Abstract
Case summary: The patient was a 42-year-old man. His chief complaint was sharp pain in the left temporal region, masseter, and neck. When he became busy and exhausted with work, the frequency of his tension-type headaches and pain intensity were exacerbated. No abnormalities were found in a thorough neurosurgical examination, and he was referred by his primary dentist to an oral surgeon for examination for suspected temporomandibular disorder. At that hospital he was diagnosed as headache caused by temporomandibular disorder, and underwent jaw exercise and splint treatment. However, his headaches continued to worsen and he was referred to our department for examination. Because the headaches occurred on consecutive days, he had been taking 3-4 tablets of 60mg loxoprofen sodium each day for 3 months prior to the examination. From the transition of episodic tension-type headaches to daily headaches and other findings, he was diagnosed as medication overuse headache; MOH. First, he was immediately taken off of loxoprofen sodium. At the same time amitriptyline was started to prevent tension-type headaches and diazepam was started to ease anxiety. The following day his headache was alleviated to less than one third. The dose of amitriptyline was gradually increased to 50mg/day, and his severe headaches nearly disappeared.
Discussion: MOH was diagnosed from the fact that the headaches began to occur daily as he started taking a daily dose of analgesic. The pain was also thought to be exacerbated by strong anxiety toward the pain.
Conclusion: This patient had been diagnosed as headache attributed to temporomandibular disorder, but he had both MOH and strong anxiety. For accurate diagnosis, it is necessary to have knowledge of not only toothache and temporomandibular disorder but also headache disease.
