"Headaches" Is Not a Diagnosis
One crash, three headaches
In a recent case I reviewed, the records said "headaches" from the first visit to the last. That one word covered three separate diagnoses. They started at different times, came from different places, and need different treatment.
The first began in her neck. After the crash she had pain that traveled from the neck into the head, brought on by looking up. That pattern is a cervicogenic headache. Her first MRI showed a fresh disc tear at C3-C4. The follow-up MRI three years later showed bone spurs and narrowing where the left C4 nerve exits the spine. The same level had progressed, and the headache followed it.
The second was a band-like, squeezing headache across the front of her head, about once a week and lasting up to two days. It began right after the crash and was still occurring more than three years later. That makes it a persistent post-traumatic headache.
The third appeared seven to nine months after the collision. She began seeing zigzag lights, followed by a headache with nausea. She had no migraine history before the crash. This was new migraine with aura.
How this changed the future care plan
Each diagnosis needed its own pathway:
Neck injury at C3-C4 (the source of the cervicogenic headache): diagnostic medial branch block, radiofrequency ablation if it confirms the joints as the pain source, PRP, physiatry and neurosurgery follow-up, and physical therapy and massage for flare-ups
Post-traumatic and migraine headaches: neurology evaluation and a brain MRI, since new visual aura had developed
Chronic pain and headache: cognitive behavioral therapy, a first-line treatment when pain has outlasted the original injury
The Takeaway
A single "headaches" entry tends to lead to a generic care plan. When the types are separated, the plan reflects what the client needs, and each treatment ties back to a specific diagnosis.
If you have a case where the client's headaches have changed since the crash, I'm glad to review the records with you.