11.2.2 Headache attributed to retropharyngeal tendonitis

Identification: A 52-year-old male patient presents with intense pain in the occipital and upper cervical region, associated with difficulty swallowing and neck stiffness. History of Present Illness: The patient reports sudden, continuous, stabbing pain located in the occipital region and nape, radiating to the bilateral temporal region. The pain is aggravated by cervical movement (especially extension) and swallowing. The patient has experienced a low-grade fever (37.8°C) and malaise for 3 days, without meningeal signs. There are no reports of photophobia, phonophobia, or visual aura. Physical/Neurological Examination: Cervical palpation reveals pain on palpation of the anterior neck region, below the mandibular angle. Cervical movement shows painful limitation of extension and rotation. Oropharyngeal examination reveals no signs of infection or visible abscess. Neurological examination shows no motor or sensory deficits. Complementary Exams: Cervical Magnetic Resonance Imaging shows thickening and edema of the retropharyngeal tendon (C1-C2), without abscess or spinal cord compression. Neck Computed Tomography reveals tendinous calcification and retropharyngeal inflammation. Laboratory tests show mild leukocytosis (11,000/mm³) and elevated CRP (18 mg/dL).