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Failure to Make the Correct Diagnosis: Part II - A Physical Therapist's Perspective

Steve Kraus

Introduction

The 2013 International Headache Society (IHS) has identified 14 diagnostic categories for headache and facial pain [1] (Appendix 1). Each of these categories have several diagnostic subtypes for a total of 284 sources for headache and facial pain. This extensive list of headache and facial pain disorders becomes a diagnostic challenge even for the most seasoned clinicians. A thorough history and a cranial nerve exam assessing neurological deficit(s) and/or altered mental state can eliminate more serious pathologies that may be causing headache and facial pain. If pathology or infection is suspected, imaging studies and blood analysis would rule out most concerns [2]. Neuropathic and neurogenic sources for headache and facial pain must be considered but are very complex and difficult to diagnose [3]. Category 11 of the IHS classification system addresses additional diagnoses that are relatively common and can mimic and compound temporomandibular joint pain (Boxes 2.1 and 2.2).

Electronic supplementary material The online version of this chapter (doi: 10.1007/978-3-319- 51241-9_2) contains supplementary material, which is available to authorized users.

S. Kraus, PT

Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA

The Georgia School of Orthodontics, 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

G.F. Bouloux (ed.), Complications of Temporomandibular Joint Surgery, DOI 10.1007/978-3-319-51241-9_2

Box 2.1 Classification of Headache Disorders [1]

Part one: the primary headaches

  • 1. Migraine
  • 2. Tension type headache
  • 3. Trigeminal autonomic cephalalgias
  • 4. Other primary headache disorders Part two: the secondary headaches
  • 5. Headache attributed to trauma or injury to the head and/or neck
  • 6. Headache attributed to cranial or cervical vascular disorder
  • 7. Headache attributed to nonvascular intracranial disorder
  • 8. Headache attributed to a substance or its withdrawal
  • 9. Headache attributed to infection
  • 10. Headache attributed to disorders of homeostasis
  • 11. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structures
  • 12. Headache attributed to psychiatric disorder

Part three: painful cranial neuropathies, other facial pains, and other headaches

  • 13. Painful cranial neuropathies and other facial pains
  • 14. Other headache disorders

Box 2.2 Diagnostic Subsets of Category 11 [1]

Headache or facial pain attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structures

  • 11.1 Headache attributed to disorder of cranial bone
  • 11.2.1 Cervicogenic headache
  • 11.2.2 Headache attributed to retropharyngeal tendonitis
  • 11.2.3 Headache attributed to craniocervical dystonia
  • 11.3 Headache attributed to disorder of the eyes
  • 11.3.1 Headache attributed to acute glaucoma
  • 11.3.2 Headache attributed to refractive error
  • 11.3.3 Headache attributed to heterophoria or heterotropia
  • 11.3.4 Headache attributed to ocular inflammatory disorder
  • 11.3.5 Headache attributed to trochleitis
  • 11.5 Headache attributed to disorder of the nose or paranasal sinuses
  • 11.5.1 Headache attributed to acute rhinosinusitis
  • 11.5.2 Headache attributed to chronic or recurrent rhinosinusitis
  • 11.6 Headache attributed to disorder of the teeth or jaw
  • 11.7 Headache attributed to temporomandibular joint disorder (TMD)
  • 11.8 Headache attributed to inflammation of the stylohyoid ligament
  • 11.9 Headache or facial pain attributed to other disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structures
 
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