Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI
Everyone gets an occasional manageable headache from time to time but for those that suffer with chronic headaches, it is anything but manageable. Chronic headaches can be an incredibly frustrating and painful malady to live with and people will go through great lengths to find relief. Each year, headache sufferers in the United States receive $1billion worth of brain scans each year attempting to figure out the source of their pain. Without a doubt, the first stop for someone who suffers from chronic headaches should be their primary care physician. There are numerous medical conditions and causes that can yield chronic headaches and your MD is the best person to address those. However, did you know there are multiple DENTAL conditions that can yield chronic headaches as well?? It’s true! We’ll discuss how a dentist can help cure your chronic headaches here today!
First, we need to have a basic understanding of what types of headaches exist. Headaches are typically classified into two categories: Primary headaches & Secondary headaches. A primary headache is a headache that is not directly caused by an external factor. People may carry genes that make them more likely to develop such headaches. Primary headaches are typically divided into three subcategories: Migraines, Tension, & Cluster. Migraine headaches generally present with moderate to severe pain that pulses and generally occurs on one side of the head. Migranes are further classified into two groups: Episodic & Chronic. Episodic migraines typically occur less than 15 days per month whereas Chronic Migraines occur 15+ days per month with headaches typically lasting 4+ hours for at least a three month period. Tension headaches generally present with diffuse mild to moderate pain that’s often described as squeezing. Although the tension headache is the most common type of primary headache, its causes aren’t well understood. Cluster headaches generally present as a n attack of severe pain on one side of the head, lasting 15 minutes to 3 hours, and occurs between once every other day to 8x/day. Although not a direct cause, primary headaches often have “triggers” that cause their appearance. Some primary headaches can be triggered by lifestyle factors including: alcohol (particularly red wine), certain foods, such as processed meats that contain nitrates, changes in sleep or lack of sleep, poor posture, skipped meals/low blood sugar, & stress. Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can also play a role in triggering primary headaches.
A secondary headache is a headache that is present because of another condition, such as a sinus headache from sinusitis. Many conditions, varying greatly in severity, may cause secondary headaches. Possible causes of secondary headaches include: acute sinusitis, arterial tears (carotid or vertebral dissections), blood clot (venous thrombosis) within the brain, blood sugar levels, brain aneurysm, brain tumor, carbon monoxide poisoning, concussion, dehydration, ear infection, glaucoma, hangovers, high blood pressure (hypertension), influenza (flu) & other febrile (fever) illnesses, Intracranial hematoma (blood vessel ruptures with bleeding in or around the brain), medications, meningitis, monosodium glutamate (MSG), overuse of pain medication, panic attacks & panic disorder, pressure from tight headgear (such as a helmet or goggles), stroke, toxoplasmosis, trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain), & poor vision.
Phew! That’s a LOT of possible secondary headache causes (and I even edited the list)! For the remainder of this article we are going to discuss a few more possible causes of secondary headaches that are dental in origin: Dental maladies, Dental malocclusion, & Bruxism/Clenching/TMJ problems.
Dental Maladies & Headaches
Of the three dental causes of headaches we’ll be discussing, this one is certainly the most straightforward. Maladies such as toothaches, cavities, broken teeth, & infections are all capable of yielding a secondary headache. They are typically treated with conventional dentistry capable of removing the source of the stimuli. Once the dental issue is addressed, the headache ceases.
Dental Malocclusion & Headaches
A dental malocclusion is a situation where a person’s teeth do not fit/line up correctly. How can this cause a headache? A dental malocclusion can interfere with the normal patterns of movement of the body’s jaw muscles. It’s this interference that can yield the headache. If the teeth aren’t in the right locations and causing issues, the body will often try to correct these issues. Sometimes these corrections are slow and relatively painless. An example of this would be uneven tooth wear only on the specific teeth that are out of place and interfering with normal path of function. The body wears down the tooth structure in an attempt to minimize the malocclusion. This wear is the body’s attempt to equilibrate or even out the person’s bite. Another example is the loosening of a malpositioned tooth creating perpetual localized tooth mobility in the problem area. Creating this mobility often allows for enough “play” to compensate for any malocclusion present. However, the body isn’t always very gentle. Sometimes it corrects issues quite violently as illustrated when a patient breaks off a portion of a tooth or restoration. Sometimes the entire tooth will be snapped off or cracked by another tooth via the force generated by the body’s powerful jaw muscles as an attempt to correct the problem.
Bruxism/Clenching/TMJ problems & Headaches
Bruxism, Clenching, and Tempromandibular Joint (TMJ) problems are three very common ailments that frequently occur simultaneously in patients. Bruxism (aka nighttime tooth grinding) wears down the teeth by grinding away tooth enamel. We’ll skim the surface of this topic a bit today but for a much more in-depth look into bruxism, please revisit my article from the February 2014 office newsletter. (Link to the article here: https://goo.gl/Ox31zl and the newsletter here: https://goo.gl/dc1ca5.) Patients typically exhibit two major bruxism wear patterns: side-to side and front-to-back. Jaw clenching is a negative habit that imposes excessive vertical pressure on the teeth. For both bruxism and clenching, the degree of negative impact on the body is typically relative to the severity of the ailment (ie the more force applied, the faster and more severe the destruction.) Powerful bruxism or clenching can cause severe damage such as fracture of teeth, fracture of dental restorations like fillings and crowns, loosening of teeth in the bone, and abfractions (notching ) in the tooth along the gumline. Occasionally I’ll even see teeth split from tip to tip due to these conditions and there’s nothing modern dentistry can do to save the tooth. It must be extracted.
“TMJ problems” is a umbrella phrase for a slew of conditions affecting one of both jaw joints. Like bruxism and clenching, the severity of the TMJ symptoms typically reflects the severity of the condition. Painful movement of the jaw, popping, clicking, difficulty opening or closing, and even dislocation are all possible TMJ problems that are seen. The majority of TMJ pain resolves on its own without any direct dental treatment. Perhaps you had a big yawn and in doing so accidentally strained your right TMJ. It’d feel stiff and difficult to move for awhile much like a sprained ankle. With a little rest, some warm compress, and perhaps some Ibuprofen or Aleve, the joint will soon be back to normal with no lasting negative repercussions.
So how are bruxism, clenching, and TMJ problems linked to headaches? Jaw muscles! Each of these three conditions has a direct cause/effect relationship with the muscles that connect the jaw to the skull. Powerfully grinding your teeth at night while you sleep not only puts additional stress & strain on your teeth, but on the muscles as well. This directly results in the classic morning headache that you feel immediately upon waking. The same can be true for clenching and certain TMJ problems. The body is meant to rest during sleep, but due to these conditions that doesn’t happen and your jaw muscles are overworked and sore when you wake.
Treatment Options to Relieve Dental Related Headaches
So what can a dentist do to help stop the headaches? Once the cause is determined, it needs to be treated. Dental maladies are typically treated with conventional dentistry. Treatments such as fillings, root canal therapy, and extractions all can remove the dental source of a secondary headache. Localized dental malocclusion can be treated with conventional dentistry as well. For example, a poorly positioned tooth could be extracted to thereby remove the malocclusion. On a much smaller scale, a dentist can perform an equilibration. This is when a dentist examines how the teeth fit together and selectively grinds small amounts of tooth structure to improve the fit. Patients will often use the term “leveling my bite” to describe equilibration and it’s quite an accurate description. For generalized malocclusion cases, orthodontic movement of the teeth is often recommended as treatment. By straightening the teeth they will both fit and function better together. Both Invisalign as well as conventional braces can help achieve this.
Dental nightguards are one of my favorite dental treatments! They are low invasiveness, low cost, and high results. Perhaps you’ve heard me speak about this “trifecta” before! Whenever a dental treatment can satisfy my trifecta, it’s always one of my favorites! Incidentally, several other treatments that come to mind in addition to dental nightguards are 1) rechargeable toothbrushes (like Sonicare) 2) fluoride containing antibacterial mouthwashes (like Listerine Total Care Zero…discussed in the April 2013 newsletter article. Link to the article here: https://goo.gl/JMg8j9 and the newsletter here: https://goo.gl/dc1ca5), and 3) dental sealants (my Pinterest infographic can be found here: https://goo.gl/Z0vZwy. A dental nightguard is capable of decreasing and possibly solving headaches caused by multiple categories of causes: malocclusion, bruxism, clenching, & TMJ problems. By covering teeth on one arch, it allows the opposing teeth to easily slide during bruxism rather than grind teeth on teeth. The thickness of the nightguard aids in clenching patients as it prevents the muscles from closing the teeth completely together. This thickness helps TMJ patients relieve pressure to their jaw joints as well. All this benefit and no invasive drilling on the teeth!
Headaches come in many shapes/sizes and have numerous causes. If you suffer from chronic headaches, don’t forget to include your dentist as part of your treatment team! If you would like to speak about dental treatment of headaches, or any other dental topic, please feel free to call the office and schedule a complimentary appointment with me. Email and Twitter are also available options. I am extremely passionate about modern dentistry and love discussing it with patients, so don’t hesitate to contact me.
Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI