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Failure to Make the Correct Diagnosis Part I - A Neurologist's Perspective

Andrew Guidry and Gregory J. Esper


A basic knowledge of headache is important in treating the pre- and postoperative temporomandibular joint (TMJ) surgical patient. Understanding the epidemiological characteristics of headaches, headache types, treatments of headache, and current clinical data will help practitioners make the correct diagnosis initially. This will allow the surgeon to better identify a good surgical candidate as well as recognize other sources of head pain requiring diagnosis and treatment. A directed history and pertinent physical examination combined with an algorithmic approach will lead to the correct diagnosis and treatment of most headaches.


According to the World Health Organization in 2012, 50-75% of the global adult population had at least one headache in the last year [1]. One such headache disorder is headache attributed to temporomandibular disorder (TMD), which is classified as a secondary headache caused by a disorder involving structures in the temporomandibular region [2].

Temporomandibular joint dysfunction remains common with approximately 75% of the US population having at least one sign or symptom of TMD during their lifetime [3]. Additionally the prevalence of TMD is estimated to be 46.1% with at

A. Guidry, MD (*)

Department of Neurology, The Sandra and Malcolm Berman Brain and Spine Institute,

Baltimore, MD, USA

e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

G.J. Esper, MD, MBA

Emory University School of Medicine, Atlanta, GA, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing AG 2017 1

G.F. Bouloux (ed.), Complications of Temporomandibular Joint Surgery,

DOI 10.1007/978-3-319-51241-9_1

least 10% of the population having a painful TMJ [3-5]. The prevalence of TMD is also higher in the headache population than in the general population [6]. When considering individuals diagnosed with a headache disorder, there is a 56.1% prevalence of concomitant TMD [6]. Conversely, patients diagnosed with TMD are also very likely to report headaches with an incidence that approaches 80% [7]. Despite the strong association between TMD and headache, it behooves the surgeon to accurately diagnose the etiology of headache prior to considering any treatment for TMD.

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