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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)
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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)
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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
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TENSION TYPE HEADACHE - MIGRAINETENSION TYPE HEADACHE - MIGRAINE
DIFFERENTIAL DIAGNOSIS:DIFFERENTIAL DIAGNOSIS:
PAIN QUALITYPAIN QUALITY
LOCATIONLOCATION
DURATIONDURATION
AUTONOMIC SYMPTOMSAUTONOMIC SYMPTOMS
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1. Migraine1. Migraine
1.1 Migraine without aura1.1 Migraine without aura
1.2 Migraine with aura1.2 Migraine with aura
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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
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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
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TENSION TYPE HEADACHETENSION TYPE HEADACHE
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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
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Before treatmentBefore treatment
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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
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After treatmentAfter treatment
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Classification of headache disorders, Classification of headache disorders, cranial neuralgias and facial paincranial neuralgias and facial pain
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
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conjunctival injection
lacrimation
nasal congestion and/or rhinorrhoea
facial sweating
miosis and/or ptosis
eyelid edema
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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
1 0.6
5 + 0.7 2.4 TTH
11 + 0.4 1.75
11 +++ trigger 0.2
2 0.2
14 + 1.6 2.75 DEP+GAD
9 trigger 0.1 DEP+GAD
7 + worse 1.8 2.5 Prev. DEP +M
2
8 + 2.5 2 DEP+GAD
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DIFFERENT PATIENTDIFFERENT PATIENT
TYPOLOGIES?TYPOLOGIES?
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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
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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
4
3
2
1
0
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
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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
4
3
2
1
0
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
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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
4
3
2
1
0
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
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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
5
4
3 X X X X X
2
1
0
1 1 1 1 1 1 1
DRUG INTAKE. Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray (X)
X X X X X
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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
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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
3
2
1
0
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
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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
3 M M
2
1
0
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
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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
5
4 X X X X X X
3 X X X X
2 X X
1
0
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
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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
5
4 X X
3 X X X X
2 X
1 X
0
4 4 16 4 4 4 4 4 4
DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)
X X X X X
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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
5
4
3
2 X X
1 X
0
4
DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)
X X
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Classification of headache disorders, Classification of headache disorders, cranial neuralgias and facial paincranial neuralgias and facial pain
3. Cluster headache and other trigeminal autonomic 3. Cluster headache and other trigeminal autonomic cephalalgiascephalalgias
3.1 cluster headache3.1 cluster 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