Tension Headaches and TMJ

Question 1

what is the differential diagnosis of primary headaches

Answer 1

tension headaches (most common)
migraine
medication overuse
cluster headache/trigeminal cephalgias

Question 2

worst headache of their life

Answer 2

Subarachnoid Hemorrhage= emergency

secondary headache

Question 3

headache + new focal neurologic weakness

Answer 3

stroke (emergency)

secondary headache

Question 4

onset of headache at greater than 50 years old

Answer 4

neoplasm, temporal arteritis

secondary headache

Question 5

headache + associated systemic symptoms

Answer 5

meningitis, encephalitis (emergency)

secondary headache

Question 6

headache + acute eye pain

Answer 6

acute angle glaucoma (emergency)

secondary headache

Question 7

high blood pressure + headache

Answer 7

hypertensice urgenct/emergency or preeclampsia

secondary headache

Question 8

the most difficult diagnosis to figure out is the _ diagnosis

Answer 8

secondary

chief complaints come from multiple etiologies and require multiple treatments (lifestyle modifications are one of them)

Question 9

what is the pain pattern of tension type headaches

Answer 9

bilateral tight/achy pain/band like

radiates from occipital/cervical region

Question 10

what are the subcategories of tension headaches

Answer 10

infrequent < 1 day a month
frequency 1-15 days a month
chronic > 15 days a month

Question 11

associated symptoms with tension headaches

Answer 11

usually none

Question 12

most cases of tension headaches originate from?

Answer 12

the cervogenic trigeminal nerve complex

Question 13

most common causes of tension headaches (3)

Answer 13

myofascial pain referral
cervical facet referral
TMJ dysfunction

Question 14

what is myofascial pain refferal

Answer 14

this can be influence from cervical, cranial , or trigger point dysfunction that cause tension headaches

Question 15

what is a trigger point

Answer 15

this is a dyfunctional muscle that is mapped out and has a focal/discretevery sensitive predictable location with predictable referral patterns

Question 16

trigger points are usually causes by?

Answer 16

traum, chronic pain/strain, overuse and sedentary lifestyles

Question 17

what are the associated symptoms of trigger points

Answer 17

a taut band of muscle that has a palpable nodule/knot; upon palpation there is reproduction of pain and a. twitch response (muscle spasm)

Question 18

what is the difference between trigger point and a tender point

Answer 18

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

Question 19

what is the treatment of myofasical pain referral

Answer 19

conservative therapy first: manual manipulation with ischemic compression (ST)
- physical therapy
- spray and stretch
- dry needling

injections into trigger point, medication

Question 20

where is the cervical fact joints located

Answer 20

they are posterior lateral between cervical vertebra

Question 21

how does cervical facet referal cause tension headaches

Answer 21

the joint capsule will result in facet pain that refers up to the head

(its a referral pattern)

Question 22

what causes cervical facet referral

Answer 22

degeneration/arthritis, overuse/poor posture

Question 23

associated symptoms of cervical facet referral pain

Answer 23

palpation of facet joint is paiful or gives a headache

protective muscle spasms that results in a painful loss in ROM

Question 24

how do we treat cervical facet referral pain?

Answer 24

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)

Question 25

what is the normal physiology of the TMJ

Answer 25

the mouth opens at the condylar hinges and the disc should slide foward with anterior glide

the muscles will control the jaw position

Question 26

what are some pathologies associated with the tmj giving TMJD

Answer 26

trauma (joint degeneration)
disc displacement
improper loading of innervated structures (muscle overuse)

Question 27

tension headache due to TMJD is primarily due to?

Answer 27

internal : malocculsion and bruxism (grinding teeth)
external: trauma
joint displacement/disc dislocation ( opening mouth a lot)
reffered cervical and cranial muscle pain

Question 28

what are the types of pain associated with TMJD

Answer 28

myofascial pain from gaurding
joint capsule pain from dislocation ( reducing vs non-reducing)

Question 29

associated symptoms of TMJD

Answer 29

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

Question 30

what are the treatments for TMJD

Answer 30

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

Question 31

_ is contraindicated in TMJD

Answer 31

SURGERY