TMD and Headaches


Headaches are NOT "Normal" Some people suffer from repeated headaches so frequently that they consider them to be "normal" and a regular part of their daily life. Others try to "tough it out", go into denial that there may be a more serious problem, or, think that it is a sign of weakness to seek help. But pain is the body's message that something is wrong. Pain (headache) is an alarm that should never be ignored. Over 90% of all people experience pain in the head, neck or upper body, with headache being the most common complaint. Next to hunger the most common complaint of all mankind is "headache".

Studies show that less than one half of one percent (0.5%) of all headaches arise from the brain or other structures inside the head. Ninety-nine percent plus of headaches arise from structures outside the brain (sinuses, muscles, joints, etc.)

  • Migraine headaches

    Most people consider any bad headache a "migraine", but most headaches are not migraines. Scientific studies show that 60% of all migraine sufferers have not been properly diagnosed and are being ineffectively treated for migraines when they should be treated for some other problem that also causes headaches. Migraines, which in years past used to affect 5-10% of the general population, now affect 15-30% mostly women beginning in the third and forth decades of life. Between 1980- 1990 the prevalence of headache dysfunctions increased by 60%, but over 90% of all people who suffer from headaches have never seen a specialist

    Migraine may begin with visual symptoms (spots, flickering light, zigzag lines, etc.), then nausea with a dull, throbbing pain and lasts from 4-72 hours. This is called "classical migraine. If it occurs without the visual symptoms it is called a "common" migraine. This type has moderate to severe pulsating pain together with nausea and sensitivity to light and noise. It has a 75% rate among women largely due to their hormonal connection to estrogen. Physical activity makes a real migraine worse.

  • Cluster headaches

    Eighty-five percent of all cluster headaches occur in males. This type of headache has very severe pain in, around or behind the eye on one side. It occurs in "clusters" of time, either for weeks or months, separated by months or years of remission when it mysteriously disappears. It is also called an "ice pick" headache due to its extremely excruciating stabbing pain felt in the eyeball of the sufferer. Others have described it as a red hot poker being pushed through the eyeball. As many as eight attacks can occur per day. The affected eye is bloodshot with tears, and the eyelid swells. There is uncontrollable sweating of the face and forehead and discharge from the nostril on that same side. Statistically, 47% of these patients will have jaw pain and 53% will have toothache pain.

  • Tension or muscle contraction headaches

    This is the most common type of headache, occurring more frequently in women, and, beginning between 20-40 years of age. It can occur every day, or, from 30 minutes to 7 days at a time, several times a month for months on end. The headache may be "band-like" or associated with sensations of tightness, heaviness or pressure. It may be dull or pounding and its location may be on both sides of the head or vary from time to time. It is usually not associated with nausea, vomiting, or, sensitivity to lights or noise. Physical activity does not make it worse. The belief that stress is the underlying cause and once eliminated will terminate this type of headache has been proven false. The cause and effect of stress as a headache trigger due to its over emphases by non-traditional therapists is currently being challenged by most headache specialists.


  • Sinus headaches / allergy headaches

    Many patients state they have "sinus" headaches because they have pain in the facial region. Pain or pressure in the face is usually caused by migraine or muscle contraction headaches. It will not be due to a sinus unless you have an infection in that sinus and you are also experiencing a low-grade fever. The infection causes the mucous membranes lining the sinus to swell and block normal drainage. Pressure inside the sinus increases causing constant and severe pain, beginning in the morning and worsening if you bend over and put your head down. If you don't have these symptoms, you don t have a "sinus" headache. If you do, you need antibiotics to treat the infection.

    Many patients state they have "allergy headaches" because they have a stuffy nose or drainage from one nostril. This is another problem. Allergies are rarely the direct cause of a headache.

  • Stress is not the cause of headaches

    Most people think that occupational stress, family/marital stress or financial stress is the prime cause of their headaches and, if only they could get rid of their stress they would simultaneously get rid of their headaches. Such is not the case. Stress is never the prime cause of headache, but it can and will exacerbate an existing headache or a predisposition to headaches. People with headaches and mild stress in their lives think all people respond to stress with headaches. However only a small percentage do. Stress has completely different effects on different people. If twenty people were confined in a room and subjected to a sustained stressful situation like constant pounding on the walls of that room, only a very few would get headaches. A few would get high blood pressure, others hair loss, others would get psoriasis, some might stutter or develop facial tics, etc. Stress, regardless of its cause, does not affect all people the same way, i.e., with headaches.

  • Time to look elsewhere

    If you have sought solutions to your headaches and face pains from biofeedback, hypnotism, acupuncture, chiropractic, tissue massage, physical therapy, nutrition, etc, without success, perhaps it is time for you to consider a fresh approach.

  • Symptoms associated with headaches

    Many headaches are accompanied by dramatic, often stroke-like clinical symptoms which can be even more disconcerting and disabling than the headache pain itself. Additionally, these symptoms may be magnified by the effects of excessively used painkillers, sedatives, etc. that are inappropriately self-administered.

    A list of the symptoms of which you should be aware is:

    • Mental and cognitive impairment
    • Irritability, depression and forgetfulness
    • Blurred vision, double vision, visual disturbances.
    • Inability to talk, walk, etc.
    • Nausea, vomiting, diarrhoea
    • Sensitivity to noises and/or lights
    • Sleep disturbances, or, constantly sleeping
    • Inappropriate behaviour such as moaning, screaming, crying and
      outbursts of anger.
    • Running nose, nasal stuffiness
    • Changes in blood pressure, heart rate, skin pallor
    • Alterations in routines of daily living activities

    Accurate information

    It has been estimated that as much as 75% to 92% of all headaches are related to jaw malalignment and jaw muscle dysfunction with most occurring in the large muscle in the temple area that is used to close the jaw. Head pain described as "migraine" often is not true migraine but is really a severe form of this jaw muscle pain that is caused by a TMJ problem: usually a malalignment of the lower jaw to the upper jaw as evidenced by a bad bite; or, a dislocated jaw joint directly in front of the left or right ears, as evidenced by popping or grating noises upon mouth movement. The muscle goes into spasm to prevent you from overusing your jaw. The problem is also within the jaw joint. This joint contains a piece of cartilage about the size and thickness of a silver dollar, similar to the knee joint containing the kneecap. It is when this cartilage goes out of place (dislocation) that the muscles surrounding the jaw joint go into spasm to limit your use of your jaw and you feel the pain/s on the side of your head.

  • What do people mean?

    Lately, when people say, "I have TMJ", they are referring to various problems of an arthritic or muscular nature which primarily affect the parts of the jaw joint/face muscle complex and which can also produce secondary symptoms in other structures with pain ranging from the neck to the forehead to the top of the skull and to the eye or ear. This pain can be very severe and prolonged at times.

    True TMJ problems are felt in the joint area itself with the patient noticing reduced jaw joint motion, pain, clicking, grinding, etc. True headache problems often affect jaw muscles causing pain and altered ability to move the mouth. Since the entire temple area and side of the head contains a large jaw muscle (called the temporalis muscle) headache in this area most often relates to dysfunction in this jaw muscle and not to "migraine". Frequently temporomandibular joint, headache and muscle contraction problems occur together.

  • Poorly understood problem

    Until recent years these problems were poorly understood with patients often going from one doctor to another in an effort to find relief. It is not unusual for a patient to report having consulted many general practitioners, chiropractors, orthopaedists, neurologists, dentists, otolaryngologists, internists, gynaecologists and plastic surgeons amongst others. When the true nature of the problem goes undetected many patients are finally referred to a psychiatrist. For many patients the only answer has been that the patient just has to "learn to live with it" for the rest of their life.

    Fortunately our knowledge has increased to the point where it is clear that malfunction in the joint-muscle complex is the true culprit. Treatment is aimed at eliminating inflammation within the jaw joint, relieving associated muscle pain and restoring the various parts of the joint to their normal anatomical positions. Such treatment has become a primary responsibility of the dental profession.

    Many medical and dental health problems are related to the balance of the jaws, muscles, bite and the temporomandibular joint. Some conditions that may be helped by TMJ related therapies are the following:

    • Jaw joint clicking and popping
    • Limitation of painful mouth opening
    • Daytime clenching and nocturnal bruxism
    • Sleep apnea
    • Facial tension muscle aches
    • Facial tics
    • Atypical facial pains and neuralgia
    • Neck and shoulder pain
    • Ear pain
    • Ringing/hearing loss
    • Eye and sinus pain
    • Vertigo and dizziness
    • Whiplash/trauma - face/neck injury
  • Pattern of headaches and associated symptoms as you go through life

    Ages 4-10

    Headaches   In forehead and temples
    Ears   Ringing sounds, stuffiness and/or itching, earaches with no infections
    Dental   Bruxing and clenching of teeth, upper and lower back molar teeth sore
    TMJ   Popping and/or clicking of jaw joint whenever it is used. Less than normal mouth opening
  • Ages 11-20

    Headaches   Forehead, temples, sides and back of head
    Eye   Pain behind the eyes, eyes are red
    Neck & Shoulder Pain
      Intermittent neck and shoulder pain
    Scoliosis   Neck and back very apparent. Frequent head tilt
    Ears   Roaring, ringing, frequent vertigo, buzzing, hissing, intermittent auricular and preauricular pain
    Dental   Pain in posterior teeth, chewing muscles sore
    TMJ   "Grating" sound, limited opening, movement painful
  • Ages 21-40

    Headaches   As previously mentioned with maxillary sinus-like pain increasingly frequent, pain can be incapacitating
    Eye   Pain as previously mentioned continuous, facial asymmetry
      Chronic "soreness"
    Shoulder   Pain mimicking bursitis; chronic
    Arm   Areas of numbness
    Backaches   Chronic
    Neck pain   Chronic
    Facial pain   Continuous
    TMJ   Osteoarthritic degeneration of jaw joint, chewing muscles sore (or Painful) and tired
  • Ages 41-60

    Headaches   Continuous and incapacitation
    Eye   Pain severe and continuous
      Frequent numbness, drops things
    Neck pain   Incapacitating
    Facial pain   Incapacitating
    TMJ   Osteoarthritic degeneration more severe
  • Ages 60-plus

    Uncontrollable eye tics and facial movements. Progression of above symptoms
Mr. Patrick Grossmann B.D.S. D. Orth. R.C.S. GDC No. 48080
Flat 1 Lister House, 11-12 Wimpole Street, London W1G 9ST.
Orthodontic Specialist & Treatment
of Temporomandibular dysfunctions.   Private practice only