Does anyone else have this head/face/neck pain?

Discussion in 'Fibromyalgia Main Forum' started by ssMarilyn, Jun 24, 2003.

  1. ssMarilyn

    ssMarilyn New Member

    I do have TMJ, but normally only the right jaw joint is involved in pain. Now I have pain on the right side of my face in the cheekbone area, and along the lower, middle and top of the right side of my head. I also have a dull headache in the right side of my head. Does anyone else ever experience pain in these areas? I can't even rest on my right side because it's really uncomfortable to put pressure of any kind on the side of my face. I had a heating pad on those areas for awhile and it seemed to help....Tylenol didn't. Is this anything like that myofacial condition that some have?

  2. Shirl

    Shirl New Member

    Could you be having a sinus problem? I get pain just like your described, and its my sinuses. Nothing will touch that pain unless its an antihistamine.

    I use the Tynelol Sinus for it, and it works great. At nightime I take the Tynelol Sinus 'Nightime' formula.

    I use cold compresses on it instead of heat, don't ask why, it just feels better with cold instead of heat on my face and head.

    The rice socks are great for this, as they are not drippy like an ice bag, just a nice cool feeling.

    I put an article below on the Myofascial pain for you.

    Take care, and I do hope you feel better soon.

    Shalom, Shirl


    Position Paper on Trigger Point Injections [Fibromyalgia and Myofascial Pain News]


    By Reuben S. Ingber, M.D.
    I. Background

    The first medical textbook that took the position that muscles cause pain was published by J. Travell and D.G. Simons in 1983 (1). This is a radical concept of the musculoskeletal system, given the dominance of orthopedic surgeons in the treatment of musculoskeletal injuries. In currently accepted medical theory, structural problems are the only perceived reason for having pain. The concept of Myofascial dysfunction, or muscle-connective tissue abnormalities, posits that muscle abnormalities can exist in a painful joint with or without structural abnormalities.

    Trigger points are hyperirritable bundles of fibers within a muscle which become "knotted" and inelastic, unable to contract or relax, due to an injury. The hallmarks of the physical examination are marked muscle tenderness, muscle and fascial hyperirritability phenomenon, loss of range of motion and muscle weakness. Shortening and loss of range of motion, which is observed in injury to a muscle when muscles are strained or used eccentrically, may be the harbinger of the Myofascial dysfunction.

    Myofascial treatment in the form of injection of lidocaine, dry needling or deep muscle massage followed by a specific, supervised, therapeutic stretching program aims to re-establish a painless, full range of motion.

    Since the 1983 publication of the textbook, Myofascial Pain and Dysfunction the Trigger Point Manual by J. Travell and D.G. Simons (1), trigger point injections, like other medical procedures, have been both used and unfortunately abused. In 1995, development of guidelines for the management of acute low back pain was sponsored by the U.S. Department of Health and published in November(2).

    The guidelines were compiled by a panel of experts from the AHCPR. The majority of the physicians on that panel were surgeons, either orthopedic surgeons or neurosurgeons; their recommendations are accordingly and significantly biased. Based upon a skewed reading of the literature, they concluded that trigger point injections are not effective. Since no clinical controlled trials have demonstrated the effectiveness of trigger point therapy for low back pain or lumbar radiculitis, the panel recommended against the continued use of trigger point injections in the treatment of low back pain or lumbar radiculitis. Yet no trials demonstrated ineffectiveness either.

    Of several clinical controlled trials of lumbar epidural corticosteroid injections, only one demonstrated some effectiveness for three months after the injection. Nevertheless, the AHCPR panel did recommend its use in treating lumbar radiculitis even though "there was no evidence that epidural steroids are effective in treating acute radiculopathy, but the panel's opinion was that epidural steroid injection may be useful as an attempt to avoid surgery" (page 48). The bias is evident in the faulty logic.

    Based on the panel's recommendations, HCFA issued its guidelines, and as a result, several states have stopped Medicare reimbursement for trigger point injections in the treatment of any spinal problem, cervical or lumbar. It is likely that many other states will follow suit, as undoubtedly will many insurance companies. This lack of backing will inevitably lead to the peripheralization of what seems to be a very valuable, potentially highly effective and riskless medical procedure which aims to treat a muscle when a musculoskeletal diagnosis is made.

    Simply stated, the theory of Myofascial pain posits that when a person has, for example, tendonitis, a muscle treatment will effectively eliminate the problem or predisposing perpetuating problem, and will be just as effective as a cortisone injection in returning the normal function of a joint.

    To date, very little is known about trigger point injections--how effective are the treatments, how many injections, which muscle(s) to inject, what corrective maneuvers need to be made after a trigger point injection. The reason for the gap in our knowledge is that very little funding has gone into the research of these treatments, as there is very little financial incentive for anybody to sponsor such research efforts. In the thirteen years since the original publication of the Myofascial dysfunction textbook by J. Travell and D.G. Simons, no clinical studies with proper controls have been published.

    II. Research to Date

    What little research we do have proves that trigger points do exist and are not a figment of the imagination of some very enterprising physicians. Studies by Ngoo et al.(3) (1994) and Gerwin et al.(4)(1997) have shown good interrelator reliability when examining for trigger points, if experienced and trained personnel are conducting the examination. Controlled studies have also demonstrated that effective treatment can be achieved with different trigger point injection techniques, as studied by Garvey et al.(5)(1989). In that study, dry needling was shown to be as effective as injection of either lidocaine or a combination of lidocaine and cortisone in the treatment of a group of low back pain patients.

    Hong (6) in 1994 demonstrated that injection of lidocaine and dry needling were equally effective but dry needling caused more complaints of soreness in the period immediately following trigger point injection. More significantly, Hong pointed out that achieving a local twitch response with the needle was the most important factor in achieving an effective response, more important than what type of treatment was utilized, i.e., dry needling vs. injection of lidocaine.

    No controlled studies are available on the clinical response to trigger point injections. No studies have been done, for example, to measure the clinical response of a group of patients with low back pain or lumbar radiculitis to trigger point injections to a specific muscle.

    One controlled study by Aleksiev and Kraev (7) in 1994 of low back pain patients, comparing Myofascial release to thrust manipulation, shows them to be equally effective in relieving low back pain. We cannot say with certainty which muscle or muscles are most important to treat a specific diagnosis, or whether response in trigger points is enhanced by post-injection stretching exercises. These are important questions that need to be answered.

    There are, however, case reports of failed low back pain treated with iliopsoas Myofascial treatments (8)(Ingber, 1989), a series of patients with low back pain treated with dry needling (9)(Gunn, 1980), a series of patients with lumbar radiculitis treated with dry needling (10)(Chou, 1995), a series of patients with lumbar radiculitis treated with iliopsoas dry needling (11) (Ingber[abstract], 1996), a series of patients with shoulder pain treated with subscapularis Myofascial treatments (12)(Ingber[abstract], 1986) and a case of atypical chest pain caused by a trigger point in the diaphragm muscle (13)(Ingber[abstract], 1988). Lewit (14)(1979) reported on various musculoskeletal problems treated with dry needling.

    There have also been case reports presented at the annual meetings of the American Academy of Physical Medicine and Rehabilitation, including reports of Myofascial diagnoses and treatments for unusual abdominal and pelvic pains, runners with shin splints, compartment syndromes and Achilles tendonitis, tennis players with shoulder impingements, and musicians with focal hand dystonias.

    The physicians who have presented cases of Myofascial problems mimicking musculoskeletal syndromes that go by other names are not misguided clinicians out to steal orthopedic patients. They are astute clinicians who are trying to bring to the fore their observations in a very important area of musculoskeletal treatment that has been, to date, under-recognized and under-studied. Frequent calls for clinical control trials have gone out in the hope that efficacy compared to standard treatment can be demonstrated, but funding and enthusiasm from the medical hierarchy are grossly lacking.

    III. Position

    Many physiatrists feel that trigger point injections should continue to be reimbursed by all medical carriers for all musculoskeletal disorders, with the number of trigger point injections limited to a series of 3 to 4. A second series of 3 to 4 would be allowed with demonstration of response by history and physical examination by written report. Further trigger point injections would be allowed only on a case-by-case basis, reviewed by appropriately trained medical personnel from the insurance carrier. The status quo ante should remain and should continue for a period of five years. These limitations would be acceptable to many physiatrists, provided that governmental agencies encourage the immediate institution of research in the area of Myofascial pain.

    The government, through the NIH or AHCPR (Agency for Healthcare Research and Quality), should launch this research with a conference on Myofascial pain modeled after the alternative methods conference sponsored by the NIH in October 1995. A panel of medical scientists and experts in fields as varied as anatomy, kinesiology, and orthopedics specializing in muscles, osteopathy and physiatry would be assembled to analyze and assist with the more promising proposals. Everyone would be invited to present approaches and ideas regarding Myofascial pain. Then, several studies could be initiated, acceptable to all factions in the medical and non-medical community, to see if any significant improvement can be achieved through acceptable clinical trials.

    Recent years have seen an epidemic of musculoskeletal injuries such as repetitive stress injuries, carpal tunnel syndrome, runner's shin and knee pains, cervical whiplash injuries and lumbar disabilities. The number and variety of cures and treatments for pain (pain clinics, pain blocks, work-hardening, Botox injections) have also exploded. The cost of musculoskeletal injuries, both in direct medical bills and in lost productivity, is crippling Western industrialized countries.

    If Solomonow's observation (15) of the important "role of the muscles associated with the joint in maintaining its integrity" is correct, then Myofascial treatments may be an important box currently missing from the treatment algorithms for musculoskeletal pain.


    1. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, Williams & Wilkins, 1983.
    2. Guidelines
    3. Njoo KH, Van der Does E: The occurrence and inter-rater reliability of Myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 58: 317-323, 1994.
    4. Gerwin RD, Shannon S, Hong C-Z, Hubbard D, Gevirtz R: Identification of Myofascial trigger points: inter-rater agreement and effect of training. Pain (in publication, 1997).
    5. Garvey TA, Marks MR, Wiesel SW. A prospective, randomized, double-blind evaluation of trigger point injection therapy for low back pain. Spine 1989;14:962-964.
    6. Hong C-Z: Lidocaine injection versus dry needling to Myofascial trigger points: the importance of local twitch response: Am J Phys Med Rehabil 73: 256-263, 1994.
    7. Aleksiev A, Kraev T: Postisometric relaxation versus high velocity low amplitude techniques in low back pain. J Orthop Med 16: 38-41, 1994.
    8. Ingber, RS. Iliopsoas Myofascial dysfunction: a treatable cause of "failed" low back syndrome. Arch. Phys. Med. Rehabil. 70:382-386, 1989.
    9. Gunn CC, Milbrandt WE, Little AS, Mason KE: Dry needling of muscle motor points for chronic LBP. Spine 5:279-291, 1980.
    10. Chu J: Dry needling (intramuscular stimulation) in Myofascial pain related to lumbar radiculopathy. Eur J Phys Med Rehabil 5: 106-121, 1995.
    11. Ingber, RS. Lumbar radiculitis with inability to heel walk, treated with iliopsoas Myofascial treatments: a retrospective analysis of a series of six cases (abstract). Arch. Phys. Med. Rehabil. 77:939, 1996.
    12. Ingber, RS. Myofascial dysfunction of the subscapularis as a cause of shoulder pain (abstract). Arch. Phys. Med. Rehabil. 67:616, 1986.
    13. Ingber, RS. Atypical chest pain due to Myofascial dysfunction of the diaphragm muscle: a case report (abstract). Arch. Phys. Med. Rehabil. 69:729, 1988.
    14. Lewit K: Needle effect in relief of Myofascial pain. Pain 6:83-90, 1979.
    15. Baratta R, Solomonow M, Zhou EE, et al.: Muscular coactivation. The role of the antagonist musculature in maintaining knee stability. Amer J Sports Med 16: 113-122, 1988.

    Source: Medscape.

  3. Applyn59

    Applyn59 New Member

    I have one of the conditions I think you might be talking about. It is Sluder's syndrome and is like cluster
    headaches and gives me tingling, pain and numbness
    on my cheek and severe head pain in the temple area.
    When really bad, it makes me nauseated as well.

    I have had the feeling that I couldn't put that side of
    my head down on the pillow as well.

    Do you have sinus problems? Do you cheeks hurt
    if you tap on them? I also get headaches in the
    side of my head. I am always telling my mother
    that I feel like I got kicked in the side of my head
    by a horse!!!! Don't know if mine is allergy or sinus
    related or what. Feels very tenderlike.

    Hope someone else can be more helpful than I am!


    PS Do you have any benadry or other antihistamine
    on hand? You could try that.[This Message was Edited on 06/24/2003]
  4. kredca4

    kredca4 New Member

    Sorry you are having Pain like that. I had a CT this afternoon of my Head, along the neck area mainly, I can't recall right now the name of the bone, but it's something like the temporal bone? I'll look it up later.

    You are describing the Pain that is similiar to what I have been gripping about for 2 months now. I have been doing research on the "Pain Disorders That Are Confused With TMJ"

    Some are Temporal Tendinitis, Ernest Syndrome, I think this is a part of the Pain I'm having, the symptoms are right on.
    So we shall see what the ENT Doc. say's on Fri.

    Occipital Neuralgia, this has Pain located in the Cervical and Posterior regions of the head, which is another Possibility.

    Trigeminal Neuralgia, This one I do have, it's where you get that unbearable twitch, it's a facial pain with no apparent cause. I have had a couple of MRI's trying to figure that one out. You'll have to check that one out, it's a, "Sharp electrical pain which lasts for seconds".
    You can set it off by just putting on makeup, that's probably what cause's mine, lol. Or even shaving for men who have this. There are 2 kinds, but this is the one I have been dx with, so far.
    Number 2, (not that one) is a more serious problem, the pain is serve from just a simple touch.

    Then the 2 that I think are probably linked to the MPS, is Atypical Trigeminal Neuralgia and Atypical Facial Pain. These have symptoms and cause's close to FMS/CMP.

    I know you know how to look that stuff up, if you want, I don't know how to leave, Clues, with out getting myself into trouble. I guess I should learn to cut and paste, but I like to visit the websit the Information is gleamed from, cause there may be more there that I would be interested in. Ya know?

    ANyway, you might check thoes out and then call your Dr., they are the only ones who can tell you for sure.
    More than likely it's TMJ, with the FMS, making it Hurt worse than it should. I hate when that Happens'.

    For the CMP, look up the SCM Trigger Point.

    Hope you feel better soon, and let me know what you find out, try the website of The American Academy of Head, Neck & Facial Pain.

    [This Message was Edited on 06/24/2003]
  5. ssMarilyn

    ssMarilyn New Member

    For the information and the sites to look up. I was awake most of the night with this pain, and most of the morning. Now I'm feeling pretty good, but my cheekbone is still tender.

  6. ssMarilyn

    ssMarilyn New Member

    I don't have that yet, just the cheekbone, and side of the head and neck. I'm going to go look up myofascial pain right now. I've heard about it for ages, but never looked into it to see what its about. Thanks!!

  7. nje

    nje New Member

    i know just how you feel, i`m going to my doctor friday,and tell him he`s got to give me something different for the horrific pain like i`ve never had, it starts in my left side mostly of my head,(i`m left-handed) so who knows? anyway,it goes down my face,jaw and ear,all hurting at one time.i have a heating pad,i switch from side to side,it still hurts, i even take 2 lortab 10 pills when it hurts like that,the other night, i did and you know what,it barely knocked the edge off the pain. so i`m looking for a pow wow with my doc, as he doesn`t like giving any pain meds much less any different or stronger. i`m not giving up tho,i`ve read enough of these posts to know you got to let them know you hurt,and not be pushed aside. but i have had tmj also in the past,this is not tmj,this is related to our disease fibro,and even tho my ears ache, they`re clear,no fluid,according to my ENT; its also related to this stuff. i`ve been diagnosed with this fibro for a year now,i have had pain all over days, pain in legs and arms days,now its the worst of them all the ear,jaw,headache, face days,and they are coming much more frequently than they use to. i have had them 2 days so far this week and its ,well its thursday now,and if it goes like its been going i`ll have another 1 or more this week. just do like i`m doing,fight to get the right meds you need,if you have to change doc. then do so. hope i helped. nje oh yes my sister told me today not to use dry heat, but get a moist heating pad,just thought i`d tell you. good luck .nje
    [This Message was Edited on 06/25/2003]
  8. debonlake

    debonlake New Member

    Marilyn: TMJ with face and neck pain have been my biggest problem for 15 years. TMJ and FM absolutely go hand in hand. I haven't been able to sleep on my left side for years due to the pain and tenderness. I have found that if I keep my ph in balance that it helps the muscle spasms in my shoulder and neck and that decreases the face pain. Also magnesium, malic acid, coral calcium, and 5 HTP have helped trmendously. The book Trigger Point Therapy has great hints with helping to difuse the pain in those darned trigger points with things you can do yourself. I also use use acupressure on my jaw and that helps too. If you do a search on that book, you will find alot of info. Deb
  9. tandy

    tandy New Member time it was a problem with an upper tooth(in the back near your wisdom).Another time it was a bad sinus infection~I had the head pain,cheekbone and neck was whole side of my face pretty much! Best of luck.....get it checked,you may need an antibiotic.