Migraine Headaches, Cluster Headaches, Tension Headaches, Temporal Arteritis, Cervicogenic Headaches, Headaches related to Temporomandibular Joint Disease.

Physical Exam Findings:

Cervical ranges of motion were limited in lateral bending, flexion, extension, and rotation bilaterally. There was pain at the end ranges of motion. Dermatome evaluation, muscle strength tests and reflexes were normal. Cranial nerve evaluation was unremarkable. Cervical compression tests were negative for radiculopathy. Fixations existed at the right occiput as well as C1 in flexion on the right. There were cranial faults at the mastoids, temporal bones, and zygomatic arches bilaterally. Cervical flexors and upper cervical spine muscles were contracted. There seemed to be normal muscle tension around the patient’s skull.

TMJ evaluation by Vertical Range of Motion scale indicated that there was limitation of full open to 35mm out of the normal 60mm. There was a lateral shift to the right of 3 mm at 25 mm open. There was a click at the lateral shift upon opening. Palpation of the TMJ indicated spasms of the mastoids and temporalis muscles. Internal evaluation of the lateral pterygoids bilaterally indicated tight painful and spastic muscles bilaterally. This patient is unaware if they clench or grind their teeth at night.

Question: What is your working Diagnosis at this point?