Tension Headaches and TMJ Flashcards
what is the differential diagnosis of primary headaches
tension headaches (most common)
migraine
medication overuse
cluster headache/trigeminal cephalgias
worst headache of their life
Subarachnoid Hemorrhage= emergency
secondary headache
headache + new focal neurologic weakness
stroke (emergency)
secondary headache
onset of headache at greater than 50 years old
neoplasm, temporal arteritis
secondary headache
headache + associated systemic symptoms
meningitis, encephalitis (emergency)
secondary headache
headache + acute eye pain
acute angle glaucoma (emergency)
secondary headache
high blood pressure + headache
hypertensice urgenct/emergency or preeclampsia
secondary headache
the most difficult diagnosis to figure out is the _ diagnosis
secondary
chief complaints come from multiple etiologies and require multiple treatments (lifestyle modifications are one of them)
what is the pain pattern of tension type headaches
bilateral tight/achy pain/band like
radiates from occipital/cervical region
what are the subcategories of tension headaches
infrequent < 1 day a month
frequency 1-15 days a month
chronic > 15 days a month
associated symptoms with tension headaches
usually none
most cases of tension headaches originate from?
the cervogenic trigeminal nerve complex
most common causes of tension headaches (3)
myofascial pain referral
cervical facet referral
TMJ dysfunction
what is myofascial pain refferal
this can be influence from cervical, cranial , or trigger point dysfunction that cause tension headaches
what is a trigger point
this is a dyfunctional muscle that is mapped out and has a focal/discretevery sensitive predictable location with predictable referral patterns
trigger points are usually causes by?
traum, chronic pain/strain, overuse and sedentary lifestyles
what are the associated symptoms of trigger points
a taut band of muscle that has a palpable nodule/knot; upon palpation there is reproduction of pain and a. twitch response (muscle spasm)
what is the difference between trigger point and a tender point
trigger points have a characteristic pain pattern, located only in the muscle, radiating pain, in a tuat band of tissue, and has a twitch response with palpation
tenderpoints- no characteristic pain patter, located in tendons, ligaments, fasica, and muscle. no radiating pattern and no taut band/twitch respone
totally different
what is the treatment of myofasical pain referral
conservative therapy first: manual manipulation with ischemic compression (ST)
- physical therapy
- spray and stretch
- dry needling
injections into trigger point, medication
where is the cervical fact joints located
they are posterior lateral between cervical vertebra
how does cervical facet referal cause tension headaches
the joint capsule will result in facet pain that refers up to the head
(its a referral pattern)
what causes cervical facet referral
degeneration/arthritis, overuse/poor posture
associated symptoms of cervical facet referral pain
palpation of facet joint is paiful or gives a headache
protective muscle spasms that results in a painful loss in ROM
how do we treat cervical facet referral pain?
Conservative treatment first: RICE, manual medicine (OMM), physical therapy
meds, injections guided by fluoroscopy or radiofrequency ablation to burn out nerve innervation of facet (this is for more chronic cases)
what is the normal physiology of the TMJ
the mouth opens at the condylar hinges and the disc should slide foward with anterior glide
the muscles will control the jaw position
what are some pathologies associated with the tmj giving TMJD
trauma (joint degeneration)
disc displacement
improper loading of innervated structures (muscle overuse)
tension headache due to TMJD is primarily due to?
internal : malocculsion and bruxism (grinding teeth)
external: trauma
joint displacement/disc dislocation ( opening mouth a lot)
reffered cervical and cranial muscle pain
what are the types of pain associated with TMJD
myofascial pain from gaurding
joint capsule pain from dislocation ( reducing vs non-reducing)
associated symptoms of TMJD
decreased jaw ROM
creptius of joint (pop when joint displacing/reducing)
pain with chewing, closing/opening mouth
jaw deviation
pain in morning due to grinding teeth at night
what are the treatments for TMJD
TMJD specific- bite splint, stretching, CBT
conservative mannual medicine! (treatments are in the lab)
physical therapy, medications, injections if there is an associated trigger point
_ is contraindicated in TMJD
SURGERY
