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An Overview of Headaches

Any ache but a heartache; any pain but in the head.
—the Talmud

When I have a headache I feel like a different person is living inside my body.
—a 30-year-old nurse

The headache is one of the oldest human diseases, and one of the most common. If you have any doubt about the universality of headaches, a quick look at television, radio, or magazine advertising should convince you. Most of the ads for painkillers are targeted to the headache sufferer. Headaches are often considered a normal outcome of lives filled with daily stress and tension, an unavoidable part of modern living. Americans spend close to a billion dollars a year on over-the-counter pain relievers to help them cope with this "normal" complaint.

A headache is unlike pain in any other part of the body. If you have a pain in your arm, you may be disabled in some way, but usually you can separate that pain from your thought processes and emotions. However, pain in the head attacks one's very emotional and intellectual center.

A CRIPPLING PROBLEM

Because headaches are common and seen as a normal part of living, having a headache now and then is understood and acceptable. But only a headache sufferer who lives in chronic and intense pain can understand the way this pain can alter—even destroy—a whole life.

People who do not get headaches, or have only occasional mild ones, tend to suspect the sufferer is creating the pain for some psychological reason. This suspicion is strengthened by the absence of medical findings establishing a clear reason for the pain.

Having headaches is a kind of handicap or disability. Normal living is possible but more difficult. In fact, some very accomplished and famous people are said to have lived with chronic headaches. They evidently were able to rise above pain and live extraordinarily productive lives. George Bernard Shaw, Cervantes, Sigmund Freud, Lewis Carroll, Virginia Woolf, and Charles Darwin are only a few notables said to have suffered from regular severe headaches.

For many people, headaches come and go with no particular rhyme or reason, and variation in lifestyle has little effect. A headache can strike in the midst of a relaxing vacation or in the midst of conflict. Some victims of muscle-contraction, or tension, headaches say that relaxation seldom prevents the onset of a headache.

The language we use is rich in words that describe headache pain. People will say their heads are pounding, splitting, throbbing, or grinding. Or people say things like, "I feel like my head is breaking in two," or "There must be a red-hot poker in my head." Other people complain that they feel as if their brain is being squeezed in a vise, or that someone is driving nails into their head.

LONELY PAIN

Typically, a headache sufferer's pain has no direct connection to an obvious disorder or injury. Seeing an inflamed throat, a deep cut, or a sprained ankle, we expect that the person is in pain. But headache pain can be lonely and ultimately socially isolating. If the headaches are regular, the sufferers may end up hiding their pain in order to remain socially and professionally acceptable.

Patients have said that family members, friends, and co-workers have accused them of using their pain to manipulate others or gain sympathy for some hidden reason. One patient said, "A friend came right out and told me once that he thought my problem was in my head—but he didn't mean a headache. He thought I was nuts. I learned just to keep my mouth shut and not tall; about my problem unless the pain got so bad I had to leave work or a party, or when I couldn't even answer the phone."

Some people—usually those who have little personal experience with headaches—think that this kind of pain is just an excuse. An individual who has a cold or a broken leg invites few questions by cancelling plans. But doubts arise when a person leaves work early, is in no mood to make love, or cancels a social arrangement because of a headache. Again, headache pain is lonely pain and open to suspicion.

CAUSES

Headaches may have one or numerous causes. A headache is usually felt as a single experience, but it could be a combination headache—one that has more than one cause. An evaluation of headaches must consider all possible causes and treatments. Not to do so is tragic, because today we know much about physiological reasons for the various headache types.

A headache can be a symptom of many minor or serious diseases and disorders. People often experience headaches with a common cold or flu, hypoglycemia, diabetes, anemia, allergy, and disorders of the eye. Other causes of headaches include tumor or concussion.

Anyone suffering from headache more than once in a while—especially if headaches are interfering with daily activities or increasing in severity or frequency—should seek help from a physician. This advice includes people seeking TMJ evaluation:

Have a medical work-up for headaches first.

VASCULAR HEADACHES

The majority of headaches are categorized into two types, vascular and muscle-contraction. The most common type of vascular headache is a migraine. The term migraine is often applied to all headaches that are severe and debilitating but not life-threatening when no specific diagnosis can be made. In a way it's become a generic term for severe.

Migraines

More accurately, migraine headaches have their own characteristics and usually can be distinguished from other headaches. There are two kinds of migraine headaches, classic and common. In both types, the arteries in the head are painfully irritated and swollen. Both headache types generally affect only one side of the head at a time. The pain is caused by constriction of blood vessels, followed by their expansion and swelling. The expansion phase causes the intense pain.

Classic migraine is usually preceded by what has traditionally been called an aura. The aura is a change in visual perceptions—flashing lights, blind spots in the field of vision, confusion and/or light-headedness, and often an increased sensitivity to noise. Some migraine sufferers report feeling partially paralyzed prior to the onset of the pain. A few say they also experience changes in their sense of smell.

Common migraine, also called a "sick" headache, got that name because it is often accompanied by nausea and vomiting. The headache is often preceded by a general feeling of depression or irritability. Some people report feeling a euphoria or an unexplained sense of extreme well-being prior to the onset, but this is rare. The common migraine makes up about 80 percent of all migraines; classic migraines account for the other 20 percent.

Many recognized medical authorities on headaches agree that some migraines are triggered by a substance known as tyramine. Many migraine sufferers can eliminate or reduce the frequency of attacks by avoiding foods containing tyramine, such as cheese, peanuts, chocolate, and red wine. (Many excellent books are available with complete lists of these foods and more detailed information about migraine headaches.)

Many other possible causes of migraine headaches have been identified. They include tobacco smoke, sun glare, strenuous exercise, erratic eating habits, excessive fatigue, and car exhaust. Migraines may strike weekly, monthly, yearly, or even less frequently. Some people report having migraines almost every day.

It is believed that more women than men are migraine sufferers. And, although it hasn't been conclusively shown, it's thought that migraines run in families.

Sinus Headaches

The sinus headache is a popular self-diagnosed headache. The pain is usually described as dull and aching, but generally not throbbing or pulsing. Sinus headaches are caused by inflammation of the mucous membranes or pressure in the sinuses, located on either side of the nose and in the forehead. Many headache authorities believe that sinus headaches are relatively uncommon. People sometimes label their headaches as sinus related because their pain is accompanied by a stuffy nose or tearing eyes. However, these same symptoms may or may not be related to other types of headaches.

Cluster Headaches

One of the most baffling kinds of vascular headaches is the cluster headache. It is thought to be a variant of the migraine. People who suffer from cluster headaches usually describe them as being truly unbearable. The pain experienced with cluster headaches is characterized by burning, searing, or a stabbing type of pain, usually on one side of the head and often centering around one eye. The sufferer may also have nasal stuffiness and sweating.

The term "cluster" is descriptive rather than diagnostic. A cluster headache occurs in groups. Each attack can last up to two hours, and four or more attacks may occur daily. Cluster headaches are said to occur more frequently during periods of rest, and this type of headache is more common among men than women.

Chemical and Environmental Headaches

Another group of headaches has received various labels and may be considered chemical or environmental in origin. The so-called "Chinese restaurant headache" is a good example of this. The culprit in this case is monosodium glutamate (MSG), a substance used to enhance flavor and commonly, but by no means exclusively, used in Chinese restaurants. If this is the only headache a person experiences, it is easy enough to eliminate it by simply avoiding MSG.

Some processed meats, such as hot dogs, lunch meats, ham, bacon, and sausage, use preservatives. But some people are extremely sensitive to them and get headaches every time they eat foods containing preservatives. This kind of headache can be prevented by avoiding the offending foods.

Other causes of headaches are also relatively easy to eliminate. However, identifying the habits, foods, or chemicals that could be responsible for the headaches can be difficult. For instance, exposure to certain chemicals will cause headaches in some people. Even a tiny gas leak in one's home can quickly bring on head pain. Eating ice cream too quickly has been blamed for certain kinds of headaches, as has eating too much salt. And headaches may occur when there is a drop in blood sugar. You do not have to be clinically hypoglycemic to experience a headache caused by low blood sugar. Skipping breakfast or lunch, eating too much sugar, or drinking copious amounts of coffee can trigger low-blood-sugar headaches.

Some people report headaches when they try to withdraw from caffeine. This kind of headache is so common that it now has its own name—logically, the caffeine-withdrawal headache. Those wishing to eliminate caffeine from their diets are generally advised to cut back slowly to avoid this kind of headache.
Some women experience a headache before the onset of menstruation. They may have one headache a month, and why this occurs is still a mystery. Many authorities link the headaches to water retention, common just before menstruation.

Brain Tumors

Almost all people who suffer from regular debilitating headaches will report fearing a brain tumor. Headaches caused by brain tumors are undoubtedly the most feared type, and these headaches share symptoms and characteristics of other types of headaches. Fortunately, brain tumors are extremely rare, and diagnostic tools are available to rule out a brain tumor early in the medical investigation of the pain.

MUSCLE-CONTRACTION HEADACHES

Most experts agree that muscle-contraction headaches are far more common than vascular headaches. They are the most common headache type of all, and for many people they represent an almost daily nagging of pain. Yet many people will call these headaches migraines because they are frequent and excruciating, and migraines sound like the most "serious" kind of headache. But much of this self diagnosis and, unfortunately, medical misdiagnosis leads people to attempt treatment that trades debilitating pain for the use of drugs. Although great strides have been made in preventing migraine attacks and relieving the pain when one does strike, too many patients are told to learn to live with the pain, or dull it with drugs, or learn to avoid stress (an impossible task), when no reason can be found for headache pain and its related symptoms.

For some reason or combination of reasons, the muscle contraction headache has been viewed as the type that the sufferers are expected to control by themselves. These headaches are dismissed, often cavalierly, as not particularly serious. Perhaps because they are so common, they aren't as mysterious or "glamorous" as migraines. Consequently, although muscle-contraction headaches are more common, much more research has centered around vascular headaches.

WHY ARE THESE HEADACHES COMMON?

In humans, the muscles of mastication are responsible for balancing the muscles in the front of the body with those in the back. This extra burden makes these muscles more susceptible to stress.

In addition, nature has provided protective mechanisms to ensure a species' survival. For example, many vital organs come in pairs, so that we can survive if something happens to one of them. For example, an animal can survive in the wild and we can survive in the modern world with one functioning kidney. We make accommodations in society to people without functioning ears or eyes. Yet an animal responsible for its own survival will probably not live long if it loses the functioning of both of its eyes or ears. Nature has also provided a strong protective mechanism for the jaw. Even if it isn't perfect, it will work and carry out needed functions, and the neuromuscular protective mechanisms will act to protect the teeth and their supporting structures. Unfortunately, this often leads to spasms in the muscles of mastication.

It may seem impossible that the vast majority of muscle contraction headaches could result from a tooth-gearing problem. However, this is in part because of the terminology used for muscle- contraction headaches. This kind of headache is generally blamed on the catchall term "stress." But stress is often a misunderstood phenomenon. In modern society, we have been forced to adapt to increased noise levels, changes in diet, pollution, chemical agents in our food, complex family structures, pressure for achievement, and more. The list is endless. But it's important to remember that stress doesn't automatically make muscles go into spasm. A muscle spasm has to be triggered by something more.

Sleeping in a draft can make a back muscle go into spasm. A twisted ankle can cause a muscle in the upper calf to go into spasm because of the body's protective mechanisms. An injury in any part of the body can cause muscles to go Into spasm. A tooth-gearing problem is one of the most common reasons for muscles in the head and neck to spasm. These spasms are the cause of the so- called tension or stress headaches.

PAIN FROM TOOTH-GEARING PROBLEMS

When we talk about muscle-contraction headaches, we're actually talking about a problem ultimately caused by a tooth-gearing problem overlaid with stress. When animals become stressed, they have an inborn reflex to gnash their teeth or clench their jaws. We can see this with dogs who react to strangers in the house. As an animal's stress increases, the clenching or gnashing increases.

Human beings have a similar response. We clench our jaws and sometimes gnash or grind our teeth in response to various stressors. Society also expects us to control or handle our stress, and in our valiant efforts to do so, we often produce more stress.

A tooth-gearing problem coupled with the additional balancing task of the muscles of mastication make the spasm cycle not only possible but extremely common. People who do not have tooth-gearing problems are not vulnerable to muscle-contraction headaches. However, because 80 to 90 percent of the population has less-than-perfect gearing, muscle-contraction, or TMJ, headaches are one of the most common health complaints known in human history

TMJ and muscle-contraction headaches are actually synonymous. When people with gearing problems and symptoms are treated, their headaches go away. In TMJ treatment we see this day in and day out. The vast majority of people have symptoms of TMJ so mild that they will probably never need treatment. However, for people who suffer severe pain and other discomforts associated with TMJ, knowledge of this disorder will change attitudes and treatments within the health care community.

COMBINATION HEADACHES

Occasionally a patient describes headaches that sound as if they are TMJ-related. The patient then describes other headaches that sound like another type. Headaches occurring in one person are not always caused by one problem. Many patients' symptoms have a combination of causes. To a person in pain, it is difficult to differentiate between various kinds of headaches. People tend to attribute pain, especially if it is almost constant, to the same cause. As one patient put it, "pain is pain."

When TMJ treatment begins, a patient with more than one headache type can be confused about what is occurring. Within the first month a significant number of headaches go away. The patient is, of course, relieved; some even begin to believe that TMJ is the only reason for their pain. When the muscle spasms end and headaches are fewer, the other symptoms -can be differentiated more clearly.

Some patients have migraine headaches that are "submerged" in the TMJ-related pain. Others have sinus conditions that cause headaches. Once the TMJ symptoms disappear, the other headaches can be evaluated. Often a dentist can help choose specialists to deal with the other sources of pain. Dealing with the TMJ component of the pain is a little like peeling away one layer of an onion. The second layer then becomes visible and can be evaluated. In some patients, TMJ headaches trigger migraines. Once the TMJ is treated, the frequency and severity of migraines are often drastically reduced.

WHIPLASH

Chronic whiplash symptoms, such as pain, stiffness, and restricted motion of the neck, have been found to be TMJ symptoms that were triggered by the accident causing the original whiplash injury.

OTHER SYMPTOMS

While headaches are the most common symptom of TMJ, this symptom seldom exists in isolation. Many patients report that they have few headaches but are plagued by other, less common TMJ symptoms. For those who suffer, these symptoms are equally troublesome and can lead to frustration and anguish. They too deserve attention in any discussion of TMJ.