Migraines/ cervicogenic/ tension headaches differential diagnosis

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Last updated 6:23 AM on 8/23/26
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9 Terms

1
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Migraines diagnostic criteria

X aura:  

  1. Duration: 4-72 hrs 

  2. At least 2 of following 

  • Unilateral → change sides in / bwt attacks 

  • Pulsating quality 

  • Moderate to severe intensity 

  • Aggravated by physical activity 

  1. At least one of following

  • Nausea/ vomiting 

  • Photophobia + phonophobia 


w/ aura: 

  1. Aura precedes headache 

  2. Unilateral 

  3. Fully reversible visual/ sensory/ CNS symptoms 


Episodic

Chronic : 15 headaches per month + 7 are true migraines


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Stages of migraine

 

  1. Early warning symptoms 

  2. Aura 

  3. Headache 

  4. Resolution 

  5. Recovery → feel drained after for 24 hrs


3
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MSK impairments associated w/ different types of headache

Pt X MSK impairments + X sensitivity to tests ( pain provoked ) 

→ referred pain from head → symptom of migraine

Pt hv MSK impairments + X sensitivity 

→ local cervical nociceptive referred neck pain 

Pt X MSK impairments + hv sensitivity 

→ referred neck pain + peripheral cervical sensitisation 


Pt hv  MSK impairments + hv sensitivity

→ local cervical nociceptive referred neck pain + peripheral cervical sensitisation



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Diagnositc criteria for tension type headache

Episodic: 

  1. Duration: 30 mins - 7 days 

  2. At least 2 of following 

  • Pressing/ tightening/ X pulsing 

  • Bilateral + bandlike 

  • Mild to moderate intensity → will hinder but X stop activity 

  • X aggravated by physical activity

  1. Both: X nausea/ vomiting/ can have either photo or phonophobia


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Cervicogenic headache diagnostic criteria

Pt interview: 

  1. Unilateral dominant 

  2. X sideshift 

  3. Pain starts in neck 

  4. X pulsing/ throbbing → aches 

  5. Aggravating factors: neck related activities/ postures 

  6. Associated w/ restricted neck motion 

  7. Temporal association w/ neck pain + headache onset ( neck pain is worse → headache worse) 

  8. X other headache type accounts for 



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Pattern of physical impairments for cervicogenic headache


Specific signs: 

Combination: 

  1. Segmental joint dysfunction → feeling of restriction in specific segments + gradual muscle spasm 

  2. Altered muscle behaviour in CCFT 

  3. Restricted RoM 

  4. Painful upper cervical joint dysfunction


X specific signs: 

  1. Tenderness/ trigger points 

  2. RoM


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Potential causes of neck pain in headache

  • Comorbid neck condition 

  • Cervicogenic headache → neck pain referring to the head 

  • Peripheral sensitisation → trigemino-cervical nucleus 

  • Referred pain


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Possible mechanism for headache to cause neck pain

  1. C1-3 → MSK dysfunction 

  2. Referred pain → migraine/ tension type headache

  3. Peripheral sensitisation of trigemino-cervical nucleus 

  4. Vertebral artery 

  5. Dura


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Pain sites for different types of headaches

Neck 

On top of head + occiput 

Tension

Bilateral band 

Migraine 

Unilateral mostly but can be bilateral  

TMJ 

Closer to temporal area/ TMJ 

C0-1 

Subocciput → but can radiate into the orbit