Differential Diagnosis
Potential diagnoses included CTTH, cervicogenic headache (CH), cervical
facet arthropathy and cervical spondylosis. Notably, the patient
presentation did not match the revised diagnostic criteria for
CH63 developed by the Cervicogenic Headache
International Study Group (CHISG)63-65 consisting of
(1) unilaterality of head pain without side shift, starting in the upper
posterior neck or occipital region, eventually spreading to the
oculofrontotemporal area on the symptomatic side, (2) pain triggered by
neck movement and/or sustained awkward positions, (3) reduced range of
motion in the cervical spine66 (i.e., less than or
equal to 32 ° of right or left passive rotation on the Flexion-Rotation
Test),67-69 (4) pain elicited by external pressure
over at least one of the upper cervical joints (C0-3), and (5) moderate
to severe, non-throbbing and non-lancinating pain. Nevertheless, the
diagnosis was guided by the patient’s subjective presentation of
bilateral headache pain, the IHS criteria for CTTH including (1)
headache occurring ≥15 days per month on average for >3
months (2) lasting hours to days and (3) demonstrating at least two of
the following four characteristics: bilateral location, pressing or
tightening (non-pulsating) quality, mild or moderate intensity, not
aggravated by routine physical activity,2 and specific
reproduction of the patient’s headache symptoms with palpation of the
levator scapulae muscle and it’s enthesis.