Homem, 43 anos Belo Borizonte , Queixa Principal: Forte dor de Cabea e nos dentes do lado esquerdo Paciente relatou

sentir dor que comea no dente, latejante, espalha pela regio esquerda da cabea, olho lacrimeja e tende a fechar um pouco a plpebra. Cerca de 1,5 h depois a dor de cabea some e reaparece em facadas, no melhora com analgsicos e dura cerca de 3 hs por dia por cerca de 14 a 15 dias, de forte intensidade predominantemente noite. Teve a primeira crise aos 25 anos, tendo outras crises aos 29, 34, 39 e outra atualmente aos 43 anos. Relatou tambm ter sofrido uma cotovelada no queixo aos 24 anos e comeou a sentir estalos na regio da ATM tendo colocado uma placa na ltima crise com a qual obteve um alvio da dor. Relatou ainda ter realizado alguns tratamentos endodnticos em decorrncia das dores nos dentes durante as crises. Antecedentes mdico-hereditrios e Doena sistmica atual : Nenhum relato Medicao atual Decadron e amoxicilina Exames Fisico Presena de linha alba bilateral, abfraes dentais e facetas de desgaste. Ausncia dos 4 terceiros molares, endodontia dos dentes 24, 25, 26, 46, 47 e 37. Apresenta sensibilidade dos msculos mastigatrios, principalmente masseter e temporal. Realizou recentemente cirurgia de apicectomia no dente 25. Apresenta sade bucal geral boa. Complementares Rx Panormico (foram indicados rx periapical para avaliar os dentes 15 e 46) tomografia e ressonncia magntica Hiptese de diagnstico para a queixa principal: CEFALIA EM SALVAS ODONTALGIA DE ORIGEM NO ODONTOGNICA CONDUTA SUGERIDA Uso de medicamentos como sumatriptano ou ergotamina Uso de oxignio puro por cerca de 20 minutos durante a crise Realizao de uma polissonografia ENCAMIMHAMENTO PARA INTERCONSULTA Encaminhamento para neurologista Encaminhamento para realizao de polissonografia Diagnstico final CEFALIA EM SALVAS ODONTALGIA DE ORIGEM NO ODONTOGNICA

TRATAMENTO SUGERIDO TRATAMENTO PROPOSTO POR NEUROLOGISTA Male, 43 years old Belo Horizonte, Main complaint: Strong pain in the head and the teeth on the left Patient reported feeling pain that starts in the tooth, pounding, spread through the region left of the head, eye tearing and tends to close the lid a little. Approximately 1.5 h after the headache and reappears in some stabs not improve with analgesics and lasts about 3 hours per day for approximately 14 to 15 days, strong intensity predominantly at night. Had the first crisis for 25 years, with other crises to 29, 34, 39 and another for 43 years now. Also reported to have suffered a poke in the jaw for 24 years and began to feel the crack in the ATM and put a plate in the latest crisis with which obtained a relief of pain. Reported to have made some endodontic treatment due to pain in the teeth during crises. Medical history and hereditary disease-current system: No report Current medication and amoxicillin Decadron Examinations Physical Presence of midline bilaterally, abfraes and dental wear facets. Absence of the 4 third molars, endodontics teeth 24, 25, 26, 46, 47 and 37. Shows sensitivity of the masticatory muscles, masseter and temporal mainly. Held recently in surgery of apicoectomy tooth 25. Shows good general oral health. Additional Rx Panorama (rx periodontitis were shown to evaluate the teeth 15 and 46) tomography and magnetic resonance Chance of diagnosis for the main complaint: Cluster headache ORIGIN OF NON-Odontogenic Toothache SUGGESTED CONDUCT Use of drugs such as sumatriptan or ergotamine Use of pure oxygen for about 20 minutes during the crisis Implementation of a polysomnography Directing for interconsultation Referral to neurologist Referral to completion of polysomnography Final diagnosis Cluster headache ORIGIN OF NON-Odontogenic Toothache

Suggested treatment TREATMENT PROPOSED FOR NEUROLOGY