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Chronic 24/7 Headache Pain
Patient Description
Male, Age 62, Retired Airplane Mechanic
Medical History
Symptom list presented by the patient during first visit:
1. A constant headache 24/7 Some days the pain is debilitating.
2. Head rush feeling, the feeling one has when one gets up too quickly. Also 24/7 then when I do get up
from a crouch position I often feel I could pass out.
3. Headache behind the eyes, very painful and can stay for weeks. Began in my early 30's.
4. Severe tinnitus. I thought it came from years of working with jet aircraft.
5. Very small mouth, cannot open wide and easily gagged.
6. Atoxic gate with my right knee giving way on occasion.
7. Poor balance and I bump into walls often. The earth is stable and I am the one off balance. I cannot
walk heel to toe or on my toes or heels.
8. Grind teeth daily with the hardest in the evenings.
9. Ears sensitive to touch.
10. Blurred vision.
11. Eyelid muscle spasms very severe. I also have difficulty in opening my eyes once closed.
12. What I call my "stretchy thing" all the muscles in my body feel tight. I stretch but without any relief.
13. Seizure-like tremors in left and right hands.
14. Poor concentration due to pain.
15. Difficulty in finding words, with everyday jargon, and technical terms while working in aircraft
maintenance.
16. Eye pain, tired eyes most of the day.
17. Whole body jumps or shakes for no apparent reason.
18. Very light and wind sensitive eyes. I currently wear frames with a ptosis crutch to keep my eyelids
open.
19. My wife says my body jumps in my sleep, and my feet bend in strange positions, they tend to point up
to my head.
20.1 have always been right handed. I can no longer write with my right hand. One doctor told me to learn to write left-handed. I can print with my left hand but no cursive except for my signature.
He had been previously treated by his medical doctor, a neurosurgeon, neurologist and opthamologist. He was taking multiple medications prescribed by his doctors. He had been forced into early retirement by his debilitating symptoms.
Oral Condition
The patient had a deep bite, overdosed mouth, retrognathic jaw. Every time he put his teeth together his jaw would slide to the right 3 mm. His maximum opening was 30 mm (normal range is 50 - 55 mm), his right lateral excursion was 5 mm, his left lateral excursion was 6 mm (normal range is 12 mm right and left).
Treatment Record
After x-rays, muscle testing and exam, treatment was begun with temporary occlusal guards made of soft, thick rubber. He reported three days later that his headaches were gone, he had slept well 8-10 hours each night, and he had more energy. Three weeks later he was fitted with a Bionator to correct his jaw position.
The patient was seen every 4 weeks to adjust the appliance for the next ten months and he continued to do real well.
Phase II of his treatment was started with upper and lower expanders to expand his narrow arches. These were adjusted every four weeks for six months, then every couple of months.
A Gelb MORA lower orthotic was fabricated to maintain his TMJ in the proper Gelb 4/7 position 24 hours a day. It is much smaller and less obtrusive than the Bionator. Impressions for Elastodontics were made to finish his orthodontic tooth movement.
As treatment progressed, his maximum opening had increased to 40 mm, his right lateral excursion was 9 mm, left 9 mm. The Elastodontics were to be worn at night while wearing the MORA in the daytime.
The patient continues to wear the MORA during the daytime and now uses a Farrar nighttime appliance to control night time clenching and grinding.
Routine maintenance adjustments and occassional replacement of appliances have succeeded in creating a normalized and stable bite that has been essentially symptom free.
Risto E. Hurme, D.D.S.
Craniofacial Pain and TMJ Disorders
1017 Shook Avenue
San Antonio, TX 78212
(210) 826-4441
www.tmjsanantonio.com
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