General Headaches and Facial Pain in Dentistry

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71% of the population suffers from headaches at some point in their lives. Of those 71%:

  • Approx. 38% suffer from tension headaches (3 % chronically)
  • Approx. 27% suffer from migraine headaches
  • Approx. 6% suffer from less common types of headaches

Other studies have shown that tension headaches are the most predominant chronic type of headache with 63-86% of sufferers, followed by migraines with a prevalence of 12-14% for women and 6-8% for men.

Overall, more than 90 % of all headache conditions are represented by these two primary types of headaches. Oftentimes, various types of headaches occur at the same time. Thus, for example, many migraine patients also suffer simultaneously from tension headaches. Tension headaches are somewhat more frequent in women and in patients with a family history of tension headaches.

Secondary headaches, i.e., headaches resulting from other diseases, are significantly rarer. In most patients seeking headache advice from a general practitioner, no serious causes can be found.

Simply questioning patients about their discomforts is usually enough to distinguish the various types of headaches from one another. Questions should include:

  • The type of pain
  • Timeline: Since what age; since when have they increased; when do they occur during the day; duration; frequency; intervals; regularity?
  • Localization: unilateral; diffuse; limited to one area; constant localization or changing character?
  • Intensity: pulsating; hammering; thumping; dull; oppressive; piercing; twitching; deep; superficial; limited general condition?
  • Trigger: posture of the head; coughing; pressing; food; medications; depending on body posture (standing, lying); light; weather changes; environmental influences; menstruation; psychological influences?
  • Are there any alleviative factors?
  • Medications; darkness; silence; lying down; sleep; coffee?
  • Attendant symptoms: Photophobia, flickering, sensory (abnormal) sensations, nausea, vomiting, heart palpitations, dizziness, tinnitus, unconsciousness, psychological changes, reddening of the face and eyes, cognitive disorders, neurological deficits, changes in blood pressure, runny-nose, tears, sweating, increased urination?
  • Previous diseases: Trauma of the head or the cervical spine; high or low blood pressure; afflictions of the eyes, ears, teeth, paranasal sinuses; known seizure disorders, meningitis; metabolic disorders; vegetative diseases/disturbances (sleep, digestion); stimulants and addictive drugs, medications; psychological components: nervousness, anxiety, depression, stress, exhaustion; life circumstances, daily routine, workplace and working atmosphere?
  • Family medical history
  • Neurological illnesses, headaches running in the family; previously performed headache diagnostics with results; previous headache treatment: medications/painkillers (dosage, duration, therapy results); other therapies?

Based on this detailed questioning, most types of headaches can be pinpointed; furthermore, a physical examination should be performed including the following areas:

  • General symptoms
  • Respiratory distress yes/no; increased sweating; venous congestion, edema, lymph node swelling, skin alterations, circulatory disorders; tremors, alcoholic odor, temperature increase
  • Chest examination
  • Heart and lung auscultation, percussion; heart murmurs, cardiac arrhythmia, emphysema, pulmonary congestion
  • Taking blood pressure on both arms
  • (Guideline hypertension), hypertension/hypotension, pulse rate, side difference
  • Vascular status (neck arteries, arteritis temporalis)
  • Hardening, carotid bruits
  • Cervical spine and neck
  • Mobility, hardened musculature
  • Face, throat, head
  • Pain on percussion of the cranial vault, injuries, hematoma, infections, bone changes, scars, dental status, dental prosthesis, mastication, paranasal sinus: Pressure or percussion sensitivity
  • Eyes
  • Testing of the eyeball, fundus (endoscopy of the fundus of the eye), vision (counting of fingers); increased intraocular pressure, papilledema, hypertensive retinopathy, vision reduction
  • Ears (hearing) (e.g. by rubbing the fingers)

The neurological examination should include the following areas:

  • Check for meningism
  • Kernig, Lasègue
  • Cranial nerve emission points
  • Paresis, strabismus, nystagmus, diplopia, anisocoria, disturbance in the eye-pupil reaction (pupil width, reaction to light, convergence)
  • Visual field (finger perimetry)
  • Defects regarding the visual field
  • Muscle tone with side comparison
  • Gross strength (passive movement of the arm and legs, holding out the arms with supinated hands, freely held legs): Pareses, loss of strength
  • Reflexes (intrinsic reflexes, abdominal skin reflexes, Babinski)
  • Side difference, loss of reflex, pyramidal path symptoms
  • Coordination (finger/nose test, knee/heel text, diadochokinesia, walk, Romberg’s test)
  • Language
  • Psychological findings: State of consciousness, orientation, abilities to think, concentrate and remember, perceptive faculty, alertness, impetus, disposition, emotionality, depression, anxiety disorder, suicidal tendency, strategies for coping with pain and stress

Although headaches are common, their causes are unexplained in most cases. Therefore, it is important that the physician excludes all known causes through detailed questioning and examination, so that the correct treatment option can be administered as quickly as possible. The above-mentioned list is meant to give you an idea of the extent of patient questioning.

This post is also available in: German

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