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  • Cephalalgia
  • Headache

  • 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

  • G43 Migraine
  • G44 Other headache syndromes
  • G44.009 Cluster headache syndrome, unspecified, not intractable


  • 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

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.


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


  • 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

  • Imaging
  • Nutritionist
  • Optometrist for an eye exam
  • Neurologist
    • Imaging

  • Vision
  • Hearing
  • Restricted mobility of the upper/mid-thoracic spine and subcranial spine
  • Hypermobile mid-cervical spine
  • Tight pectoralis major and minor
  • Weakness noted of longus coli and longus capitus
  • Weakness noted of periscapular ...

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