关于头痛病例报告.ppt

谢谢！ * Severe Daily Headaches 2011.12 A 28-year-old women consulted her dentist because of severe headaches. She worked a full-time secretary. General Idea The patient had suffered from daily headaches for the last 10 years. Severe analgesics had also been prescribed, but with little or no alleviation of the pain. She described a dull, constant headache located in the forehead and temples. The patient was aware of a teeth-clenching habit in the daytime and night. Case History Clinical Examination ※The patient had an Angle Class Ⅱ,division 1 malocclusion, but no significant occlusal interference. ※Nearly all of her jaws muscles, as well as her right TMJ, were very tender to palpation. Preliminary Diagnosis Tension-type headache. TMJ pain dysfunction. Treatment ★The patient was told to be more aware of her teeth-clenching in the daytime and to try to avoid it. ★She was also given a Shore plate to wear at night, as well as in the daytime as much as possible. ★If this treatment had a significant effect on her headaches, she maybe choose the orthodontics and orthognathic surgery to retain the effect. Treatment Outcome a further improvement a slight decrease in the headache single days without headaches 2Weeks 8Weeks 10Weeks Treatment Outcome ※After 2 more months, the headache was felt only periodically, approximately once a week. ※During active orthodontic treatment, she had periods with intense headaches without using Shore plate. After orthognathic surgery, headache declined to 2 to 3 times a month. ※Three years after the end of treatment, she reported that the headache had increased to 2 to 3 times a week. The headache improved when given a stabilization appliance. A more posterior position of the mandible was recorded, and in this “new” position, there was unilateral contact in RCP. Minor occlusal adjustment was performed. Trouble has coming again Comments Although the signs in the masticatory system warranted treatment, severe headaches have r