M10.05.02 Common Complaints of the Head and Neck

Understanding common complaints of the head and neck is crucial for medical students as these areas are often the site of numerous pathologies. This section covers typical complaints, their underlying causes, and associated clinical findings, providing a foundational knowledge for effective diagnosis and management.

Headache

• Types:
  • Tension Headache: Characterized by a dull, aching pain, often described as a tight band around the head.
  • Migraine: Typically presents as a unilateral, throbbing pain, often accompanied by nausea, vomiting, and photophobia.
  • Cluster Headache: Severe, unilateral pain usually around the eye, often occurring in cyclical patterns.

Facial Pain

• Causes:
  • Sinusitis: Inflammation of the sinuses causing pain and pressure in the forehead, cheeks, and eyes.
  • Temporomandibular Joint Disorder (TMJ): Pain in the jaw, temple, or ear, often related to jaw movement.
  • Trigeminal Neuralgia: Sudden, severe facial pain, typically on one side, triggered by touch or movement.

Sore Throat

• Causes:
  • Viral Pharyngitis: Most common, accompanied by cough, runny nose, and hoarseness.
  • Bacterial Pharyngitis: Often caused by Streptococcus pyogenes, presenting with fever, tonsillar exudates, and swollen lymph nodes.
  • Mononucleosis: Caused by the Epstein-Barr virus, characterized by severe sore throat, fever, and swollen lymph nodes.

Neck Pain

• Causes:
  • Cervical Strain: Muscle strain due to poor posture, overuse, or injury.
  • Cervical Spondylosis: Degenerative changes in the cervical spine causing chronic neck pain and stiffness.
  • Thyroiditis: Inflammation of the thyroid gland, presenting with neck pain, swelling, and dysphagia.

Swollen Lymph Nodes

• Causes:
  • Infection: Localized infections (e.g., pharyngitis, dental abscess) or systemic infections (e.g., infectious mononucleosis).
  • Malignancy: Lymphoma, leukemia, or metastatic cancer.
  • Autoimmune Diseases: Conditions such as lupus or rheumatoid arthritis.

Hoarseness

• Causes:
  • Laryngitis: Inflammation of the vocal cords due to infection, overuse, or irritation.
  • Vocal Cord Nodules or Polyps: Benign growths on the vocal cords causing voice changes.
  • Thyroid Disorders: Enlargement or malignancy of the thyroid gland affecting vocal cord function.

Key Points to Remember

• Comprehensive History: Always obtain a detailed history of the complaint, including onset, duration, associated symptoms, and aggravating/relieving factors.
• Systematic Examination: Perform a thorough physical examination, including inspection, palpation, and auscultation of the head and neck.
• Differential Diagnosis: Consider a broad differential diagnosis based on the presenting complaint and associated clinical findings.
• Referral and Investigation: Identify when to refer patients for further investigation or specialist evaluation.

Related Abnormal Conditions

1. Sinusitis
2. Migraine
3. Trigeminal Neuralgia
4. Bacterial Pharyngitis
5. Mononucleosis
6. Cervical Spondylosis
7. Thyroiditis
8. Lymphoma
9. Vocal Cord Nodules
10. Laryngitis

Bibliography

1. Harrison, T. R., & Jameson, J. L. (2018). Harrison’s Principles of Internal Medicine. McGraw-Hill Education.
2. Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s Guide to Physical Examination. Elsevier.
3. Lalwani, A. K. (2020). Current Diagnosis & Treatment Otolaryngology–Head and Neck Surgery. McGraw-Hill Education.
4. Swartz, M. H. (2019). Textbook of Physical Diagnosis: History and Examination. Elsevier.