Cephalgia secondary to neuroma in a patient with ankylosing spondylitis: a case report.

A case is presented in which a 26-year-old male with intermittent headaches of many years duration, presents to the Arlington chiropractic Clinic for evaluation and therapy. Routine palpation of the painful area reveals a small mass in the region of the greater occipital nerve. Microscopic examination of the tumor after surgical removal suggests neuroma formation. Headaches did not recur. This patient also experienced exacerbations and remissions of vague low back pain with no radiation. A sacroiliitis was both clinically and radiographically evident. These findings, a positive HLA B27 and the consistent symptom complex allowed a diagnosis of ankylosing spondylitis to be ascertained. It is concluded that palpation of the painful area is a vital portion of the physical examination and must be included in all evaluations. This case also demonstrates that the diagnosis of one problem does not preclude the presence of others. When one condition is diagnosed and therapy is instituted, diagnostic suspicion must not be relaxed.