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Introduction

By. Alan R. Hirsch, M.D.

What do Thomas Jefferson, Sigmund Freud, Karl Marx, Julius Caesar, Edgar Allen Poe, Lewis Carroll, Charles Darwin, George Bernard Shaw, and thirty million Americans have in common? They all suffer or suffered from recurrent, debilitating headaches. Headaches are ubiquitous in society.

Historically, the treatment of headaches is quite interesting, if not bizarre. Early therapy from old Irish manuscripts instructed the headache sufferer to pray to the eye of Isaiah, the tongue of Solomon, the mind of Benjamin, the heart of St. Paul, and the faith of Abraham. One early therapy involved placing the skins of reptiles over the face and head. Another suggestion was that leeches should be attached to the body to induce bleeding and blister formation on the skin. Still another treatment included the use of seeds from the elder tree, cow's brain and goat dung, all dissolved in vinegar. And yet another early therapy even involved the use of beaver testes bottled in spirits.

There are numerous types of headaches. Some recur and are very painful, yet pose no significant threat to the patient, while others indicate a serious disease. Fortunately, the great majority of headaches fall into the first, or benign, category. Among the more common types of this kind of headache are migraine, cluster, sinus, allergy, chemical sensitivity, and muscle contraction or "tension" headaches. It is to sufferers of these muscle contraction type headaches (constituting a large portion of the benign category) that Dr. Goldman addresses this book.

Generally, headache pain has more than one cause in a given patient at a given time. Because of the similarities of the types of pain that these different causes can create, the diagnostic challenge is great. Temporomandibular joint dysfunction syndrome must be included as a possible cause (or one of the combination of possible causes) for all headaches.

In TMJ Syndrome, Dr. Goldman has eloquently described temporomandibular joint dysfunction. Throughout medical school, this syndrome is barely touched on-perhaps covered in only a single lecture. Yet clearly millions of people suffer from this disease.

Throughout the many years I have seen patients suffering from headache and temporomandibular joint dysfunction, the number who have undergone ineffective treatment and invasive surgical management for their pain has been enormous. I have seen patients who have had all of their teeth removed; people who have had multiple operations on their jaws to alleviate TMJ syndrome. Usually, these approaches have been unsuccessful and have required further treatment.

Dr. Goldman's well thought of and conservative approach to temporomandibular joint dysfunction makes medical sense and has been successful for thousands of patients. His thoughtful and innovative style has assured the diagnosis and successful treatment of temporomandibular joint problems and has also led to the diagnosis of diseases that mimic temporomandibular joint dysfunction. Clearly, Dr. Goldman is to be commended as an example for all of us in the medical community who deal with headache and temporomandibular joint pain.

Alan R. Hirsch, M.D. Neurologist, Director Hirsch Headache Center Chicago, Illinois