Temporal Tendinitis: Migraine Mimic

Abstract

by Edwin A. Ernest, III, DMD

This article describes a very common headache disorder called temporal tendinitis1-7 which is often initiated by auto accident trauma and is complicated diagnostically by the intrinsic and extrinsic components of the temporomandibular joint (TMJ) and dental occlusion.

Figure 1. Temporal muscle and its tendon inserting at the mandibular coronoid process. Courtesy Ernest Publications

In pain management, diagnosis is key. Goethe’s maxim says “What ones knows, one sees.�Conversely, what one does not know, one does not see. When diagnosing, physicians look through a mental filter when viewing the patient. Appropriate and effective diagnosis and treatment of neck and head injuries requires both dental and medical knowledge in the areas of teeth, soft tissue, and TM joint function. If the patient has jaw joint pain and soft tissue pain, the clinician must determine which is primary and which is secondary in the diagnostic stream. In particular, it is crucial to first assess the condition of the jaw joint and its muscles and tendons before proceeding to equilibrate the teeth.

Intense, chronic head pain of questionable origin has been a dilemma for patients and doctors alike. The patient may often complain of pain and an aching sensation over the eye, behind the eye, radiating into the lateral temple over the ear, and into the occiput, or the rear of the head. The pain may radiate from the rear of the head into the neck, shoulder, back, as well as the arm and hand. The cheek and cheek-bone areas may be reported to be swollen along with aching and throbbing. The eye may feel sore and feel as if the eye ball is trying to pop out of the socket.

With many patients suffering from temporal tendonitis,8-12 the ear, jaw joint, insertion of the stylomandibular ligament, and the upper and lower molar teeth may ache and throb. The range of vertical opening of the mouth may also be restricted due to the contracture of the injured temporal tendon. Another feature of temporal tendinitis is seen in some patients who do not seem to be able to close the back teeth together.1 This problem is apparently related to the inability of the injured tendon (splinting effect) to properly contract due to pain and inflammation.

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â€?May/Jun 2006 From:   http://www.ppmjournal.com/