Temporal tendinitis has been called "The Migraine Mimic" because so
many symptoms are similar to migraine headache pain. Symptoms include: TMJ
pain, ear pain and pressure, temporal headaches, cheek pain, tooth
sensitivity, neck and shoulder pain. Treatment consists of injecting local
anesthetics and other medications, a soft diet, using moist heat, muscle
relaxants and anti-inflammatory medications, and physiotherapy. Only rarely
(in approximately 4% of cases) is surgery needed.
This TMJ-like problem involves the stylomandibular ligament, at tiny structure
that connects the base of the skull with the mandibular, or lower jaw. If
injured, this structure can produce pain in as many as seven specific regions
of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye;
the throat, especially when swallowing, and the lower back teeth and jaw bone.
Treatment of Ernest syndrome, which is successful about 80% of the time,
consists of injections of local anesthetic and medication (cortisone or
Sarapin), physiotherapy, and at times, the use of an intraoral splint.
Occipital neuralgia is generally ignored in the medical
textbooks. This disorder is characterized by pain located in the cervical and
posterior regions of the head (these are the occipital areas) which may or may
not extend or radiate into the sides of the head and ultimately, into the
facial and frontal regions. There are actually two major types of occipital
neuralgia: lesser occipital and greater occipital, with the lesser type being
Trigeminal neuralgia is a terrible disorder of the trigeminal,
or fifth cranial nerve. This is one of the most painful problems that plagues
human beings. In fact, its description first appeared in the scientific
literature in 1672. Another common name for trigeminal neuralgia is tic
douloureux which literally means unbearably painful twitch. Far
too often, when a person is suffering with severe facial pain with no apparent
cause, the diagnosis given is trigeminal neuralgia. Because of this, the
patient may be subjected to medications and even very serious surgical
procedures which are not necessary. The symptoms tic douloureux are
very characteristic: sharp electrical pain which lasts for seconds. This pain
is triggered by touching a specific area of the skin by washing, shaving,
applying makeup, brushing the teeth, kissing, or even cold air. The second
division of the trigeminal nerve (the maxillary division), which supplies
feeling to the mid-face, upper teeth and palate, seems to involved most. The
pain is so severe that the sufferer will do virtually anything to avoid
touching the trigger zone, producing the pain.
In contrast to the typical type, atypical trigeminal neuralgia
seems to cause pain constantly with the intensity increasing and decreasing.
There are trigger zones with this type; however, there also is an area of dull
aching which is intensified by touching the trigger zones. All three divisions
of the trigeminal nerve seems to be affected equally. A common cause of this
disorder is trauma, especially after a surgical incision or blow to the face.
Atypical facial pain is a disorder that also affects the
trigeminal nerve. However, the symptoms are not clearly defined as they are in
typical and atypical trigeminal neuralgia. Atypical facial pain seems to
affect people who are under a tremendous amount of stress and may even have a
history of psychiatric problems. This does not mean that one suffering with
atypical facial pain is mentally ill. We who treat this problem need to do
much more research to understand this terrible disorder.
recent as 1979, a newly described pain disorder was reported. This disorder,
which came to be known as osteocavitational lesions (Ratner's
bone cavities,) produced pain similar to trigeminal neuralgia, both the
typical and atypical types. In fact, usually these patients were diagnosed
with trigeminal neuralgia. The diagnosis is complicated by the fact that the
x-ray examination of the bone is usually normal. Also, NICO produces referred
pain patterns which also serve to confuse both patient and doctor. However,
just like trigeminal neuralgia, there are trigger areas that, when pressed,
produce pain. These trigger areas develop directly over the areas of dead
bone. The mandible is affected more often than the upper jaw. One important
aspect of NICO is a history of tooth extraction usually years earlier. Any
tooth may be involved. However, lower back teeth seem to be most common. Small
areas of bone actually die, producing neuralgia-like pain symptoms. It appears
that after a tooth extraction, NICO may develop due to injury of the blood
vessels in the area which ultimately results in poor circulation, resulting in
bone death in some cases. Pathologically, this is termed osteomyelitis.
This bone infection, which can result in bone death, has been known for years.
Yet, in the form of NICO, it is a newly described problem.
|NICO (Neuralgia Inducing Cavitational
this treatment for
this diagnosis is under
investigation. Please seek out
reliable resources for treatment of this condition. 1/06|
Article provided by AAHNFP. For , contact the American Academy of Head, Neck &
Facial Pain by sending a stamped (55 cents), self-addressed envelope to:
The American Academy of Head, Neck & Facial Pain
520 West Pipeline Road Hurst, TX
Index | Our
Patient Education | Site