Event 5: Christine's First Follow Up

Pain Since Beginning Treatment

Christine says both her jaw and headache pain have not improved.

Adherence to Prescriptions

Christine describes which of the prescribed medications she's taken and which she hasn't.

Mouth Guard

Christine says she bought a mouth guard from her local pharmacy but chewed through it in about two days due to her teeth clenching and grinding.

Warm Compresses

Christine says the warm compresses feel good. She uses them a lot.

Christine's First Follow Up Exam

Maximal Inter-incisal Opening

TMJ Exam

Muscles of Mastication


  • Myalgia of right masseter muscle: no improvement
  • Myofascial pain associated with right anterior temporalis muscle: no improvement
  • Tension-type headache: no-improvement
  • Parafunctional habit (e.g. grinding/clenching): no improvement
  • Anxiety with possible depression

Updated Treatment Plan

  • Trigger point injections
    • Bupivacaine - 0.5 ml to right masseter muscle and masseter muscle origin
  • Metaxalone 400 mg
    • 2 tablets 3 times daily for 2 weeks
  • Gentle passive jaw stretching exercises
  • Warm compresses prn
  • To consider custom-made occlusal appliance /professional TMJ physical therapy
  • Return to office in 2 weeks
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