TMJ or occipital neuralgia
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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TMJ syndrome is a collection of symptoms which result when there is mechanical dysfunction involving the joints and muscles responsible for chewing.
When normal relationships between the condyle of the mandible (jawbone), the cushioning disc, and the shallow cup, called the fossa, are altered, the result is termed "internal joint derangement". Internal derangement includes cartilage disc displacements, clicking, popping, stretched or torn ligaments, perforated discs, inflammation of the capsule or tissues, and adhesions.
Myofascial pain is pain due to persistent contraction of the muscle as they attempt to keep the lower jaw from excessive movement. This causes pain in the jaw, face, head, and neck.
One of the most common TMJ symptoms is headache. Over 90 percent of all chronic headaches arise from muscle contraction, most of which originate in the neck. The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. When neck muscles are tight, they compress the occipital nerves, one of the common nerves associated with headaches. When there is additional stress, mostly abnormal jaw alignment, that causes TMJ dysfunction. The jaw muscles become tighter, and compress nerves, blood vessels, and other structures within the joint. This combination of process can lead to the development of various kinds of headaches.
The pain is usually localized but may spread to the temple, toward the middle of the face, or across the top and front of the skull. The pain is aggravated by chewing. Patients frequently describe clicking and locking of the jaw. On examination, there is tenderness over the jaw, and joint slipping may be felt with opening and closing the mouth. In addition, patients often cannot open their mouths widely.
The cause of TMJ disorders is not clear, but the symptoms are thought to develop from stress or dysfunction involving the muscles of the jaw and the joint. Possible causes include:
• Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
• Grinding or clenching the teeth, which puts pressure on the TMJ
• Osteoarthritis or rheumatoid arthritis in the TMJ
Treatment for TMJ disorder usually begins with a combination of any of the following: anti-inflammatory drugs, muscle relaxants, mouth splints, biofeedback, physical therapy, and counseling.
Occipital neuralgia is pain at the back of the head, often starting at the upper neck or base of the skull. It may occur on one or both sides of the head. Pain can be infrequent, can occur several times per day, or can be constant. The pain is described as jabbing or throbbing. The usual cause is whiplash injury or blow to the back of the head or twisting of the head. A patient may experience pain or pressure behind the eyes, light sensitivity, and pain radiating to the ear, shoulder, and arm.
Pain may radiate to the front of the head or to the eye. In addition, patients report that their scalp is sensitive to the touch. At times, pain can be brought on by movement, especially extension of the head. Other symptoms may include dizziness as well as nausea and vomiting.
Physical examination may reveal neck tenderness, range of motion limitation, and decreased sensation at the back of the head.
Treatment depends on the severity of the problem and may include use of a soft cervical collar, analgesics, muscle relaxants, local injections, and on rare occasions, surgery.
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