This is a 40-year-old female patient who comes to her bedside physician with daytime sleepiness and frequent nocturnal awakenings of months of evolution to which now an important temporary tension-type headache was added.
The patient was referred to the pneumologist with suspected sleep apnea syndrome, which was ruled out by appropriate tests, including polysomnography.
Since the painful component was increasing, the patient was referred to our Orofacial Pain Unit.
The clinical examination revealed a class 2 occlusion with slight occlusal wear, as well as signs and symptoms of masticatory muscle pain due to myofascial syndrome with both trigger points in masticatory muscles and covering.
The patient also complained of back pain, heavy digests and meteorism.
Treatment was established with AINES and muscle relaxants, as well as Michigan flat occlusal splint.
At 3 months, the patient came to the consultation showing an evident improvement of facial pain, although she referred bad night rest with frequent awakenings.
Upon examining the discharge splint, dark green staining-impregnation was observed, which recalled the gastric content (juice).
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With suspicion of gastroesophageal 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).
In the new review, at 6 months, the symptomatology had almost completely disappeared and the patient continued the treatment protocol for her myofascial syndrome.
