Fibromyalgia Syndrome (FMS) of the head and neck is like that occurring elsewhere in
the body. It is typiﬁed by pain of variable duration, find quality ( dull or sharp), and intensity.
Many patients with FMS, (about 50%) may suffer from chronic headaches of either the
tension or migraine type. These headaches can be severely debilitating.
Tension headaches are caused by the spasming of muscles in the shoulders, neck, jaw,
back and head. The most common description is of a band or vise tightening around
the entire head. They typically last several hours and can be moderate to severe in
Migraine headaches are cause by the constriction and or spasming of the blood vessels
to the brain. They can be triggered by light, fatigue, stress, illness. Migraine pain is
severe and can be accompanied by nausea and or dizziness. Migraines are often
heralded by visual disturbances just prior to the onset of the pain. Unfortunately
migraine pain can be exhausting and worsen tolerance of the FMS pain. There is a
higher incidence of depression associated for FMS patients with migraines. Treatment
and management of headaches is best managed with a combination of the FMS
medications and adjunctive therapies such as breathing exercises, stress management,
relaxation techniques, exercise. Interestingly, many of the medications used to treat
migraines, e.g., anticonvulsant drugs and antidepressants are also very effective in
treatment of FMS.
It has been reported that as many as 97% complain of jaw and facial pain which often
presents as Temporo-Mandibular Joint Dysfunction Syndrome (TMJDS). Symptoms
may radiate from the key “tender spots” of the neck and shoulders typically seen with
FMS or they may be independent. The symptoms include, extreme tenderness upon
palpation of the area; tenderness with normal opening/closing; pain with chewing and
other normal movements of the jaw such as talking, yawning or sneezing. There is
often an associated decrease in range of motion of the joint due to the patientʼs
attempts to limit the pain. If range of motion is limited over a prolonged period an actual
physical constriction and shortening of the muscles may occur. In addition, the pain of
FMS may also lead to clenching and or teeth grinding (bruxism).
Despite itsʼ presentation as TMJDS, the cause is usually pain in the ligaments and
muscles of the joint and face rather than an actual anatomical derangement or
anatomical damage to the joint itself. Further, there is no actual inﬂammation leading to
permanent tissue damage or deformation.
Nevertheless, the symptoms of FMS induced TMJDS are best treated with some of the
typical TMJDS treatments in conjunction with the FMS medications used to ameliorate
the other somatic pains and sleep disturbances.
Typical TMJDS treatments include compresses (temperature dependent upon the
patient), daily full range of motion exercises done with the aid of the compresses for
comfort or even in the shower if warmth is tolerated, a soft diet that avoids all hard,
chewy or crunchy foods. A hard plastic occlusal guard commonly known as either a
“bite plate or night guard” should be fabricated to alleviate the potential damage to the
dentition from the clenching/bruxism. Acupuncture may also be an excellent adjunct
therapy as provided by a licensed and knowledgeable practitioner. Similarly deep-tissue
massage may be as beneﬁcial. In a recent Consumer Reports survey more than 50%
of those who used massage therapy found it “helped a lot”.
Consumer Reports/Sept 2011, pg.23