Introduction. Orofacial muscle spasm is a major problem, as the diagnosis and detection of the causes of muscle pain in the face is difficult because of the variety of clinical symptoms. Complexity of diagnosis often leads to a prolonged and ineffective treatment. Muscle function disorders play a crucial role in the processes of change in contractile muscle, manifested in the form of increased tone of the muscle and leading to its hypertrophy. Features of the central regulation of muscle function, related to the activity of trigeminal nerve, the nuclei of which are related to the reticular system of alerting, cause a correlation between feelings of fear, anger, pain, and increased tone.
Case presentation. We examined 6 patients with complaints of headaches and pronounced diffuse regional pain (oromandibular and temporal region) with an apparent hypertrophy of the temporal muscle, fatigue masticators muscles in the evening and after the conversation, “violent clenching of teeth”. As a result of a neurological examination, patients had the following diagnoses: tension-type headache as a manifestation of the myofascial pain syndrome in patients with temporal muscle hypertrophy (3 patients), bruxism (teeth grinding) (1 patients), psychogenic headache (1 patients), the side effects of drugs “Salmeterol” (1 patients). All patients had favorable response to treatment with muscle relaxant “Tolperisone” (150 mg orally three times a day) and anxiolytic “Hydroxyzine” (25 mg orally three times a day) with a positive effect from 10–14 days and marked 27–32 days of treatment with 3 patients showed a decrease (38–44 days of treatment) and the complete lack of effect, while increasing doses twice for 2 weeks. In these patients, a positive trend was observed from a first injection of Botulinum toxin (20 units “Disport”) in the region of the temporal muscle, an average of 7– 10 days after injection.
Conclusion. Thus, the traditional use of muscle relaxants and anxiolytics for the purpose of removing myofascial pain syndrome results in therapeutic effect after 3–4 weeks. When using Botulinum toxin, effect became much earlier — on the second week of treatment. An important effect of Botulinum toxin is a quick cosmetic correction of facial muscles hypertrophy.