Author: Josh Worley, DO
Co Author #1: Joshua Rhead Worley, DO
Co Author #2: David Liddle, MD
Senior Editor: Drew Duerson, MD
Editor: Suraj Achar, MD

Patient Presentation:
A 16-year-old male high school sophomore presented to a sports medicine clinic in November 2024 with recurrent headaches, head pressure, sleep disturbances, and nausea. He participated in both wrestling and football. His medical history was otherwise unremarkable, with no prior surgeries, medications, hospitalizations, or known drug allergies.

History:
In January 2024, the patient sustained a sport-related concussion during a high school wrestling match after being thrown and landing head-first on the mat. No loss of consciousness was reported. He was evaluated by his athletic trainer, received appropriate treatment, and was fully asymptomatic by February 2024, at which point he was cleared to return to normal activity.

He subsequently completed the 2024 football season without reported head injury or
recurrent symptoms.

In November 2024, he returned with headaches, head pressure, nausea, and sleep disturbances similar to those experienced following his prior concussion. He was referred for speech-language pathology evaluation, physical therapy for cervical rehabilitation, and vestibular therapy. He completed these therapies in December 2024 and reported symptomatic improvement.

In February 2025, he returned with recurrence of symptoms during wrestling practice. He denied any new head trauma. The recurrence of symptoms without a new mechanism of injury prompted reconsideration of the diagnosis and further evaluation.

Physical Exam:
Physical examinations were performed at three separate clinic visits.

At the initial November 2024 visit, the patient was alert and oriented with appropriate affect. Spurling testing was negative bilaterally. Tenderness was present in the paraspinal musculature at the base of the skull. Cervical range of motion was restricted in both rotation and lateral bending.

At follow-up in December 2024, the patient demonstrated normal affect and appeared more settled compared to his initial visit. Neurologic examination remained normal, and cervical examination findings were otherwise unchanged.

At the February 2025 follow-up, the patient remained alert and oriented. Examination demonstrated focal tenderness over the C2-C3 spinous processes with associated right-sided paraspinal tenderness. Restricted cervical motion persisted.

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