tmj disorders myogenous pain referred pain tension type headache migraine cluster headache

TMJ DISORDERSTMJ DISORDERS

MYOGENOUS PAINMYOGENOUS PAIN

REFERRED PAINREFERRED PAIN

TENSION TYPE HEADACHETENSION TYPE HEADACHE

MIGRAINEMIGRAINE

CLUSTER HEADACHECLUSTER HEADACHE

NEUROPATHIC PAINNEUROPATHIC PAIN

DEAFFERENTATION PAINDEAFFERENTATION PAIN

PAIN IN SOMATOFORM DISORDERSPAIN IN SOMATOFORM DISORDERS(ATYPICAL FACIAL PAIN)(ATYPICAL FACIAL PAIN)

TMJ DISORDERSTMJ DISORDERS

MYOGENOUS PAINMYOGENOUS PAIN

REFERRED PAINREFERRED PAIN

MIGRAINEMIGRAINE

CLUSTER HEADACHECLUSTER HEADACHE

NEUROPATHIC PAINNEUROPATHIC PAIN

DEAFFERENTATION PAINDEAFFERENTATION PAIN

PAIN IN SOMATOFORM DISORDERSPAIN IN SOMATOFORM DISORDERS(ATYPICAL FACIAL PAIN)(ATYPICAL FACIAL PAIN)

Classification of headache disorders, Classification of headache disorders, cranial neuralgias and facial paincranial neuralgias and facial pain

11. Migraine. Migraine

2. Tension-type headache2. Tension-type headache

TENSION TYPE HEADACHE - MIGRAINETENSION TYPE HEADACHE - MIGRAINE

DIFFERENTIAL DIAGNOSIS:DIFFERENTIAL DIAGNOSIS:

PAIN QUALITYPAIN QUALITY

LOCATIONLOCATION

DURATIONDURATION

AUTONOMIC SYMPTOMSAUTONOMIC SYMPTOMS

1. Migraine1. Migraine

1.1 Migraine without aura1.1 Migraine without aura

1.2 Migraine with aura1.2 Migraine with aura

1.5 Complications of migraine1.5 Complications of migraine

1.5.1 Chronic migraine1.5.1 Chronic migraine

1.5.2 Status migrainosus 1.5.2 Status migrainosus

1.5.3 Persistent aura without infarction1.5.3 Persistent aura without infarction

1.5.4 Migrainous infarction1.5.4 Migrainous infarction

1.5.5 Migraine-triggered seisure1.5.5 Migraine-triggered seisure

1.5 Complications of migraine1.5 Complications of migraine

1.5.1 Chronic migraine1.5.1 Chronic migraine

1.5.2 Status migrainosus 1.5.2 Status migrainosus

1.5.3 Persistent aura without infarction1.5.3 Persistent aura without infarction

1.5.4 Migrainous infarction1.5.4 Migrainous infarction

1.5.5 Migraine-triggered seisure1.5.5 Migraine-triggered seisure

2. Tension-type headache2. Tension-type headache

2.1 Infrequent episodic tension-type headache2.1 Infrequent episodic tension-type headache 2.1.1 associated with pericranial tenderness2.1.1 associated with pericranial tenderness 2.1.2 not associated with pericranial tenderness2.1.2 not associated with pericranial tenderness

2.2 Frequent episodic tension-type headache2.2 Frequent episodic tension-type headache 2.2.1 associated with pericranial tenderness2.2.1 associated with pericranial tenderness 2.2.2 not associated with pericranial tenderness2.2.2 not associated with pericranial tenderness

2.3 2.3 Chronic tension-type headacheChronic tension-type headache 2.3.1 associated with pericranial tenderness2.3.1 associated with pericranial tenderness 2.3.2 not associated with pericranial tenderness2.3.2 not associated with pericranial tenderness

2.4 Probable tension-type headache2.4 Probable tension-type headache

Before treatmentBefore treatment

VERTIGINIVERTIGINI

FIACCHEZZAFIACCHEZZA

ABITUDINI ABITUDINI VOLUTT.VOLUTT.

PARAFUNZPARAFUNZ

CLONICLONI

CRAMPI MUSC.CRAMPI MUSC.

PARESTESIEPARESTESIE

PAT. VASC. FAM.PAT. VASC. FAM.

TURBE CIRC. TURBE CIRC. PERIF.PERIF.

FREDDO FREDDO ESTREMITA’ESTREMITA’

DOL. SCHIENADOL. SCHIENA

MAL. REUM.MAL. REUM.

TURBE MINZ./ALVOTURBE MINZ./ALVO

FRAGILITA’ FRAGILITA’ CAPELLICAPELLI

FRAGILITA’ FRAGILITA’ UNGHIEUNGHIE

CHINETOSICHINETOSI

ACETONEMIAACETONEMIA

FRIGIDITA’FRIGIDITA’

VAGINISMOVAGINISMO

IMPOTENZAIMPOTENZA

EIACULAZIONE EIACULAZIONE PREC.PREC.

UMORE DEPRESSOUMORE DEPRESSO

COLITICOLITI

GASTRITIGASTRITI

DIFF. DIFF. DEGLUTIZIONEDEGLUTIZIONE

PROBL. DIGESTIONEPROBL. DIGESTIONE

ANORESSIA ANORESSIA

BULIMIABULIMIA

ANSIAANSIA

FOBIEFOBIE

DIST. SONNODIST. SONNO

CRISI DI PANICOCRISI DI PANICO

PALPITAZIONIPALPITAZIONI

SBALZI DI UMORESBALZI DI UMORE

SVENIMENTISVENIMENTI

After treatmentAfter treatment

3. Cluster headache and other trigeminal autonomic 3. Cluster headache and other trigeminal autonomic cephalalgiascephalalgias

3.13.1 cluster headachecluster headache

3.2 chronic paroximal hemicrania3.2 chronic paroximal hemicrania

3.2.1 Episodic paroximal hemicrania3.2.1 Episodic paroximal hemicrania

3.2.2 Chronic paroximal hemicrania3.2.2 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 cephalalgia4.4 Probable trigeminal autonomic cephalalgia

4.4.1 Probable cluster headache4.4.1 Probable cluster headache

4.4.2 Probable4.4.2 Probable paroximal hemicraniaparoximal hemicrania

4.4.3 Probable SUNCT4.4.3 Probable SUNCT

conjunctival injection

lacrimation

nasal congestion and/or rhinorrhoea

facial sweating

miosis and/or ptosis

eyelid edema

Psych symptoms

Parafunction Stress PTS CTS Comorbidity

6 0.2 0.1

8 ++ worse 0.2 0.1

+ worse

9 + 2.1 2.6 GAD, MP

5 + 0.7 2.4 TTH

11 + 0.4 1.75

11 +++ trigger 0.2

14 + 1.6 2.75 DEP+GAD

9 trigger 0.1 DEP+GAD

7 + worse 1.8 2.5 Prev. DEP +M

8 + 2.5 2 DEP+GAD

DIFFERENT PATIENTDIFFERENT PATIENT

TYPOLOGIES?TYPOLOGIES?

COLITISCOLITIS

GASTRITISGASTRITIS

KINETOSISKINETOSIS

SWALLOWING DIFF.SWALLOWING DIFF.

DIGESTIVE PROBL. DIGESTIVE PROBL.

ANOREXIA ANOREXIA

BULIMIABULIMIA

ANXIETYANXIETY

PHOBIASPHOBIAS

SLEEP DISORDERSSLEEP DISORDERS

PALPITATIONPALPITATION

PANIC ATTACKSPANIC ATTACKS

MOOD CHANGESMOOD CHANGES

FAINTINGFAINTING

VERTIGOVERTIGO

LASSITUDELASSITUDE

PARAFUNCTIONSPARAFUNCTIONS

CLONUSCLONUS

CRAMPSCRAMPS

PARESTHESIASPARESTHESIAS

BACK PAINBACK PAIN

URINATION URINATION DISTURBANCESDISTURBANCES

DIARRHEA OR DIARRHEA OR CONSTIPATIONCONSTIPATION

HAIR FRAGILITYHAIR FRAGILITY

NAIL FRAGILITYNAIL FRAGILITY

CIRCULATION CIRCULATION DISORDERSDISORDERS

COLD LIMBSCOLD LIMBS

FREQUENT FREQUENT DEPRESSED MOODSDEPRESSED MOODS

I.D. Mar. 2003

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

5 X X X X X X X X

2 4 3 2 2 2 2 2

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

X X X X X X X X

I.D. May 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

5 X 2 2 5 2 X X X 2 2 2 X X 2 X 2 2 X X X X 3 2

2 3 3 4 1 1 3 3 3 3 2 2 2 1 1 3 3 1 2 2 1 4 1

DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X)

X X X X X X X X X X X X X X X X X X X X X X X

I.D. Jun 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

5 X X X X X X X

1 1 1 1 1 1 1

DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X)

X X X X X X

I.D. Aug 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

3 X X X X X

1 1 1 1 1 1 1

DRUG INTAKE. Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray (X)

X X X X X

COLITISCOLITIS

GASTRITISGASTRITIS

KINETOSISKINETOSIS

SWALLOWING DIFF.SWALLOWING DIFF.

DIGESTIVE PROBL. DIGESTIVE PROBL.

ANOREXIA ANOREXIA

BULIMIABULIMIA

ANXIETYANXIETY

PHOBIASPHOBIAS

SLEEP DISORDERSSLEEP DISORDERS

PALPITATIONPALPITATION

PANIC ATTACKSPANIC ATTACKS

MOOD CHANGESMOOD CHANGES

FAINTINGFAINTING

VERTIGOVERTIGO

LASSITUDELASSITUDE

PARAFUNCTIONSPARAFUNCTIONS

CLONUSCLONUS

CRAMPSCRAMPS

PARESTHESIASPARESTHESIAS

BACK PAINBACK PAIN

URINATION URINATION DISTURBANCESDISTURBANCES

DIARRHEA OR DIARRHEA OR CONSTIPATIONCONSTIPATION

HAIR FRAGILITYHAIR FRAGILITY

NAIL FRAGILITYNAIL FRAGILITY

CIRCULATION CIRCULATION DISORDERSDISORDERS

COLD LIMBSCOLD LIMBS

FREQUENT FREQUENT DEPRESSED MOODSDEPRESSED MOODS

FRIGIDITYFRIGIDITY

VAGINISMVAGINISM

P.A. Jan 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

5 5 5 5 2 2 2 2 2

4 M M 4 4 4 4 2 3 3 2 2 2

15 15 15 15 30 30 30 30 30 30 45 30 30 40 30

DRUG INTAKE: * Verapamil 120mg 1x2 daily + Sumatriptan 50-100mg almost daily

P.A. Feb 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

5 X X 2 2 3 M M

4 X X 4 M M M M M

DRUG INTAKE: Verapamil 120mg 1x3 daily Sumatriptan 100mg or I.M. (X) Ibuprophene 200-400 mg (X)

X X X X X X X X X X X X X X X X

P.A. Mar 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

4 X X X X X X

3 X X X X

8 8 4 16 8 4 4 8 4 16 16 16

Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

X X X X X X X X

P.A. Apr 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

3 X X X X

4 4 16 4 4 4 4 4 4

DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

X X X X X

P.A. Jun 2004

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

3. Cluster headache and other trigeminal autonomic 3. Cluster headache and other trigeminal autonomic cephalalgiascephalalgias

3.1 cluster headache3.1 cluster headache