TMJ or occipital neuralgia
When a problem is related to the muscle disorders, this is called myalgia/myofascial pain (pain from sore muscles). Pain is usually due to persistent contraction of the muscle as they attempt to keep the lower jaw from excessive movement. This causes pain to the jaw, face, head, neck and eventually translating to the shoulder, arm, back, hip, knee and foot.
One of the most common TMJ disorder symptoms is headache. Over 90 percent of all chronic headaches, however painful, arise primarily 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 dysfunctional or tight, this compresses the occipital nerves, one of the common nerves causing 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 lymphatic channels within the joint space. This combination of process can lead to the development of various kinds of headaches; migraine, tension-type, cluster-type. The pain is usually localized but may expand to the temple, toward the middle of the face, or across the top and front of the skull. The pain is usually aggravated by chewing. Patients frequently describe clicking and locking of their jaw. Upon examination, there may be tenderness over the jaw, and joint slipping may be felt upon 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 arise from either stress or problems with the muscles of the jaw and/or with the parts of the joint itself. Possible causes include: • Injury Occipital neuralgia includes pain experienced 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. Symptoms include occipital pain on both sides of the back of 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 an overextension of the head. Other symptoms may include dizziness and, rarely, nausea and vomiting. Occipital neuralgia is often seen in athletes -- particularly weight lifters, wrestlers, and football players -- and others, such as persons involved in automobile accidents and those who incur extension and flexion injuries. Physical examination may reveal cervical area tenderness, range of motion limitation, and decreased sensation at the back of the head. Radiographic imaging at the brain-cervical vertebrae junction may reveal abnormalities. 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.
TEMPORAL TENDINITIS: Symptoms include TMJ pain, ear pain and pressure, tooth sensitivity, cheek pain, eye pain, temporal headache, neck, and shoulder pain.
A patient may complain of stuffiness and or a clogged feeling in the ear.
The diagnosis is confirmed by injection into the temporal tendon with anesthetic.
Treatment- anti-inflammatory medication and moist heat several times per day.
ERNEST SYNDROME: This is due to dysfunction of the mandibular ligament that connects the base of the skull with the mandible. Symptoms include pain in the temple, TMJ, ear, cheek, eye, and the throat when swallowing and in the lower back teeth and jaw bone. Treatment same as above.
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