It is evident to those who daily treat pain of the head and neck that it is almost a rule that head pain patients may suffer from two or more painful conditions present at the same time. In that context, please consider the following quote. Berman and Sinburg, two orthopedic surgeons, wrote in the Journal of Bone & Joint Surgery that “the injury of the temporomandibular joints is part of a more diffuse injury to the head and neck. This association is so common that the function of these joints is tested in any case of severe blunt trauma to the head and neck.”1 Ernest reported a study2 where 119 previously untreated patients with pain of the head, face or ear were found to have internal derangements of the TMJ (see Table 1). These studies did not state that patients would necessarily have similar disorders.
| Table 1. Internal derangement of tmj in previously untreated patients having head, face, ear pain (n=119) |
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| 112 (94%) had derangements of the TMJ 24 (20%) had unilateral derangement 95 (80%) had bilateral derangement |
In an earlier article in the January/February 2008 issue of this journal,3 this author referenced a study at The University of Kentucky Pain Clinic that stated that cardiac ischemia and heart attack was represented by craniofacial pain in 11 of 186 patients as the only presenting symptom. This statement demonstrates the fact that symptoms in the head and neck may not reveal the underlying pathology. This article will demonstrate the common finding of co-morbidity in head and neck pain patients.
Case Summary
The patient, in her early 70’s, was diagnosed by her family physician with temporal arteritis (TA). She was biopsied and temporal arteritis or cranial arteritis was confirmed. Even though the patient was in treatment for temporal arteritis, a headache lingered that did not respond to cortisone or oral pain medications.
Please refer to the May 2008 issue for the complete text. In the event you need to order a back issue, please click here.