Differential Diagnosis for Neck Pain and Radiating Symptoms

The patient presents with neck pain that started about a month ago, accompanied by intermittent tightness in the neck muscles, radiating behind her ears, and sometimes into the right side of her jaw. The symptoms have progressed to include a feeling of tightness that seems to close her airway, although she denies this symptom at triage and is in no distress. Given these symptoms, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Cervical Muscle Strain or Sprain: This is the most likely diagnosis given the onset of pain during exercise and the nature of the symptoms. The radiating pain and feeling of tightness in the neck muscles are consistent with a strain or sprain of the cervical muscles.
• Other Likely Diagnoses
  • Tension Headache: The description of pain radiating behind the ears and into the jaw is consistent with tension headaches, which often involve the neck muscles and can cause a feeling of tightness or pressure.
  • Cervicogenic Headache: This type of headache is referred from the cervical spine and can cause pain on one side of the head, including the jaw and behind the ear, similar to the patient's symptoms.
  • Temporomandibular Joint (TMJ) Disorder: Given the radiation of pain into the right side of the jaw, TMJ disorder is a possible diagnosis, as it can cause jaw pain and tightness, as well as referred pain to the ear and neck.
• Do Not Miss Diagnoses
  • Cervical Spinal Stenosis: Although less likely, this condition can cause neck pain and radiating symptoms, including a feeling of tightness or pressure. It's crucial to consider this diagnosis due to the potential for serious neurological complications if left untreated.
  • Eagle Syndrome: This condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause sharp, stabbing pain in the side of the throat, ear, and jaw, similar to the patient's symptoms.
  • Acute Coronary Syndrome: While the patient's symptoms do not strongly suggest cardiac involvement, it's essential to consider acute coronary syndrome, especially in a patient of this age group, as chest pain can sometimes be referred to the neck and jaw.
• Rare Diagnoses
  • Multiple Cranial Neuropathies: Conditions affecting multiple cranial nerves could potentially cause the patient's symptoms, although this would be a rare and less likely explanation.
  • Neoplastic Processes: Tumors affecting the cervical spine, skull base, or jaw could cause the patient's symptoms, although these would be rare and typically accompanied by other systemic symptoms or findings on examination.