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Case Report: Facial Pain is not always

Posted Sep 08 2008 10:47am

Case Report: Facial Pain is not always "TMJ"

Example of the role the "TMJ Scale" can play in evaluation and treatment.

A 48-year-old married white male was experiencing headaches and facial pain. He had a history of arthritis in his cervical spine (upper spine near the neck). He had been treated with medications, including Sansert and Cortisone. He had seen many doctors, dentists, and chiropractors for his problems, but found little relief. His headaches awakened him from sleep and were accompanied by redness and tearing of the eye and a stuffy, running nose. Drinking alcohol brought on the headaches. He was experiencing a great deal of stress from these problems, and was having difficulty sleeping.

He was given a " TMJ Scale" to help diagnose his problems.

His TMJ Scale test results indicated that his symptoms were only 'borderline' positive for overall TMJ symptoms. His results indicated significant pain and pain on pressing the facial muscles and the TM joint. However, the TMJ Scale Report indicated he did not have significant jaw joint noise or problems opening and closing his mouth. Nor were there symptoms suggesting that his teeth were not properly fitting together. This patient did indicate a high level of emotional problems, and his answers indicated he was predisposed to develop a chronic problem. This test also screens for the presence on Non-TMJ disorders which can complicate both diagnosis and treatment. The Non-TMJ Disorder scale was elevated, suggesting that a non-TMJ disorder was present.

The TMJ Scale results and a physical examination suggested that the primary problem was not TMJ, but cluster headaches with secondary myofascial pain. A sphenopalatinate block (a local anesthetic administered directly through the nose with a thin rod to a nerve near the sinuses) during a headache completely relieved the pain, confirming that the pain was vascular(related to blood vessels) in origin.

The patient was treated with physical therapy and TENS, transcutaneous electrical nerve stimulation. Two months later he was headache free. There was some 'mild' facial pain and 'moderate' muscle tenderness, but the patient was not concerned and felt he could treat these symptoms with aspirin. A follow-up TMJ Scale showed that reduced levels of pain were still present but the Non-TMJ Disorder scale was no longer significant.

This case illustrates that facial pain is not always TMJ, and that other non-TMJ factors need to be considered during examinations and diagnosis. The TMJ Scale in this case helped to point out that the patient did not have TMJ.
To see an example of the TMJ Scale Report-Patient Version go to

To read more about the TMJ Scale and how to take the patient version of this test click
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