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Craniofacial Pain

Headaches and Migraines

The term Headache has an extremely broad meaning for most people. It can refer to almost any degree or severity of head pain. Migraine Headaches are not so much a different type of headache but rather a term that describes the intensity of headache pain and several other criteria.

Differential Diagnosis

Truly objective assessments of varying degrees of headache are difficult to establish from individual to individual.... based on the subjective qualities that people attach or feel. In some instances different terms (e.g., Craniofacial Pain) are used to describe the same perception of pain which actually introduces a broader set of symptoms.

Headache Diagnosis - Initial Considerations

Headaches that have an unusual etiology (e.g., arising from neurological and other causes such as tumors, infections and hypertension) while very important, have a very low rate of incidence compared to more common causes of headaches.

Another small group of etiological factors were thought to involve vascular conditions.

The largest population of headache sufferers typically report any number of common symptoms that seem to be universally shared. These symptoms typically include:
  • Headaches (in any part of the head)
  • Face pain
  • Eye pain
  • Ear pain
  • Dizziness
  • Ringing in the ears
  • Pressure or blocked sensation in the ears
  • Blurred vision (which comes and goes)
  • Difficulty swallowing
  • Frequent sore throat or a sensation that something is stuck in the throat
  • Burning tongue

TMJ Diagnosis?

TMJ disorders have been heavily popularized to be a causal factor of headache pain. The term TMJ refers specifically to a joint and is far too general of a term to render substantial diagnostic information, thereby reducing the value of its descriptive qualities.

Many Craniofacial Pain specialists say that TMJ "related" disorders can and must be differentially diagnosed, with highly specialized evaluations to specify diagnoses that might include the following:
  • Myalgia
  • Myofascitis
  • Articular disc disorder (Disc dislocation)
  • Inflammatory arthritis
  • Muscle spasm
  • Hyoid Bone Syndrome
  • Posterior capsulitis
  • Omohyoid Syndrome
  • Temporal tendonitis (short head)
  • Temporal tendonitis (long head)
  • Rheumatoid arthritis
  • Hemarthrosis
  • Stylomandibular Ligament Sprain
  • Reflex sympathetic dystrophy
  • Degenerative arthritis
  • Anterior displacement of TMJ disc without reduction
  • Anterior displacement of TMJ disc with reduction
  • Osteocavitational Necrosis
  • Non-suppurative Osteomyelitis (NICO)
  • Osteochondritis
  • And numberous other conditions

Demographics of the Headache Patient

Severe headaches can afflict just about anyone, irrespective of gender or age... from 5 years old to 90 years old. Causal factors can occur with anyone at anytime. Trauma due to an auto accident or something as simple as falling off a bicycle, falling from roller skates or falling out of a crib or bed can become origins of pain. In many cases pain does not develop until years after the injury.

Craniofacial Pain: Alternative Diagnosis - Treatment Model

Head, neck and facial pain is viewed from a different perspective. Treatments might include physical medicine procedures which are designed to bring about healing of injured and/or dysfunctional structures such as muscles and joints. Examples of procedures include:
- Specific exercises
- Use of electronic devices to gently stimulate healing
- Orthopedic appliances of different types which assist in reducing muscle spasm
- Exercises to facilitate joint mobilization
- Nutritional recommendations

Pain syndromes that don't respond completely to the above treatments may be treated further with the introduction of safe substances to the dysfunctional muscle, tendon, ligament, joint or ganglia.

In rare cases where pain reduces but returns several times there is the possibility of using a procedure that is called Radio Frequency Thermoneurolysis, where available.

Unique Headache?

If you are experiencing headaches that have not responded well to any variety of treatments or medications... it may be a result of insufficient diagnosis. Contact a Craniofacial Pain doctor in your area.

Ira Klemons, DDS, PhD

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