TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE...

Click here to load reader

download TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER

of 34

  • date post

    26-Mar-2015
  • Category

    Documents

  • view

    214
  • download

    1

Embed Size (px)

Transcript of TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE...

  • Slide 1

TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER HEADACHE CLUSTER HEADACHE NEUROPATHIC PAIN NEUROPATHIC PAIN DEAFFERENTATION PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN) Slide 2 TMJ DISORDERS TMJ DISORDERS MYOGENOUS PAIN MYOGENOUS PAIN REFERRED PAIN REFERRED PAIN TENSION TYPE HEADACHE TENSION TYPE HEADACHE MIGRAINE MIGRAINE CLUSTER HEADACHE CLUSTER HEADACHE NEUROPATHIC PAIN NEUROPATHIC PAIN DEAFFERENTATION PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN) Slide 3 Classification of headache disorders, cranial neuralgias and facial pain 1. Migraine 2. Tension-type headache Slide 4 TENSION TYPE HEADACHE - MIGRAINE DIFFERENTIAL DIAGNOSIS: DIFFERENTIAL DIAGNOSIS: PAIN QUALITY PAIN QUALITY LOCATION LOCATION DURATION DURATION AUTONOMIC SYMPTOMS AUTONOMIC SYMPTOMS Slide 5 Slide 6 Slide 7 1. Migraine 1.1 Migraine without aura 1.2 Migraine with aura Slide 8 1.5 Complications of migraine 1.5.1 Chronic migraine 1.5.2 Status migrainosus 1.5.3 Persistent aura without infarction 1.5.4 Migrainous infarction 1.5.5 Migraine-triggered seisure Slide 9 1.5 Complications of migraine 1.5.1 Chronic migraine 1.5.2 Status migrainosus 1.5.3 Persistent aura without infarction 1.5.4 Migrainous infarction 1.5.5 Migraine-triggered seisure Slide 10 Slide 11 TENSION TYPE HEADACHE TENSION TYPE HEADACHE Slide 12 2. Tension-type headache 2.1 Infrequent episodic tension-type headache 2.1.1 associated with pericranial tenderness 2.1.1 associated with pericranial tenderness 2.1.2 not associated with pericranial tenderness 2.1.2 not associated with pericranial tenderness 2.2 Frequent episodic tension-type headache 2.2.1 associated with pericranial tenderness 2.2.1 associated with pericranial tenderness 2.2.2 not associated with pericranial tenderness 2.2.2 not associated with pericranial tenderness 2.3 Chronic tension-type headache 2.3.1 associated with pericranial tenderness 2.3.1 associated with pericranial tenderness 2.3.2 not associated with pericranial tenderness 2.3.2 not associated with pericranial tenderness 2.4 Probable tension-type headache Slide 13 Before treatment Slide 14 VERTIGINIFIACCHEZZA ABITUDINI VOLUTT. PARAFUNZCLONI CRAMPI MUSC. PARESTESIE PAT. VASC. FAM. TURBE CIRC. PERIF. FREDDO ESTREMITA DOL. SCHIENA MAL. REUM. TURBE MINZ./ALVO FRAGILITA CAPELLI FRAGILITA UNGHIE CHINETOSIACETONEMIAFRIGIDITAVAGINISMOIMPOTENZA EIACULAZIONE PREC. UMORE DEPRESSO COLITIGASTRITI DIFF. DEGLUTIZIONE PROBL. DIGESTIONE ANORESSIABULIMIAANSIAFOBIE DIST. SONNO CRISI DI PANICO PALPITAZIONI SBALZI DI UMORE SVENIMENTI Slide 15 After treatment Slide 16 Classification of headache disorders, cranial neuralgias and facial pain 3. Cluster headache and other trigeminal autonomic cephalalgias 3.1 cluster headache 3.2 chronic paroximal hemicrania 3.2.1 Episodic paroximal hemicrania 3.2.1 Episodic paroximal hemicrania 3.2.2 Chronic paroximal hemicrania 3.2.2 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 cephalalgia 4.4 Probable trigeminal autonomic cephalalgia 4.4.1 Probable cluster headache 4.4.1 Probable cluster headache 4.4.2 Probableparoximal hemicrania 4.4.2 Probable paroximal hemicrania 4.4.3 Probable SUNCT 4.4.3 Probable SUNCT Slide 17 conjunctival injection lacrimation nasal congestion and/or rhinorrhoea facial sweating miosis and/or ptosis eyelid edema Slide 18 Psych symptoms ParafunctionStress PTSCTSComorbidity 60.20.1 8++worse0.20.1 +worse 9+2.12.6GAD, MP 10.6 5+0.72.4TTH 11+0.41.75 11+++trigger0.2 2 14+1.62.75DEP+GAD 9trigger0.1DEP+GAD 7+worse1.82.5Prev. DEP +M 2 8+2.52DEP+GAD Slide 19 DIFFERENT PATIENT TYPOLOGIES? TYPOLOGIES? Slide 20 Slide 21 COLITISGASTRITISKINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIABULIMIAANXIETYPHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTINGVERTIGOLASSITUDEPARAFUNCTIONSCLONUSCRAMPSPARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS Slide 22 I.D. Mar. 2003 12345678910111213141516171819202122232425262728293031 5XXXXXXXX 4 3 2 1 0 24322222 DRUG INTAKE: Verapamil 120 mg 1x3-4 daily Sumatriptan Nasal Spray or I.M. (X) XXXXXXXX Slide 23 I.D. May 2004 12345678910111213141516171819202122232425262728293031 5X2252XXX222XX2X22XXXX32 4 3 2 1 0 23341133332221133122141 DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X) XXXXXXXXXXXXXXXXXXXXXXX Slide 24 I.D. Jun 2004 12345678910111213141516171819202122232425262728293031 5XXXXXXX 4 3 2 1 0 1111111 DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X) XXXXXX Slide 25 I.D. Aug 2004 12345678910111213141516171819202122232425262728293031 5 4 3XXXXX 2 1 0 1111111 DRUG INTAKE. Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray (X) XXXXX Slide 26 Slide 27 COLITISGASTRITISKINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIABULIMIAANXIETYPHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTINGVERTIGOLASSITUDEPARAFUNCTIONSCLONUSCRAMPSPARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS FRIGIDITYVAGINISM Slide 28 P.A. Jan 2004 * 12345678910111213141516171819202122232425262728293031 555522222 4MM4444233222 3 2 1 0 15 30 4530 4030 DRUG INTAKE: * Verapamil 120mg 1x2 daily + Sumatriptan 50-100mg almost daily Slide 29 P.A. Feb 2004 1234567891011121314151617181920212223242526272829 5XX223MM 4XX4MMMMM 3MM 2 1 0 DRUG INTAKE: Verapamil 120mg 1x3 daily Sumatriptan 100mg or I.M. (X) Ibuprophene 200-400 mg (X) XXXXXXXXXXXXXXXX Slide 30 P.A. Mar 2004 12345678910111213141516171819202122232425262728293031 5 4XXXXXX 3XXXX 2XX 1 0 8841684484 Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X) XXXXXXXX Slide 31 P.A. Apr 2004 123456789101112131415161718192021222324252627282930 5 4XX 3XXXX 2X 1X 0 4416444444 DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X) XXXXX Slide 32 P.A. Jun 2004 12345678910111213141516171819202122232425262728293031 5 4 3 2XX 1X 0 4 DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X) XX Slide 33 Slide 34 Classification of headache disorders, cranial neuralgias and facial pain 3. Cluster headache and other trigeminal autonomic cephalalgias 3.1 cluster headache 3.2 chronic paroximal hemicrania 3.2.1 Episodic paroximal hemicrania 3.2.1 Episodic paroximal hemicrania 3.2.2 Chronic paroximal hemicrania 3.2.2 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 cephalalgia 4.4 Probable trigeminal autonomic cephalalgia 4.4.1 Probable cluster headache 4.4.1 Probable cluster headache 4.4.2 Probableparoximal hemicrania 4.4.2 Probable paroximal hemicrania 4.4.3 Probable SUNCT 4.4.3 Probable SUNCT