Fibromyalgia of the Head and Neck

Fibromyalgia Syndrome (FMS) of the head and neck is like that occurring elsewhere in

the body. It is typified by pain of variable duration, 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”.


MayoClinic. com

Consumer Reports/Sept 2011, pg.23


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