The patient was a 40-year-old female patient who presented to her general practitioner with daytime sleepiness and frequent nocturnal awakenings over a period of months, to which was now added a significant tension headache in the occipital and temporal regions. The patient was referred to the pulmonologist with the suspicion of sleep apnoea syndrome, which was ruled out by the relevant tests, including polysomnography. As the pain component was increasing, the patient was referred to our Orofacial Pain Unit. The clinical examination revealed an Angle class 2 occlusion, with slight occlusal wear, as well as signs and symptoms of masticatory muscle pain due to myofascial syndrome with trigger points in the masseter and sterno-cleido-mastoid muscles on both sides. The patient also reported back pain, heavy digestion and meteorism.
Treatment was started with NSAIDs and muscle relaxants, as well as a Michigan type flat occlusal splint.
After 3 months, the patient came for consultation showing a clear improvement in facial pain, although she reported a poor night's rest with frequent awakenings.
On examining the splint, a dark green staining-impregnation reminiscent of gastric contents (juice) was observed...

Suspecting gastro-oesophageal reflux, the patient was referred to the gastroenterologist, who after performing the relevant tests (Ph-metry and endoscopy) confirmed the diagnosis.
The patient was treated with diet, postural measures and proton pump inhibitors (Omeprazole).
At the next review, after 6 months, the symptoms had almost completely subsided and the patient continued with the treatment protocol for her myofascial syndrome.

