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Facial Pain, Cervical Pain, and Headache

Graff-Radford, Steven B. DDS

CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache - p 869–882
doi: 10.1212/01.CON.0000418648.54902.42
Review Articles

Purpose of Review: This review discusses the role of musculoskeletal structures of the jaw and neck in perpetuating or triggering primary headache. Because treatments aimed at these structures often reduce headache, a better understanding of their role in headache is needed.

Recent Findings: Central sensitization may result in changes in the afferent pathways, making communication from cervical and temporomandibular nociceptive neurons to the trigeminal nucleus possible. This provides the pathophysiologic basis for directing therapy to the neck or temporomandibular joint to alleviate primary headache.

Summary: Clinicians should recognize the significant role that musculoskeletal structures of the head and neck play in the perpetuation of headache and the importance of evaluating every patient for temporomandibular disorders and cervical abnormalities.

Address correspondence to Dr Steven B. Graff-Radford, The Pain Center at Cedars-Sinai, 444 South San Vicente Boulevard, Suite 1101, Los Angeles, CA 90048,

Relationship Disclosure: Dr Graff-Radford serves as a member of the speakers’ bureau or as a consultant for Allergan, Inc.; MAP Pharmaceuticals, Inc.; Nautilus Pharma; NuPathe, Inc.; Pfizer, Inc.; and Zogenix, Inc. Dr Graff-Radford has served as an expert witness and has performed medical record review.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Graff-Radford discusses the unlabeled use of amitriptyline, selective serotonin-norepinephrine reputake inhibitors, and antiepileptic drugs for the treatment of temporomandibular disorders.

© 2012 American Academy of Neurology
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