HEADACHE TREATMENTS

Headaches can be defined as a continuous painful sensation in any part of the head. It can range from mild dull aching pain to throbbing or sharp shooting pain. It can occur on either our side, or bilaterally or can be concentrated on a specific location or may be referred to other areas as well. Headaches can be caused due to various factors. It can present with or without an underlying disease. A lack of sleep, missed meals, loud voice, incorrect power of spectacles, stress or even travelling can trigger headaches in some patients. A cold/nasal congestion or fever or simusitis can be accompanied with headaches. There are different types of headaches:-

• 1.Tension type headache
• 2.Cluster headache
• 3.Migraine
• 4.Thunderclap headache etc.

All these are primary headaches secondary headaches are those which are caused due to an underlying problem. It includes referred pain from a decayed tooth, post concussion headaches to life threatening medical conditions like meningitis. Therefore Headache Treatments also varies according to the root cause. Around 40-60 % of Headache/ Migraine presenting without a specific cause can be due to Temporomandibular Disorders. Approximately 70% of TMJ patients are present with frequent episodes of severe headache. These patients don't realize the underlying reason behind it & blindly rely on analgesics (pain killers). There might be other initial symptoms like clicking /crackling voices from the joints (TMJ) , Pain in the ear area, jaw pain, facial pain etc. which people often take frivolous. Some people seek for medical help, but end up with a misinterpreted migraine. Unfortunately the patients become completely dependent on these medications. Therefore it is crucial to detect the underlying cause before going for familiar /usual headache treatments.

Temporomandibular Joints (TMJ) are a pair of hinge like joints present on either side of the face in front of the ears. They help in protrusion,retraction,elevation & depression movements of the lower jaw (mandible). Temporomandibular Joint Disorders (TMDs) are a group of diseases which involves the jaw joint, associated muscles and the dental occlusion (bite). A lot of factors can contribute to the development of TMD. The various causes include missing/ decayed teeth, a trauma or blow to the joint area, a general mal alignment of teeth, continuous clenching / grinding of teeth etc. The symptoms also varies from patients to patients. Patients can present with headaches, dental pain, facial pain, jaw pain, ear, neck, back & shoulder pain. The clicking / popping voices from the joint area often reduces with time, but then leads to limited mouth opening, deviated jaw movements, restricted lateral movements etc. In chronic cases of TMD, without treatment it can cause Lock Jaw and severe Hypertrophy of face unilaterally. Also it may lead to Facial rotation. Thus by undergoing treatments for TMD, the patients wil get relief from all these associated painful & dysfunctional symptoms. And this might be the only Headache Treatment that is going to benefit a TMJ patient.

This treatment includes 2 phases. In the first visit, the TMJ specialist will take a detailed & thorough case history. The onset, course & duration of all the symptoms are recorded. Also the muscles of the face & neck are examined for any tenderness or tension. Intra-oral examination is done to identity any missing/ decayed teeth. Also any impacted teeth & mal alignments, especially Deepbite are noted,all these leading to a Faulty BITE which results in TMD. Most of these patients complains of frequent episodes of headache either unilaterally or bilaterally. And they will be fed up with the current headache treatments they are following as it provides only temporary relief. In the first phase of treatment, the patient is given an ANATOMIC ORTHOTIC. This is fabricated in the NEUROMUSCULAR BITE of the patient which is identified with the help of a J5 myomonitor/ K7 Kinesiograph . This Tens machine produce bilateral electrical stimulation which helps in relaxing the muscles of face & neck. The Neuromuscular Bite is registered in this most relaxed & comfortable position. The ANATOMIC ORTHOTIC delivered can be of 3 types:- Acryllic, Resin & CADCAM. Patient can select the type of orthotic according to their comfort level. This orthotic has to be worn for 4-10 months, 24 hours a day. The treatment time may vary with patients. The orthotic needs bimonthly corrections. A TMJ specialist may do both MANUAL & DIGITAL CAIBRATION. OCCLUSENSE by Bausch is used for digital calibration of orthotic. After the first phase, patient's natural bite has to be modified/ brought to the early registered Neuromuscular Bite position. This is done in the 2nd phase. Only after the completion of this 2nd phase, a total cure is obtained. Especially the patients, who received headache treatments along with their jaw & bite correction should religiously follow the rehabilitation phase to avoid relapse. It is done either Orthodontically (with self ligating braces) or Prosthodontically (with crowns, onlays or occlusal tops.)

MIGRAINE TREATMENTS

Migraine is a primary headache disorder characterized by a recurrent headache that is moderate to severe, felt as a throbbing pain on one side of head. It is more common in females, peaks between 20 to 50 years. Some people might get frequent migraine attacks which lasts for a long period of time. Other people only have a migraine occasionally possible years to pass between migraine attackes. 40% to 50% migraine occur without only specific etiology. Migraine headache is a common, disabling clinical problem affecting many. Various Dental problems are related to headache and many conditions can cause orofacial pain and headaches, which complicates a definitive diagnosis. Temporomandibular joint disorder, toothache, jaw and sinus pain often coexist with headaches. Missing, loose, sore or malaligned teeth may contribute to what is regarded as "bad bite". This causes intense pressure on the jaw muscles, inability to chew properly, grinding/clenchig of the teeth, difficulty in swallowing or opening or closing the mouth. 60 percent of people with these symptoms has headache misdiagnosed as Migraine.

Migraine treatments can be done by a TMJ specialist if it have a TMJ element in it. Teeth grinding or clenching can be caused by stress or TMD (TEMPOROMANDIBULAR DISORDERS). It can result in muscle spasms, that can trigger headaches and migraines. The usual signs of teeth grinding include sore jaws, a dull recurrent headache, tender teeth, issues with opening and closing the mouth and a clicking noise when opening the mouth. Tooth decay and gum disease can push pain to the head. Many headaches can be caused by reffered pain, where the pain in experienced in an area of the body different from the original cause of the pain. Visit a TMJ specialist and inform them immediately if you are dealing with migrames or a headache and any of the symptoms mentioned above. The TMJ Specialist will be able to correct your dental issues and possibly your migraine as well with specifec NEUROMUSCULAR TREATMENTS. They may even diagnose a more serious TMJ and AIRWAY issues that requires immediate attention. Many people overlook warning signs, mistaking them for regular headaches or migraines or avoid the right Specialist because of anxiety. The truth in that most people would rather not seek professional help until the problem worsens severely. At that stage, the damage may be permanent or more expensive and burdensome.

Diagnosis of Migraine Treatments

TMJ specialist will take a detailed case history, and evaluate the 3D CT/CBCT of TMJ and AIRWAY and diagnose wether the MIGRAINE/HEADACHE has a TMJ element in it. If the Migraine / Headache is due to an underlyng TMJ DISORDER/ SLEEP DISORDER, it is 100 percent treatable with out any medication. During initial visit with a TMJ specialist, diagnosis begins with a comprehansive review. They first obtain a history and perform examinations that include head, neck, muscle examination, evaluation of jaw movements and TMJ joint sounds and sleep. This includes the history of onset of problems, its progression, medicine and treatments undergone. The TMJ specialist will examine and palpate, muscles of neck & muscles outside and inside the mouth, possitions and amount of overlapping of whole teeth and also will evaluate your posture. They will palpate TMJ on opening and closing of mouth and amount of mouth opening. A 3D CT/ CBCT of TMJ area will be achived to be taken which will be helpful for more evaluation. An early diagnosis of migraine treatments or other type of headaches or TMD may avoid the progression to severity. The treatment for Temporomandibular Disorder include 2 phases. First phase, patient is given an ANATOMIC ORTHOTIC which is fabricated according to the NEUROMUASULAR bite of the patient, This bite is determined with the help of J5 myomonitor/ K7. It is a completely painless procedure where bilateral electrical stimulations are delivered from the J5 TENS unit. These low frequency impulses relaxes the jaw and neck muscles and the patients most relaxed NEUROMUSCULAR jaw position is recorded and the ORTHOTIC is made to this bite.

Patient have to wear this orthotic 24 hours or day for 4-10 months. The ORTHOTIC relaxes the jaw and neck muscles and corrects the MUSCLE TENSON which inturns cures the MIGRAINE/ HEADACHE and all the other associated symptoms. The orthotic needs corrections every 2 months. TMJ specialist use OCCLUSENSE by Bausch or T-scan for the DIGITAL OCCLUSION CALIBRATION. The second phase include ORTHODONTIC OR PROSTHODONTIC treatment. In this phase, patient's bite is brought to the earlier registered therapatic bite position. Orthodontically, the patient occlusion is corrected with self-ligating braces. Prosthodontically the bite is corrected with crowns, onlays (ceramic/ composite). etc. In case of edentulous patient's, the TMJ expert will deliver a neuromuscular denture in the registered physiologic bite. Patient often rely on medicines or other remedies. But this will only give temporary relief from migraine or TMDs. When people refuses to see the dentist periodically for an appointment, dental issues that causes migraines and other health issues can be left untreated. So immediatly appointing a TMJ specialist for migrane or other Temporomandibular Disorder and other dental health issues can prevent chronicity or severity and also can get cured casily.