Across America nearly 90% of the population experiences a general headache each year. Approximately 45 million people suffer from chronic headaches and (according to government statistics - National Institute for Neurological Disorders and Stroke) 28 million people suffer from migraine headaches, a condition that affects one in four households and women three times more likely than men. In addition to the personal pain and suffering caused by headaches, the broader cost to U.S. employers is estimated at $24 billion annually.

Whether the headache is daily or more infrequent, pain in and around the head, face, jaws, neck and ears, can be anything from a major annoyance and inconvenience, to downright painful and disabling.

There are four types of headaches: vascular, tension, traction and inflammation. The latter two are caused by strokes and sinus infections. Headaches should not be trivialized or discounted because they can serve as a warning signal of more serious disorders.

 

Sinus Headaches
The sinuses are air-filled spaces located in bones of the skull. Inflammation or infections in the sinuses can prevent the normal flow of sinus secretions (mucus) and can create pressure within these spaces that produce the pain of a sinus headache.

Due to their location, sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with head movement, straining or any activity that increases pressure in the sinuses (changes in altitude or barometric pressure, blowing the nose, etc). Other symptoms often include “runny nose”, ear congestion, facial swelling or fullness, and fever. These types of headaches are best diagnosed and treated by a physician or ENT specialist.

 

Vascular or Migraine Headaches
Migraines are the most common type of what is traditionally called a “vascular headache”. Migraines are a particularly vexing type of headache primarily because of the severity of the symptoms and how disabling the symptoms and pain can be. These headaches are characterized by head pain that is usually one-sided. The pain is often described as an intensely strong pulsating or throbbing pain that is often (but not always) accompanied by eye pain, light/photo sensitivity, nausea, or sound sensitivity, to name a few. Sometimes their onset is preceded by an “aura” which alerts the individual that a migraine is imminent.

It has been generally understood that migraines are the result of a vascular phenomenon called vasodilation, where small blood vessels in the lining of the brain enlarge and produce immense throbbing pain by pressing on nearby nerves. However, it has never been certain whether the dilation was a primary or secondary event. Various triggers such as chemicals, hormones, stress, and other agents have been shown to initiate or “trigger” a migraine headache. To date most medical therapies have been drug based and have been aimed at controlling and preventing this dilation response to proven triggers.

However, new information about blood flow in the brain and about the nerve endings embedded in the lining of the brain (dura mater) has revealed that the order of events in a migraine may not be as straightforward as was once thought. It appears that the nerve endings in the brain act first, releasing proteins that cause the blood vessels to be more permeable, which “primes” the nerves to be in a ready state of alert, or to be “sensitized.” Once in a sensitized state, various triggers can act upon them to initiate or propagate a wave of depolarization in the brain cells, which leads to a migraine.

Researchers have found that during the course of a migraine, the upstream (afferent) nerve fibers of the Trigeminal nerve (carrying nerve signals from the face, jaws, mouth, and forehead) are very busy with sensory nerve traffic. Likewise, the downstream (efferent) motor nerve traffic is also quite busy. Like too many cars on the freeway during rush hour, the Trigeminal nerve floods the brain’s cortex with a barrage of sensory signals (pain & muscle-skeletal status/position).

This new research now suggests that there is a neuro-muscular and musculo-skeletal component to migraines. This begins to explain how migraines get started as well as how to prevent or reduce their onset and severity. Many now believe that the elevation in upstream (afferent) sensory nerve traffic traveling to the brain and the subsequent release of inflammatory proteins in the central nervous system, is responsible for creating a sensitized brain, and that this “storm” of nervous system activity can precede and actually set the stage (sensitization) for the actual migraine activity itself. With the stage set, and a “triggering” event acting on the sensitized brain tissue, the aforementioned reflex dilation of blood vessels in the brain’s lining occurs, creating the vascular headache pain.

Because of the Trigeminal nerve’s essential involvement, migraine headaches are now being referred to as “trigeminovascular events” by many researchers. Even though the term “migraine” will not soon be discontinued, the focus in many research and treatment circles is shifting to what is happening on or to the Trigeminal nerve (the fifth cranial nerve) which happens to deal with the lower face, jaws, teeth, jaw muscles, etc.

The “busyness” or increase in neurologic traffic on this nerve happens with chronic muscle tension brought on by poor posture, muscle spasm or muscle splinting, stress, pain stimulus, etc. This barrage of often unnecessary neurologic activity burdens the brain and its abilities, depletes neurotransmitters, and sensitizes the CNS. Then when certain aforementioned triggers come along and provoke it sufficiently, a migraine headache begins.

The good news from this information is that the neuromuscular component can be better balanced and controlled, thus reducing the storm of upstream sensory traffic on the Trigeminal nerve. This is like taking cars off the freeway during rush hour. When motor and sensory activity is calmed down on these nerves, with muscles relaxed and pain pathways reduced, the onset and frequency of headaches can be reduced.

While this science doesn’t yet explain away every migraine it does explain why we very often obtain profound results in migraine elimination and reduction when the jaws and neck muscles are better balanced, when the bite or “dental occlusion” is even, and head and neck tension and neurologic traffic in and from these areas is reduced.

 

Tension Headaches
Tension headaches are the most common type of headaches among adults and are the result of overworked or stressed muscles in the forehead, jaws and neck. Some people refer to them as “stress” headaches because they associate them with being “stressed”. While this can form the initiating basis for migraine headaches mentioned above, for many people a simple or “regular” tension headache is often as far as this progresses. Nevertheless, these “garden-variety” tension headaches can still be very debilitating and annoying!

A tension headache may be described as a mild to moderate constant tight band-like pain, tightness or pressure around the forehead or back of the head and neck. They do not include vision disturbances, nausea, or auditory sensitivity, as these are more diagnostic of vascular headaches such as migraines.

Tension headaches may be short lived or last several days. Generally, the severity of a tension headache increases significantly with its frequency. The pain is usually throbbing and affects the front, top or sides of the head and is often described as though there were a tight band or vice putting pressure around the head. Often there is associated discomfort in or around the face, ears, neck, shoulders, back, and jaws.

In trying to understand muscle tension headaches, it is helpful to go “upstream” with a line of questioning that asks the basic question “Why are the muscles tense in the first place?”

By definition, a tense muscle is a muscle that is being “fired upon” by the nerve that supplies it. Without this electrical impulse from the supplying nerve the muscle would be unable to contract, and in fact would remain limp. The extreme of this is seen in cases of spinal cord paralysis and certain neurological diseases. In short, muscle activity is driven by nerve activity, some of which is voluntary or conscious, and the rest being involuntary or unconscious. Elevations in nerve firing on a muscle causes it to be tense or “hyper-active”.

The most common reason for this is due to function-related posturing. Forward head position, poor general posture, or any condition that requires extra amounts of musculo-skeletal bracing to maintain posture or to achieve function, can have a deleterious effect on muscle health. This is because chronic or ongoing increased muscle activity (regardless of its reason) diminishes the supply of oxygen in the affected muscles. This anaerobic (lowered oxygen) metabolic state creates metabolites such as lactic acid which are painful (like how your muscles feel the day after a hard day of yard work). In cases of chronic day-in/day-out muscle tension (poor posture, poor work ergonomics, habits, stress) the stakes are increased as the muscle can become damaged and produce pain. This pain can also be “referred” to other sites, especially when adjacent sites are likewise involved with postural bracing and similar hyper-function.

If you have muscle tension headaches then asking the right question will help you understand the right solution. “Why are my muscles tense?” and “What happens when the supply of oxygen is reduced due to tight overactive muscles?” Answer: The muscle converts from an efficient aerobic (oxygen) state to an inefficient anaerobic state (without oxygen), and when this persists, pain is produced. If this is to be reversed or avoided then reducing the degree of overexertion and hyper-activity is essential.

With this basic understanding of muscles, you can perhaps better understand why healthy muscles are such an important part of dealing with headaches. The biomechanical and neuromuscular models of posture, muscle balance, and healthy muscle physiology are represented in many common everyday experiences which touch your life. Workplace ergonomics, repetitive posture and motion, unbalanced jaw support or “bad dental bite”, jaw joint strains/injuries, neck and back problems – all contribute to unhealthy muscles and the production of muscle pain and headaches.

Because of the postural bracing that occurs between the muscles of the neck/shoulders and the jaws, the status of the dental bite becomes a key consideration with headaches. This is why jaw & facial pain, and pain in the temples on the side of the forehead are so often associated with headaches. The dental bite is the way the lower and upper jaws fit together as dictated by the teeth coming together. “Bad bites” or unbalanced occlusions can cause the jaw muscles to be inherently tight and over-active. This can also lead to the collateral involvement of neck muscles which are coupled together with the jaws to brace head and upper-body posture. If the bite is unbalanced, it can set off a cascade of repetitive chronic muscle tension throughout this region, along with its associated pain and dysfunction.

When the jaws, joints, teeth, dental bite, and jaw/face/neck muscles are involved with headaches, it is generally referred to as TemporoMandibular Disorder (TMD). This used to be referred to as “TMJ”. While the jaw joints are or can often become damaged, the more common presenting symptoms are muscle related (myogenic – muscle genesis) due to muscle tension.

Successful treatment must always take into consideration the stabilization of these muscles through the stabilization or balancing of the dental bite (i.e. the way the jaws fit together). Only a properly trained dentist can accomplish this treatment, which is why a dentist is an essential if not primary member of the "headache team".

It should be apparent why depending on or using medications can’t solve this problem alone. Medicines that obtund the pain, or relax the muscles, or calm the nerves, or induce sleep, can’t resolve problems that are fundamentally neuromuscular, bio-mechanical, and muscle-skeletal, and which require treatment to get at the foundation of the problem.

The bottom line is that muscles which are chronically under stress and in tension can cause muscle tension headaches as well as set the stage for more disabling migraine headaches. These problems will not fundamentally stop until something is done to lower the muscle tension and restore balance to the postural equation.

This is why consulting with a properly trained dentist is so necessary! No other health professional has the training to balance or reposition the jaws so that the muscles of the head, neck and jaws can remain in a physiologically rested, aerobically healthy stable state. Dentists often work side-by-side with other health professionals who can assist with proper structural integration, core stabilization, and muscle and ligament rehabilitation.

Regardless of the source or reasons for headaches it is important to determine whether the dental bite or other jaw factors contribute to headaches. And it must be remembered that not all headaches are caused by unbalanced muscles. Sometimes systemic or “organic” factors such as hormones, environmental chemicals, diseases, and tumors can be the cause. This is why a comprehensive evaluation is so important.

If you have worked with a physician or other health professional and still experience headaches, it would be well to visit with a dentist trained and experienced in providing treatment in this area. The facts are that the vast majority of headache sufferers have a dental component which can only be treated in a multi-disciplinary approach that stabilizes and balances muscles of the head, neck and jaws.

If you find that you are tired of living in pain and are ready to begin the road to relief and healing, you are invited to visit with a dentist trained in the complexities of treating these neuromuscular and musculo-skeletal problems.

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