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

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

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

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

7. 1. Migraine
1.1 Migraine without aura
1.2 Migraine with aura

8. 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

9. 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

11. TENSION TYPE HEADACHE

12. 2. Tension-type headache
2.1 Infrequent episodic tension-type headache
2.1.1 associated with pericranial tenderness
not associated with pericranial tenderness
2.2 Frequent episodic tension-type headache
2.2.1 associated with pericranial tenderness
not associated with pericranial tenderness
2.3 Chronic tension-type headache
2.3.1 associated with pericranial tenderness
not associated with pericranial tenderness
2.4 Probable tension-type headache

13. Before treatment

14. 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

15. After treatment

16. 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

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

18. 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

19. DIFFERENT PATIENT
TYPOLOGIES?

21. 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

22. 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)

23. 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)

24. 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)

25. 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)

27. 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

28. 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 mg almost daily

29. 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 mg (X)

30. 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 mg (X) Ibuprophene mg (X)

31. 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 mg (X) Ibuprophene mg (X)

32. 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 mg (X) Ibuprophene mg (X)

34. 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