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First published , Elsevier Limited. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. First edition ISBN British Library Cataloguing in Publication Data. A catalogue record for this book is available from the British Library.

Library of Congress Cataloging in Publication Data. A catalog record for this book is available from the Library of Congress. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided i on procedures featured or ii by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications.

It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the Editors assume any. The Publisher. Printed in China. The Publisher's policy is to use paper manufactured from sustainable forests. California, USA. Director, Spinal Education Group, Australia. Monash Medical Centre, Australia. Principal, Camberwell Medical Centre, Australia. Clinician, Headache Centre of Victoria, Australia. Headache is one of the most complex and demand- ing areas of clinical practice.

The challenge is to understand the pathophysiology, achieve an accu- rate diagnosis, and offer useful remedies. Second- ary headache may be the key symptom of a major nervous system disorder which requires urgent diagnosis and treatment in itself.

In an ill patient, who has other symptoms and signs of a major neuropathological problem, diagnosis may be straightforward, but that is not always the case — for example, in distinguishing a sentinel bleed due to a cerebral berry aneurysm from a migraine event.

Primary headache syndromes are common but there is some disagreement between experts both within and across fields as to the major pathogenic mechanisms. Most clinicians would now accept the view, long prevalent in neurology, that migraine is a discrete entity; it can be identified on the basis of established criteria and divided into migraine with or without aura known previously as common and classical migraine respectively.

The delinea- tion of migraine leads the clinician and patient down a particular diagnostic and therapeutic pathway looking for identifiable triggers, establish- ing treatments that work for acute episodes, and developing a regimen for prophylaxis which is indi- vidualised for a particular patient. The majority of patients with persistent headaches do not have secondary headaches, at least in terms of underlying major neuropathologi- cal disorders, and do not have migraine or vascular headache syndromes.

This is perhaps the most contentious and difficult field in terms of under- standing pathophysiology. Tension-type headache, the predominant headache type in this group, can be thought of either as being related predominantly to anxiety or emotional tension, or to muscle tension or myofascial pain. When I started neuro- logical practice many years ago, a majority of patients in this category were probably thought to be suffering from stress or depression.

Undoubtedly that continues to be a factor in some. Any patient with chronic headache. Over the last 30 years, a great deal of work has gone to identify factors which trigger myofascial headache.

These include the whole field of temporomandibu- lar disorders, bruxism, and the area of cervicogenic headache which are now recognised as major underlying pathophysiological factors. Today the pathophysiological factors which underlie chronic primary headache are better understood.

Healthcare workers have also become increasingly aware of the potential range of presen- tations of secondary headache that require urgent investigation and potential treatment. The pleth- ora of factors which underlie chronic myofascial headache is also becoming an increasingly well understood pathophysiological domain.

As a result of these advances the treatment of primary headache in particular has become more and more a multidisciplinary task. Most patients with primary and secondary headache present to the family doctor and it is crucial that the doctor has a good understanding of the types of headache which require more urgent or specific investiga- tion.

Having excluded other pathologies as appro- priate in particular presentations, the family doctor needs to know the presentations and diagnostic features of migraine and, increasingly, the range of factors which may trigger and prolong primary myofascial headache syndromes.

This is an increasingly complex area which may require involvement of specialists from a number of domains to achieve the best result for individual patients. Chronic headaches are all too commonly. Every effort should be made in.

This book is one of the best that I have seen in drawing together the various clinical issues paramount in the optimum management of headache not only for the family doctor but also for specialists active in headache management. There are chapters coveri ng acute presentations of major neuropathology and the factors the family doctor and other primary health workers need to look for are well set out in early chapters. There is a good discussion of migraine and its unique aspects which opens specific therapeutic possibilities.

Most importantly in the context of the book there is an excellent discussion of the various factors which underpin myofascial headache notably in the areas of psychology and psychiatry, temporomandibular disorders and bruxism and cervical spine problems which act as head ache triggers and sus- tain chronic headache syndromes.

Clinicians who read this book from cover to cover will have a good grounding of modern diagnostic and management concepts in headache. They will recognise that it is often appropriate to. The individual sections are self standing and the family doctor or therapist wanting to find more about any of the diagnostic areas and specific therapeutic approaches discussed in this book would find the information easily.

I commend this book as an excellent multidisciplinary contri- bution to the management of headache syndromes at the beginning of the 21 s t century. It brings together a range of distinguished contributors from Australia and around the world, notable by having great clinical experience in the field of headache across all relevant disciplines. The section deal- ing with diagnosis is excellent and the chapters dealing with approaches in the area of chronic daily headache are particularly useful.

Some knowledge of this area is essential for any clinician seeing large numbers of patients with headache and taken together the book provides an excellent overview of pathophysiology, diagnostic considerations and the range of approaches that have emerged.

The editors of this excellent multi-author volume, Peter Selvaratnam, Ken Niere, and Maria Zuluaga, are to be congratulated for producing this timely contribution to the management of headache, orofacial pain and bruxism. The impetus for this book comes from our clinical practice. Patients often present with headaches that clearly do not arise from a simple musculo- skeletal source. The overlap of symptoms in patients present- ing with headache, orofacial pain and bruxism provides challenges in disentangling symptoms, identifying sources and contributing factors, and arriving at an accurate diagnosis.

Because there are so many structures associated with this region it is often beyond the expertise of a single practi- tioner to address the problem without the assis- tance of colleagues from a variety of specialties.

This book has been written by clinicians for clinicians. It contains the collective knowledge of hundreds of years of clinical experience. Authors have described evidence-informed clinical prac- tice derived from anatomical, physiological, and biomechanical concepts. Anecdotal evidence, based on clinical experience, is presented because it provides clinical instruction and the inspiration for more rigorous research to validate and refine practice.

Some treatments have substantial evi- dence to support their use. Other treatments seem to work clinically but are yet to be validated by detailed research. Where it is available, empir- ical evidence for the management of headache, orofacial pain and bruxism has been provided by the authors.

The book aims to provide clinicians with the theoretical and clinical information to improve the management of patients with headache and orofacial pain and to appreciate the role of the different disciplines involved in the management of symptoms in these regions.

Once this is achieved, patient care can be optimised through appropriate referral and an interdisciplinary team approach. A substantial proportion of the book is devoted to the identification of contributing factors to aid accurate diagnosis of headache, orofacial pain, and bruxism.

The process of diagnosis and ap- propriate management begins with the general practitioner and other primary contact practi- tioners. The recognition of conditions that require immediate and urgent medical treatment is intro- duced in Chapter 1 and explored more fully in Chapter 2.

Migraine is singled out for special treatment because it is such a debilitating and often misdiagnosed condition. Headache in child- hood and adolescence is also considered sepa- rately because of the concern that is always associated with severe headache in the young.

The regions involved in and the underlying basis of the production of headache and orofacial pain are then discussed. Chapters 5 to 12 provide an account of the anatomy and physiology of the regions involved in the production of head- ache and orofacial pain. To justify any interven- tion we must be able to measure its effect on the patient and their lifestyle, thus issues involved in the measurement of pain and headache are discussed in Chapter Chapters 14 to 22 pres- ent approaches from a range of disciplines: phys- iotherapy, chiropractic, osteopathy, integrative medicine, dentistry, psychology, and psychiatry.

Where appropriate, specific treatment modalities are discussed in those chapters. Chapters 23 to 27 focus on specific interventions. Those who read this book from cover to cover will find that some information is repeated across chapters.

This illustrates a degree of commonality across disciplines. We have tried to ensure that each chapter can be read in isolation and thus some overlap is necessary. While there is no sepa- rate chapter on diagnostic imaging, even though it is vital to the differential diagnosis of certain con- ditions, we believe that is has been addressed appropriately in relevant chapters; as always,.

Although primary headaches such as tension-type headache and cluster headache have been mentioned in some chapters, we believe that a detailed account of the management of these and less common pri- mary headaches is beyond the scope of this text. Most texts have been discipline-specific in the management of headache and orofacial pain.

This book draws on the knowledge and clinical exper- tise of a range of practitioners all of whom are. It encompasses and acknowledges their role in working with patients who suffer from these often debilitating symptoms.

Our aim is for this book to inspire clinicians to use a multidisciplinary approach and to communi- cate with other health professionals in the man- agement of headache and orofacial pain.

Our hope is that our readers will remain open to new ideas and paradigms as they continue to strive for optimal patient management. There are many people who have contributed to this book.

We are indebted to the authors who have so willingly given their time, knowledge and experi- ence in the preparation, review, and final presen- tation of their chapters. We are confident that their contributions will be of assistance to clini- cians in the management of headache, orofacial pain, and bruxism. We particularly want to express our deepest thanks to Judy Waters. As style editor Judy initi- ally liaised with Elsevier on the concept of this book and then spent innumerable hours reviewing and preparing each chapter for publication.

Her unrelenting enthusiasm, encouragement, and sup- port have been most stimulating and motivating. Judy has been a tower of strength throughout and her wise advice has been pivotal in the com- pletion of this project.


Cadenas Musculares, Las - Tomo V

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Las cadenas musculares : miembros inferiores. Tomo IV



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