headache syndromes

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

Preferred Practice Pattern1

Key Features


  • 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

Essentials of Diagnosis

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

    • Considered a secondary headache

  • NIH: vascular headaches include

    • Migraine

    • Cluster headaches

General Considerations

  • 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.


  • Cluster headaches are more common in men

  • Migraine headaches are more common in women

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • 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

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 towards impaired nerve or prolonged extension

  • Facet hypertrophy

  • Trauma

  • Light

  • Sounds

  • Hydration

  • Nutrition deficiency

  • Vascular insufficiency

  • Muscular tightness

  • Stress

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis


  • 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

Findings and Interpretation

  • 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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