11.2.2 Headache attributed to retropharyngeal tendonitis

Description:

Headache caused by inflammation or calcification in the retropharyngeal soft tissues, usually brought on by stretching or compression of upper cervical prevertebral muscles.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Retropharyngeal tendonitis has been demonstrated by imaging evidence of abnormal swelling of prevertebral soft tissues at upper cervical spine levels
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the onset of the retropharyngeal tendonitis, or led to its discovery
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with progression of the retropharyngeal tendonitis
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the retropharyngeal tendonitis
    3. headache is made significantly worse by extension of the neck, rotation of the head and/or swallowing1
    4. there is tenderness over the spinous processes of the upper three cervical vertebrae2
  4. Not better accounted for by another ICHD-3 diagnosis3.
Notes:
  1. Although retroflexion of the neck most consistently aggravates pain, the same usually occurs also with rotation of the head and swallowing.
  2. Tissues over the transverse processes of the upper three vertebrae are usually tender to palpation.
  3. Upper carotid artery dissection (or another lesion in or around the carotid artery) should be ruled out before the diagnosis of 11.2.2 Headache attributed to retropharyngeal tendonitis is confirmed.
Comments:

Body temperature and erythrocyte sedimentation rate (ESR) are usually elevated in retropharyngeal tendonitis.

Calcification in prevertebral tissues is best seen on CT or MRI, but plain films of the neck can also reveal this. In several cases, amorphous calcific material has been aspirated from the swollen prevertebral tissues.