HEADACHE DUE TO AN EXTRA JOINT BETWEEN HEAD AND NECK

A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, an d the headache became chronic at around 14 years, making regular schoo l attendance impossible. The headache was ''symptom poor,'' bilateral- occipital, but with a clear left-sided preponderance and occasionally spreading to the forehead. The headache was always worst in the mornin g hours, easing up by noontime. Neck rotation to the right could provo ke long-lasting exacerbations. Neck movement was restricted on rotatio n to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to corres pond to a bony ''bridge'' with an extra joint between the first verteb ra on the left side and the skull, medially to the mastoid process tha t could be demonstrated on x-ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain dis appeared on the day of operation and has not recurred in the interveni ng time. Such bony bridges have in the past been considered to be inno cuous and not symptom producing. Although this may be the general rule , the present case tends to show that even to this rule, there are exc eptions.