TMJ DISORDERS MYOGENOUS PAIN REFERRED PAIN TENSION TYPE HEADACHE MIGRAINE CLUSTER HEADACHE NEUROPATHIC PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN)

TMJ DISORDERS MYOGENOUS PAIN REFERRED PAIN TENSION TYPE HEADACHE MIGRAINE CLUSTER HEADACHE NEUROPATHIC PAIN DEAFFERENTATION PAIN PAIN IN SOMATOFORM DISORDERS (ATYPICAL FACIAL PAIN)

Classification of headache disorders, cranial neuralgias and facial pain 1. Migraine 2. Tension-type headache

TENSION TYPE HEADACHE - MIGRAINE DIFFERENTIAL DIAGNOSIS: PAIN QUALITY LOCATION DURATION AUTONOMIC SYMPTOMS

1. Migraine 1.1 Migraine without aura 1.2 Migraine with aura

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

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

TENSION TYPE HEADACHE

2. Tension-type headache 2.1 Infrequent episodic tension-type headache 2.1.1 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 2.2.2 not associated with pericranial tenderness 2.3 Chronic tension-type headache 2.3.1 associated with pericranial tenderness 2.3.2 not associated with pericranial tenderness 2.4 Probable tension-type headache

Before treatment

VERTIGINI FIACCHEZZA ABITUDINI VOLUTT. PARAFUNZ CLONI CRAMPI MUSC. PARESTESIE PAT. VASC. FAM. TURBE CIRC. PERIF. FREDDO ESTREMITA’ DOL. SCHIENA MAL. REUM. TURBE MINZ./ALVO FRAGILITA’ CAPELLI FRAGILITA’ UNGHIE CHINETOSI ACETONEMIA FRIGIDITA’ VAGINISMO IMPOTENZA EIACULAZIONE PREC. UMORE DEPRESSO COLITI GASTRITI DIFF. DEGLUTIZIONE PROBL. DIGESTIONE ANORESSIA BULIMIA ANSIA FOBIE DIST. SONNO CRISI DI PANICO PALPITAZIONI SBALZI DI UMORE SVENIMENTI

After treatment

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 3.2.2 Chronic paroximal hemicrania 3.3 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) 4.4 Probable trigeminal autonomic cephalalgia 4.4.1 Probable cluster headache 4.4.2 Probable paroximal hemicrania 4.4.3 Probable SUNCT

conjunctival injection lacrimation nasal congestion and/or rhinorrhoea facial sweating miosis and/or ptosis eyelid edema

Psych symptoms Parafunction Stress PTS CTS Comorbidity 6 0.2 0.1 8 ++ worse + 9 2.1 2.6 GAD, MP 1 0.6 5 0.7 2.4 TTH 11 0.4 1.75 +++ trigger 2 14 1.6 2.75 DEP+GAD 7 1.8 2.5 Prev. DEP +M

DIFFERENT PATIENT TYPOLOGIES?

COLITIS GASTRITIS KINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIA BULIMIA ANXIETY PHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTING VERTIGO LASSITUDE PARAFUNCTIONS CLONUS CRAMPS PARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS

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 X DRUG INTAKE: Verapamil 120 mg 1x3-4 daily Sumatriptan Nasal Spray or I.M. (X)

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 X DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X)

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 X DRUG INTAKE: reduce Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray or I.M. (X)

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 X DRUG INTAKE. Verapamil > Lamotrigine > 200mg Sumatriptan Nasal Spray (X)

COLITIS GASTRITIS KINETOSIS SWALLOWING DIFF. DIGESTIVE PROBL. ANOREXIA BULIMIA ANXIETY PHOBIAS SLEEP DISORDERS PALPITATION PANIC ATTACKS MOOD CHANGES FAINTING VERTIGO LASSITUDE PARAFUNCTIONS CLONUS CRAMPS PARESTHESIAS BACK PAIN URINATION DISTURBANCES DIARRHEA OR CONSTIPATION HAIR FRAGILITY NAIL FRAGILITY CIRCULATION DISORDERS COLD LIMBS FREQUENT DEPRESSED MOODS FRIGIDITY VAGINISM

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 M 45 40 DRUG INTAKE: * Verapamil 120mg 1x2 daily + Sumatriptan 50-100mg almost daily

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 X M DRUG INTAKE: Verapamil 120mg 1x3 daily Sumatriptan 100mg or I.M. (X) Ibuprophene 200-400 mg (X)

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 X Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

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 X DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

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 X DRUG INTAKE: Sumatriptan 50-100mg (X) Ibuprophene 200-400mg (X)

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 3.2.2 Chronic paroximal hemicrania 3.3 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) 4.4 Probable trigeminal autonomic cephalalgia 4.4.1 Probable cluster headache 4.4.2 Probable paroximal hemicrania 4.4.3 Probable SUNCT