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  • Cephalagia
  • 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

  • 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


  • Pain in the head or neck region
  • Dysfunction in the cervical spine
    • Suboccipital
    • C1-C3 vertebral region
  • One of 5 National Institutes of Health (NIH) headache classifications

Essentials of Diagnosis

General Considerations

  • Headaches can be harmless or disabling
  • May be a sign of more severe pathology in head or brain region
  • Sinuses and vision problems can cause headaches


  • Cervical spine injury can affect any age group

Signs and Symptoms

  • Stiff neck
  • Limited mobility
  • One-sided
  • Pain may radiate to arm

Functional Implications

  • Difficulty maintaining sitting postures secondary to neck pain
  • Inability to sleep
  • Weakness with upper extremity lifting
  • Inability to drive or work secondary to intolerance for light or sound
  • Difficulty with neck movements (driving) secondary to pain

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
  • Nutrition deficiency
  • Muscular tightness
  • Stress

Differential Diagnosis


  • MRI helps to visualize the head/brain region in diagnosis
  • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen of cervical spine
  • CT

  • To hospital for imaging
  • To nutritionist for dietary/nutritional counseling, evaluate for nutritional deficiency
  • To optometrist for eye examination
  • To neurologist for imaging

  • Restricted mobility of the upper-/mid-thoracic spine and subcranial spine
  • Hypermobile mid-cervical spine
  • Tight pectoralis major and minor
  • Noted weakness of longus coli and longus capitus
  • Noted weakness of periscapular muscles

  • Rest
  • Hydration
  • Joint manipulation to the thoracic and upper cervical spine
    • Suboccipital release
    • Myofascial release
  • Cervical distraction and traction to relieve nerve compression
  • Cranio-cervical flexion exercises
  • Address ...

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