Headache and Craniofacial Pain

The Problem

Craniofacial pain, a common yet enigmatic problem, is widely recognized as one of the most daunting medical challenges.   Myriad causes, complex biomechanics, anatomy/neurophysiology and baffling presenting symptoms all contribute to widespread misdiagnosis and mismanagement.

According to the World Health Organization, the prevalence of headache alone approaches 50%.   Add to that a reported incidence rate of 10 to 26% for orofacial pain, and the resultant numbers are staggering.

The Diagnosis

Our pain detective approach allows us to assist your other doctors, dentists, orthodondists, endodondists, periodondists and maxillofacial surgeons in making treatment decisions.  As “pain detectives” our job is to employ a systematic and anatomically specific approach to avail “the smoking gun” — the cause of pain.  To that end, we combine data from the history and physical examination, imaging and electrophysiological instruments; as well as selective craniofacial and craniocervical image-guided blockade.  For temporomandibular pain our work-up might entail: TMJ fluoroscopic injection with arthrography, ultrasound guided auriculotemporal and masseteric neural blockade, and C2/3 fluoroscopic block with arthrography.

The Treatment

Spine Technology and Rehabilitation provides cause-specific treatment options to complement those of our referral sources.  Options including: 1) image-guided anti-inflammatory injections, 2) stereotactic radiofrequency ablation of craniofacial and craniocervical nerves, 3) site specific autologous biologic media (e. g. stem cell) and 4) physical therapy to allay asymmetric joint loading and to prevent recidivism.

Dr. Joseph Fortin, DO Dr. Joseph Fortin is the Medical Director at Spine Technology and Rehabilitation and a Clinical Professor at Indiana University School of Medicine.

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