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TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER.

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Presentation on theme: "TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER."— Presentation transcript:

1 TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER HEADACHE CLUSTER HEADACHE NEUROPATHIC PAIN NEUROPATHIC PAIN DEAFFERENTATION PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN)

2 TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER HEADACHE CLUSTER HEADACHE NEUROPATHIC PAIN NEUROPATHIC PAIN DEAFFERENTATION PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN)

3 Classification of headache disorders, cranial neuralgias and facial pain 1. Migraine 2. Tension-type headache

4 TENSION TYPE HEADACHE - MIGRAINE DIFFERENTIAL DIAGNOSIS: DIFFERENTIAL DIAGNOSIS: PAIN QUALITY PAIN QUALITY LOCATION LOCATION DURATION DURATION AUTONOMIC SYMPTOMS AUTONOMIC SYMPTOMS

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7 1. Migraine 1.1 Migraine without aura 1.2 Migraine with aura

8 1.5 Complications of migraine Chronic migraine Status migrainosus Persistent aura without infarction Migrainous infarction Migraine-triggered seisure

9 1.5 Complications of migraine Chronic migraine Status migrainosus Persistent aura without infarction Migrainous infarction Migraine-triggered seisure

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11 TENSION TYPE HEADACHE TENSION TYPE HEADACHE

12 2. Tension-type headache 2.1 Infrequent episodic tension-type headache associated with pericranial tenderness associated with pericranial tenderness not associated with pericranial tenderness not associated with pericranial tenderness 2.2 Frequent episodic tension-type headache associated with pericranial tenderness associated with pericranial tenderness not associated with pericranial tenderness not associated with pericranial tenderness 2.3 Chronic tension-type headache associated with pericranial tenderness associated with pericranial tenderness not associated with pericranial tenderness not associated with pericranial tenderness 2.4 Probable tension-type headache

13 Before treatment

14 VERTIGINIFIACCHEZZA ABITUDINI VOLUTT. PARAFUNZCLONI CRAMPI MUSC. PARESTESIE PAT. VASC. FAM. TURBE CIRC. PERIF. FREDDO ESTREMITA DOL. SCHIENA MAL. REUM. TURBE MINZ./ALVO FRAGILITA CAPELLI FRAGILITA UNGHIE CHINETOSIACETONEMIAFRIGIDITAVAGINISMOIMPOTENZA EIACULAZIONE PREC. UMORE DEPRESSO COLITIGASTRITI DIFF. DEGLUTIZIONE PROBL. DIGESTIONE ANORESSIABULIMIAANSIAFOBIE DIST. SONNO CRISI DI PANICO PALPITAZIONI SBALZI DI UMORE SVENIMENTI

15 After treatment

16 Classification of headache disorders, cranial neuralgias and facial pain 3. Cluster headache and other trigeminal autonomic cephalalgias 3.1 cluster headache 3.2 chronic paroximal hemicrania Episodic paroximal hemicrania Episodic paroximal hemicrania Chronic paroximal hemicrania Chronic paroximal hemicrania 3.3 Short-lasting unilateral neuralgiform headache attacks 3.3 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) with conjunctival injection and tearing (SUNCT) 4.4 Probable trigeminal autonomic cephalalgia 4.4 Probable trigeminal autonomic cephalalgia Probable cluster headache Probable cluster headache Probableparoximal hemicrania Probable paroximal hemicrania Probable SUNCT Probable SUNCT

17 conjunctival injection lacrimation nasal congestion and/or rhinorrhoea facial sweating miosis and/or ptosis eyelid edema

18 Psych symptoms ParafunctionStress PTSCTSComorbidity worse worse GAD, MP TTH trigger DEP+GAD 9trigger0.1DEP+GAD 7+worse1.82.5Prev. DEP +M DEP+GAD

19 DIFFERENT PATIENT TYPOLOGIES? TYPOLOGIES?

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21 COLITISGASTRITISKINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIABULIMIAANXIETYPHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTINGVERTIGOLASSITUDEPARAFUNCTIONSCLONUSCRAMPSPARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS

22 I.D. Mar XXXXXXXX DRUG INTAKE: Verapamil 120 mg 1x3-4 daily Sumatriptan Nasal Spray or I.M. (X) XXXXXXXX

23 I.D. May X2252XXX222XX2X22XXXX DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X) XXXXXXXXXXXXXXXXXXXXXXX

24 I.D. Jun XXXXXXX DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X) XXXXXX

25 I.D. Aug XXXXX DRUG INTAKE. Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray (X) XXXXX

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27 COLITISGASTRITISKINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIABULIMIAANXIETYPHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTINGVERTIGOLASSITUDEPARAFUNCTIONSCLONUSCRAMPSPARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS FRIGIDITYVAGINISM

28 P.A. Jan 2004 * MM DRUG INTAKE: * Verapamil 120mg 1x2 daily + Sumatriptan mg almost daily

29 P.A. Feb XX223MM 4XX4MMMMM 3MM DRUG INTAKE: Verapamil 120mg 1x3 daily Sumatriptan 100mg or I.M. (X) Ibuprophene mg (X) XXXXXXXXXXXXXXXX

30 P.A. Mar XXXXXX 3XXXX 2XX Sumatriptan mg (X) Ibuprophene mg (X) XXXXXXXX

31 P.A. Apr XX 3XXXX 2X 1X DRUG INTAKE: Sumatriptan mg (X) Ibuprophene mg (X) XXXXX

32 P.A. Jun XX 1X 0 4 DRUG INTAKE: Sumatriptan mg (X) Ibuprophene mg (X) XX

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34 Classification of headache disorders, cranial neuralgias and facial pain 3. Cluster headache and other trigeminal autonomic cephalalgias 3.1 cluster headache 3.2 chronic paroximal hemicrania Episodic paroximal hemicrania Episodic paroximal hemicrania Chronic paroximal hemicrania Chronic paroximal hemicrania 3.3 Short-lasting unilateral neuralgiform headache attacks 3.3 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) with conjunctival injection and tearing (SUNCT) 4.4 Probable trigeminal autonomic cephalalgia 4.4 Probable trigeminal autonomic cephalalgia Probable cluster headache Probable cluster headache Probableparoximal hemicrania Probable paroximal hemicrania Probable SUNCT Probable SUNCT


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