title: The paracondylar process: an unusual and treatable cause of posttraumatic headache.
abstract: METHODS
  Case report and clinical discussion.
  
  
  OBJECTIVE
  To describe a case of persistent posttraumatic headache associated with the presence of a paracondylar process, and the result of surgical resection of this osseous anomaly.
  
  
  BACKGROUND
  The paracondylar process is one of a group of congenital anomalies of the craniovertebral junction. This heterogenic group is classified in the literature based on embryologic origin. In general, the paracondylar process has little or no clinical significance. There are some cases reporting symptoms related to the paracondylar process, especially after head trauma. Few report improvement after surgery.
  
  
  METHODS
  We describe a case of a 21-year-old woman who was seen for severe persistent daily headache and neck pain after minor head- and neck injury. Clinical examination revealed tenderness and an abnormal structure in the right cervico-occipital region by palpation. A conventional radiograph and computed tomography scan of the craniovertebral junction revealed a paracondylar process on the right side of the skull.
  
  
  RESULTS
  After resection of the paracondylar process, headache and cervical pain were substantially reduced.
  
  
  CONCLUSIONS
  This case underlines the possible clinical significance of congenital anomalies of the craniovertebral junction. They can become symptomatic after head trauma, causing headache and/or cervical pain. Surgical extirpation can relieve these symptoms.
authors.affiliation: Department of Neurology, Hagaziekenhuis Leyenburg, Den Haag, the Netherlands. ndegraauw@hotmail.com
authors.forename: Nienke
authors.initials: N
authors.lastname: de Graauw
authors.forename: Hans A
authors.initials: HA
authors.lastname: Carpay
authors.forename: Willem-Bart M
authors.initials: WB
authors.lastname: Slooff
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008446:Maxillofacial Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D019838:Neck Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D009777:Occipital Bone / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D010027:Osteotomy; D051298:Post-Traumatic Headache / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018781:Tension-Type Headache / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome