Chronic cephalalgia
Headache is one of the most common clinical symptoms encountered by physicians and can have a wide range of causes - from benign to severe pathologies. Proper diagnosis is complex - it requires a systematic approach, including a detailed history, physical examination, and targeted additional tests if necessary. This algorithm is a step-by-step structured diagnostic process that helps the physician determine the possible cause of the pain and select an appropriate therapeutic strategy. The algorithm applies to chronic pain, so it is necessary to exclude acute pain and its related causes.
Review
The algorithm for diagnosing and treating headaches and facial pain is interesting and appropriately highlights the complexity of possible causes of headaches. The algorithm also illustrates the often difficult diagnosis of common problems, where the general practitioner plays a key role in correctly directing the patient through the healthcare system. For understandable reasons, the issue of chronic headaches is simplified in the algorithm, but this does not detract from its educational value.
Sources
REDAKTION GESUNDHEITSPORTAL. Zähneknirschen (Bruxism) [online]. Gesundheitsportal, March 10, 2022 [cited 2025-03-30]. Available from: https://www.gesundheit.gv.at/krankheiten/zaehne/zahnkrankheiten/zaehneknirschen.html.
BERNSTEIN, Jonathan A., Roger W. FOX, Vincent T. MARTIN, and Richard F. LOCKEY. Headache and Facial Pain: Differential Diagnosis and Treatment. Journal of Allergy and Clinical Immunology: In Practice, vol. 1, no. 3, May–June 2013, pp. 242–251. [online]. Available from: https://www.jaci-inpractice.org/article/S2213-2198(13)00148-7/fulltext[cited 2025-03-30].
AL KHALILI, Yasir, Nam LY, and Patrick B. MURPHY. Cervicogenic Headache. StatPearls [online]. Treasure Island (FL): StatPearls Publishing, 2022 [cited 2025-03-30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507862/.
WIKIPEDIA contributors. Temporomandibular joint dysfunction [online]. Wikipedia, The Free Encyclopedia, last modified March 29, 2025 [cited 2025-03-30]. Available from: https://en.wikipedia.org/wiki/Temporomandibular_joint_dysfunction.
MAYO CLINIC STAFF. Temporomandibular joint disorders [online]. Mayo Clinic, 2023 [cited 2025-03-30]. Available from: https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941.
MAYO CLINIC STAFF. Temporomandibular joint disorders – Diagnosis & Treatment [online]. Mayo Clinic, December 24, 2024 [cited 2025-03-30]. Available from: https://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/drc-20350945.
Learning targets
2. The student knows the basic examination of a patient suffering from cephalgia.
3. The student understands the complexity of headache and considers causes beyond just the neurological aspect.
Key points
2. Dental etiology should be carefully considered during headache diagnosis.
3. Proper medical history taking, with consideration of occupational and social factors, including a detailed description of the pain, is essential in the diagnostic process.
