Headaches

Eighty percent of facial pain patients have related headaches. Treatment of TMD often lessens and resolves many chronic headache issues for these patients. However, not all headaches are caused by TMD and there may be other causes such as sinus, neurological, infection and tumor. Because headaches are so prevalent in TMD patients, all orofacial pain specialists must be familiar with the diagnosis and treatment of headache. There are some headaches that will be treated in the orofacial pain center and others that will be diagnosed and referred to neurologists.

Migranes:

Migraines are severe headaches that are most common in women (67%), tend to peak at age 30 and lessen with age. They are often triggered by light, odors (e.g., perfume, gasoline), foods (e.g., chocolates, aged cheeses), irregular sleep hours, monthly menses, etc. Migraines may last for hours or days.

Typical symptoms are:

• Aura – Optical changes that occur 20 minutes before a migraine. You may see shimmering lines, lose the words on a page as you read, some people even lose vision, or become numb on their face or limbs. Aura tends to occur when a person is younger and often will disappear even though the headaches persist. Most migraineurs do not experience aura consistently.
• One sided throbbing headache – 60% of migraines follow this characteristic.
• Light sensitivity – Is the most common symptom.
• Sound sensitivity
• Headache increases with exertion
• Nausea – The typical migraine patient wants to retreat to a cool, dark room to lie down. Some patients may vomit.

Tension-Type Headache:

Tension-type headaches are the most typical headaches and tend to be less severe than migraines. They are associated with stress and muscle fatigue—feeling like a pulling, squeezing headache on both sides of the head with a “band-like feeling” across the forehead, temples and the back of the head.

Combination or “Mixed” Headache (Chronic Daily Headache):

Many headache researchers believe that all headaches are related and that, depending on your age, sex and physical condition, you may not experience pure migraine or tension headaches but have some symptoms of both as your headaches become more chronic. This type of headache sufferer also may have rebound headaches (they get into a vicious cycle where the more pain relievers they take, the more the headaches persist). Combination or mixed headaches are very difficult to treat.

Sinus Headaches:

Sinus headaches are actually less frequent than most people believe and the American Headache Association has estimated that 90% of sinus headaches are actually migraines. The symptoms are similar and they tend to last the same duration. Also, migraine and other variants of migraine tend to cause red eyes, tearing and runny nose. The easiest way to tell a sinus headache from a migraine is that sinus headaches tend to be positional, meaning that if you lower your head the headache will increase with increased sinus pressure. Also, sinus headaches are relieved with antihistamines and decongestants, whereas migraines are not.

Cluster Headaches:

Cluster headaches are a more uncommon type of headache, which tend to strike at certain times in “clusters” and then may go away for weeks or months at a time. They are much more prevalent in men than women (6:1), tend to peak at age 30, and are related to smoking and drinking. Cluster headaches are remarkable in their timing— usually attacking patients at the same time of the day and often waking them at night. Cluster headaches are the most painful type of headache and differ from migraines because they tend to center in one eye, and cause tearing and drooping eyelids. Instead of the patient wanting to lie down, the cluster headache sufferer tends to be very agitated, often pacing the room and rubbing the painful eye, which feels like it has a stabbing pain in it.

There are many other forms of headache listed by the International Headache Society (IHS). They may be related to exertion, temperature, high intracranial pressure, altitude, medication, etc., but there are certain “red flags” that will present a true medical emergency or are of immediate concern.

• “First worst headache” – A severe headache in a patient with no previous history that increases with no break may be a sign of blood in the cranial cavity (subarachnoid hemorrhage), which requires immediate attention.
• New headache in the elderly – Headaches tend to be a problem of younger people and sudden appearance of headache in the elderly may be a sign of a serious underlying disorder (e.g., stroke).
• Headaches with accompanying fever or neck stiffening may be a sign of a nervous system infection such as meningitis.
• Any headache with loss of consciousness or obvious mental impairment.

No patient wants to take a lot of medication and some headaches can be controlled by certain common sense practices. If you are headache prone, be sure to:

• Get regular sleep.
• Avoid alcohol or smoking, and foods that trigger your headache.
• Learn relaxation techniques along with massage.
• Avoid direct sunlight and noisy environments.
• Caffeine can help migraines but may trigger other headaches.
• Some people believe good, healthful nutrition along with the addition of a dietary supplement such as magnesium can be helpful.

The orofacial pain dentist can help headache patients if they have associated muscle pain by utilizing splints, physical therapy, injections and Botox. TMD can often be a trigger or make both migraine and tension headaches worse. However, many headache sufferers still may need prescription medication.

Abortives:

Abortive migraine medications are taken to stop the migraine from progressing. They are relatively safe but must be used with caution in people with blood pressure and heart problems since they constrict blood vessels. The most modern and standard medications are the triptans (e.g., Imitrex®), which can be taken in pill form, inhaler, or injection. Abortives can lead to increased headache frequency if used too often and should be limited to 4-6 uses a month. There are other older abortives (e.g., Cafregot®), which are less frequently used. Be aware, two abortive medications should never be mixed.

Prophylactics:

For patients who suffer from frequent migraines. daily preventive medications may be necessary and could include beta blockers, tricyclic antidepressives and anticonvulsives. These medications often have many side effects, including sedation, weight gain and dry mouth. A relatively new medication, Topamax®, has been shown to cause weight loss in many migraine sufferers, but it has sedation and memory loss side effects.