James W. Correa D.D.S. - Center for Cosmetic Dentistry & TMJ Institute - Call 949.706.2100

Headaches Defined- Symptoms and Treatment

November 09, 2008 @ 11:30 AM -- by
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The human body is amazingly complex. The more that is known about it the more we realize what is not known. In other words, "we don't know what we don't know." This cliche applies to medicine and applies to dentistry as well. When it comes to headaches there can be a myriad of causes. Statistically, most headaches fall into the tension-type category. These tension headaches can be the result of TMJ disorders and/or neuromuscular imbalances within the entire stomatognathic system.

Here, at the TMJ Institute for TMJ disorders, Orange County, treatment for tension-type headaches is addressed effectively utilizing computerized electrodiagnostic instrumentation. TMJ dysfunction is first identified as the causative factor. If the diagnosis of temporomandibular joint dysfunction is not the causative factor, then a referral to the appropriate specialist is made.

The following are terms used to categorize the types of headaches and their symptoms and treatments. These are only guidelines and not to be considered as all inclusive.

TMJ Headaches- Referred to as "cephalgia", TMJ headaches are characterized by head pain of moderate to severe intensity and duration. Symptoms include dull, aching pain around the ear, face, temples, neck, back of head, back of eyes, and shoulders. The presence of a clicking or popping jaw joint may or may not be audible. Causes of TMJ based cephalgia are listed below:

  • Malocclusion (improper bite)
  • Misalignment
  • Trauma/blow to the jaw or head
  • Excessive yawning or prolonged periods with the mouth open too wide
  • Clenching or grinding the teeth
  • Loss of teeth, especially the back molars
  • Cervical traction involving the head, jaws, and neck
  • Compromised tongue position
  • Upper airway constriction, resulting in chronic mouth breathing, snoring, and malocclusion
  • Poor posture (hip tilt, asymmetrical body mechanics, scoliosis)
  • Arthritis

Treatment consists of removing the root cause of the headache. This is why diagnostic instrumentation is so vital. Once the diagnosis of cephalgia secondary to TMJ Dysfunction is made, treatment can commence. The goal of treatment is to restore normal function by creating ideal anatomic relationships, establishing balance between the anatomy and physiology, and bringing harmony between the teeth, muscles, and joints.

This is accomplished by the construction of a phase 1 neuromuscular orthosis for bilateral joint stabilization, followed by a phase 2 protocol of Neuromuscular Functional Orthodontics and/or comprehensive neuromuscular dental reconstruction.

Allergy Headaches- Many people suffer from allergy headaches as a result of the allergens in the environment. They will display at times congestion of the sinuses and/or eyes that are watery. People are responsive to many types of allergens incorporated in such things as molds, pollens, and various foods. The presence of sulfite preservatives in wine has led some wine connoisseur to minimize consumption. Although antihistamines can be taken to help resolve many of these issues, it is better to find out what exactly the origin of the allergy is, and then eliminate it from the exposure experience.

Aneurysm Headache- This condition is serious. Basically, what happens is a weakness in the blood vessel develops into a balloon- like shape that may leak blood into the surrounding tissues of the brain causing the headache. If the wall of the blood vessel ruptures completely, it results in stroke. Prevention becomes the best cure in this case. High blood pressure needs to be monitored and medication taken if necessary. High blood pressure (hypertension) is known as the silent killer because there are few signs and symptoms other than the headache. As a TMJ dentist treating TMJ disorders in Newport Beach, blood pressure readings are taken at the beginning of each and every appointment. It is never assumed that the blood pressure is normal. Before TMJ dysfunction is considered, a differential diagnosis of hypertension must be ruled out. Hypertension (high blood pressure) will cause a headache that is similar in effect to a TMJ headache.

Arthritis Headache- Arthritis is a result from an inflammatory process in the body usually associated with bones, joints, and osseous sutures. The Temporomandibular joint does develop arthritic changes in the form of osteogenic degeneration that is accompanied by morphological changes in structure. A change in the anatomic relationship will give way to dysfunction. Cranial sutures in the skull have been documented as non-fixed and therefore movable by the influence of muscle pull. Arthritis headache by itself has no cure at this time. However, the common presence of chronic muscle spasm, cranial lesions, and dysfunctional joints can be treated concomitantly with TMJ disorder protocols along with pharmaceuticals such as anti-inflammatory drugs, muscle relaxants, and even osteopathic manipulations. Again, accurate diagnosis is fundamental to treatment management.

Caffeine Withdrawal Headaches- Like other kinds of withdrawal symptoms, the immediate removal of a substance like caffeine from the system can and will affect the physiologic balance of homeostasis in the body. Stimulants like caffeine have the effect of constricting the diameter of blood vessels. Consuming caffeine continuously, and in significant quantities, will maintain blood vessels in a state of reduced blood volume output. When the caffeine consumption is abruptly halted, there is a dilation effect that results. The blood vessels rebound with an instant increase in blood flow that causes throbbing headache symptomology. This can be contained more predictably by slowing the elimination program of caffeine withdrawal so that the cellular alteration of the vessel wall can passively accommodate.

Cluster Headaches- Cluster headaches occur predominately in males between 20-50 years of age. The headache has been described as the presence of excruciating pain within the craniofacial region and particularly the eye. Because of the frequent occurrence of the headache episode originating during the night, it is thought that excessive alcohol consumption and nicotine use may be a precipitating factor in the etiology of the headache. Naturally, the treatment would be elimination of these abuses. Occasionally, the use of steroids, calcium channel blockers, and lithium may be indicated for prevention.

Exertion Headache- Exertion headaches as the name indicates are initiated by bouts of over exertion related to heavy physical activity. It is described as generalized head pain (cephalgia) lasting a few minutes to a few hours. Most causes stem from migraine related origins, although, a small percentage is caused by organic disease. A definitive diagnosis is essential in determining the treatment protocol.

Eyestrain Headaches- Visual disturbances can result in headaches that mimic other facial related dysfunctions such as in TMJ disorders. In Orange County, the TMJ Institute recognizes the similarities and differences between neuromuscular and ophthalmological etiologies of muscle dysfunction using computerized electrodiagnostic instrumentation. Naturally, with eye related pain, the appropriate referral is made for correction of visual abnormalities of a pathologic nature.

Fever Headaches- Fever headaches superimpose themselves with sinus headaches due primarily to the presence of infection. Inflammation of the blood vessels result in generalized head pain. The appropriate treatment for fever is something that will reverse or minimize the swelling. Antibiotics are normally indicated. Aspirin is good because aspirin has three excellent qualities: anti-pyretic (fights against infection), anti-inflammatory (reduces inflammation and residual pain), and is analgesic (effectively blocks pain perception). A combination of analgesics and anti-inflammatories also provide effective relief against headache pain.

Hangover Headaches- Most people at some point in their life have suffered from too much ETOH or more commonly known as alcohol. After this type of learning experience, a change in behavior usually follows. For those less fortunate, learning to modify intake could be more challenging. Pain symptoms include migraine-like throbbing sensations which makes one feel like being "run over by a mac truck." Physiologically, it is the blood vessels that take the hit, resulting in vessel dilation, irritation, and pain. Treatment for some is to consume some coffee (leaded). Most can't go wrong, however, with lots and lots of water and a strong aspirin. And, of course, be wise and refrain from alcohol at least, if possible, until symptoms cease.

Hunger Headaches- Hunger headaches are more common now because of our fast society. Meal skipping occurs more often and results in drops in blood sugar. Radical diets and fasting alter the body's homeostasis which can trigger changes in blood physiology and vessel dilatation reactions. Most people in America do not suffer from this problem, although, there are some that do. Basically, the treatment is very simple-EAT.

Hypertension Headaches- The TMJ Institute of Newport Beach focuses acutely on each TMJ Disorder patient and general dentistry patient as well. It is well known that hypertension headaches mimic TMJ headaches very closely. They both can be generalized or localized. They can last for minutes, hours, days, or weeks. The differential diagnosis is made simply by taking the blood pressure reading at each and every visit. Once the blood pressure gets under control, the headaches disappear. On the other hand, TMJ headaches will continue to persist until balance is achieved between the teeth, muscles, and joints.

Menstrual Headaches- Menstrual headaches, obviously, are cycle related. They can occur at the time of ovulation or before, during, or after menstruation. These types of headaches are characterized by migraine-like pain of various durations depending on the variations of estrogen levels. Treatment recommendations point towards anti-inflammatories, analgesics, and/or endocrine management.

Migraine Headaches with/without Aura- These types of headaches are the most difficult to identify and treat. They are described as unilateral throbbing of unknown origin. There may be present photophobia (light sensitivity) with associated clamminess, nausea, and/or vomiting. "Aura" means that there is a predictable prodromol period that comes as a warning before the headache strikes. There can be many causes ranging from hormonal imbalances, dietary influences, emotional and genetic origins, changes in weather, and medications. Treatment protocols must be customized and physician based which may involve the dispensation of specific pharmaceuticals.

Post-Traumatic Headaches- Headaches in this category stem from trauma to the body. Pain is usually muscular in origin, however, a thorough diagnostic workup is required for accurate differentiation. Motor vehicle accidents (MVA) account for many of these episodes. Head trauma many times occurs simultaneously with whiplash. In these cases, changes in the cervical physiology will affect craniomandibular function. In Orange County, the TMJ dentist must comprehensively evaluate the MVA/TMJ disorder patient. Cervical discomfort and jaw pain go hand in hand. Sometimes, pain can be delayed for 6 months or more. A patient with a pre-existing condition of subclinical TMJ dysfunction who sustains injury in a MVA will most likely demonstrate a full blown TMJ disorder that becomes debilitating. The post-traumatic headache reveals itself only as the "tip of the ice berg".

Temporal Arteritis Headaches- Temporal arteritis is a condition involving inflammation of the temporal artery located in the front sides of the head. It is described more like a sharp, burning-like pain reflective of the pulse of the blood flow. It is unknown as to the exact cause but is thought of as falling into the category of an immune disorder. When treating patients at the TMJ Institute for TMJ disorders in Newport Beach, it is important to recognize this condition. The use of Tens (transcutaneous electroneuro stimulation) is contraindicated for patients with temporal arteritis. Tens is a therapeutic tool utilized for the relaxation of chronic hypertonicity of jaw musculature.

Tension-Type Headaches- Tension- type headaches have been classified in the past as their own category. However, it is now known that these types of headaches have their root cause within muscle. Stress and tension cause the jaws to clench and results in chronic muscular hypertonicity and residual contracture. In many instances, a trigger point referral pattern is sustained from the development of a neurological engram. When muscle is held in a state of chronic contracture it becomes fatigued and spasmodic. It becomes filled with the presence of lactic acid and other toxic byproducts of anaerobic glycolic metabolism. The muscle fibril also becomes depleted of ATP which is the cell's equivalent of energy currency. ATP or adenosine triphosphate is chemically required for both muscle contraction and relaxation, and for the sliding formation of the actin-myosin bridge interchange. ATP depletion does not permit the muscles to release or relax and keeps them in a chronic state of contraction. The use of Tens helps to relax muscles in spasm. At the TMJ Institute for TMJ disorders in Orange County, it has been found that tension-type headaches are really TMJ headaches that are secondary to craniomandibular and craniocervical imbalances in which the temporomandibular joint is in an altered state of pathology. Treatment for tension or TMJ headaches is based on the etiological cause. Once a definitive diagnosis is discovered, a non-surgical jaw stabilization protocol by the use of a neuromuscular orthosis is implemented. Early detection and treatment results in the most excellent prognosis.

Tic Douloureux Headaches- TD headaches can be very painful. They are described as sharp, piercing nerve-like sensations within the face. Stemming from the trigeminal nerve (cranial nerve 7), the nerve bypasses the spinal cord and leads directly to and from the CNS (central nervous system). The etiology of the disease is unknown. It sometimes can be confused with TMJ disorders because of the same neurologic pathways encountered. Treatment prognosis is uncertain. Medications can help such as anticonvulsants or muscle relaxants.

Tumor Headaches- The presence of neoplasm within the body is a serious condition necessitating a full medical workup and evaluation. Headaches from cancer are just one symptom of many other disturbances. The TMJ Institute of Newport Beach for TMJ dysfunction does not assume that incoming patients with headaches are limited to TMJ headaches only. A differential diagnosis is mandatory before TMJ treatment or medical referral.

Sinus Headaches- Sinus headaches may be confused with temporomandibular joint disorder headaches because of the close proximity and overlapping location of the sinuses to the jaw musculature. However, they are easily recognized because of the presence of infection and drainage. Direct pressure over the cheek region will elicit tenderness. Bending over downward to waist level will also cause some degree of pressure tenderness.

If anyone of you suffer from these conditions, it would be prudent of you to seek medical attention. Patients at the TMJ Institute of Newport Beach are referred back to their physician if they do not have a TMJ disorder. Newport Beach, Newport Coast, Irvine, Laguna Beach, Laguna Hills, Huntington Beach, Corona del Mar, and Laguna Niguel are areas immediately serviced by the TMJ Institute.