Review Question - QID 104431

This patient is presenting with a headache and bilateral temporal and jaw pain/tenderness when opening and closing her mouth suggesting a diagnosis of temporomandibular joint dysfunction.

Temporomandibular joint dysfunction presents with jaw pain that is worsened with jaw use, such as chewing. This pain may present as a headache, ear pain, and musculoskeletal pain localized to the temple or jaw. Physical exam may demonstrate joint clicking/locking and jaw pain with opening and closing of the jaw. Temporomandibular joint dysfunction may resolve on its own but other treatments include physical therapy, NSAIDs, and avoidance of exacerbating factors such as bruxism or chewing hard foods.

Incorrect answers:
Answer 1: Migraine headache presents in a young woman with a pulsatile headache, possible visual auras, nausea, vomiting, and possibly photo or phonophobia. Treatment involves NSAIDs, metoclopramide, and triptans.

Answer 2: Subarachnoid hemorrhage presents with a thunderclap headache typically in a higher risk patient such as an elderly patient with hypertension or on blood thinners. A head CT should be performed immediately followed by neurosurgical evaluation for repair of the ruptured vessel if indicated. A lumbar puncture can confirm the diagnosis.

Answer 3: Temporal arteritis presents with temporal pain and ipsilateral blurry vision typically in an older patient. The ESR/CRP will be elevated and the patient should promptly be given high dose steroids followed by a temporal artery biopsy to confirm the diagnosis. This patient's chronic symptoms and clear and reproducible symptoms with opening and closing of the jaw make temporomandibular joint dysfunction more likely.

Answer 5: Tension headache presents with a band-like, low-grade headache that can be treated with NSAIDs.

Bullet Summary:
Temporomandibular joint dysfunction presents with jaw pain and a headache as well as pain/tenderness when opening and closing the jaw.