11.7 Headache attributed to temporomandibular disorder (TMD)

Identification: A 32-year-old female patient reports bilateral temporal headache for 4 months. History of Present Illness: Pain: Location: Bitemporal and preauricular region Characteristic: Continuous pressure, moderate intensity (5/10) Worsens with: Chewing, yawning, and emotional stress Improves with: Masticatory rest and local heat Associated symptoms: Bilateral joint clicking Limitation of mouth opening (35mm) Morning masticatory muscle fatigue Relevant history: Nocturnal bruxism (reported by partner) Habit of biting objects Physical Examination (DC/TMD - Diagnostic Criteria): Muscle palpation: Pain on palpation of the masseter (bilaterally) and temporalis (bilaterally) Active trigger points in the right masseter TMJ evaluation: Bilateral reciprocal clicking Pain on lateral palpation of the condyles Mandibular movement: Limited opening (35mm) with deviation to the right Pain on protrusion and lateral movement Dental examination: Incisal dental wear (grade II) Absence of dental pathologies Complementary Exams: MRI of TMJ: Anterior disc displacement with reduction (right) Signs of mild synovitis (left) Resting electromyography: Elevated muscle activity at rest (masseter and temporalis)