111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
A Dismal Headache
I can't begin to describe the pain. it's
—a 46-year-old lawyer
"I'm seeing you as a last resort,"
said Sarah Johnson, a 42-year-old mother of two and former
teacher. "When I first began to get regular headaches,
I thought they would eventually pass—like a bad cold
that seems to hang on and on, but if you wait long enough
it finally goes away. But at some point my patience ran out.
I was living in constant pain, and I was scared."
To find relief for her headaches, Ms. Johnson
took a logical first step. She made an appointment with her
family physician and told him her story. "At that point
I was having headaches three times a week—big headaches,"
she explains. When a headache was at its peak, she could do
nothing but lie motionless in a dark room. The slightest noise
made her flinch. She was completely unavailable to her family
and friends until the attack passed.
When her doctor asked her to list any other
important symptoms or complaints, she added bouts with stiffness
and pain in her neck and shoulders, stuffiness in her ears,
and occasional earaches. She also experienced lower back pain
much of the time, but had been told there was nothing structurally
wrong with her back and so learned to live with some discomfort.
Ms. Johnson also reported that her husband often commented
(and sometimes complained) that she ground her teeth at night.
Not surprisingly, she said her symptoms were worst during
times of stress. In times of relative calm, she had some headaches,
but they were milder.
The family physician couldn't find any physical
cause for Ms. Johnson's headaches, but he did give her a pain
reliever to try. He also told her to come back if her problems
continued. She returned to his office ten days later. "The
pain killer barely dented the pain," she said. Her physician
decided it was time to bring in specialists to help solve
Two weeks later Ms. Johnson was in the office
of a specialist in diseases of the ears, nose, throat, and
sinuses. After a thorough examination, the specialist pronounced
her healthy. However, Ms. Johnson observes, "It's difficult
to feel healthy when you're walking around in pain."
Although she was discouraged, Ms. Johnson agreed
to try a neurologist. She not only had another thorough examination,
she also had a CAT scan and an electroencephalogram (EEG).
Again she heard discouraging news— no cause, no cure.
"And I didn't like the sound of the diagnosis. The neurologist
said the headaches appeared to be caused by 'nerves.' "
After months of investigation into her problem
of severe, debilitating headaches, Ms. Johnson had:
• A prescription for Valium for her "nerves"
• A narcotic pain reliever
• A referral to a psychotherapist
• Instructions to learn how to manage stress
Ms. Johnson was showing obvious side effects
of the pain medication. She had difficulty concentrating,
appeared to be tired, and sometimes slurred her words. She
concluded her story by saying:
In some ways the medication has helped.
I still have the headaches, but when I take the pain killer,
the excruciating pain lessens just enough for me not to care
about the discomfort. Unfortunately, I don't care about much
else either—I really don't function normally, as you
no doubt have noticed. My husband had to talk me into keeping
today's appointment because I felt so lethargic and 'spacey.'
I've been told that I'm nervous and tense. Now the psychotherapist
tells me I'm depressed. Of course I'm depressed. It's hard
not to be depressed after what I've been through. I was never
nervous or tense before, either. But I can't tell you how
many hours I've spent worrying about myself. Am I really crazy?
Am I imagining all this? Is there a disease the doctors have
missed or aren't telling me about? I'm so tired if existing
like this. I want my life back.
Ms. Johnson's story may sound bizarre. But
it isn't the least bit bizarre or even unusual. I hear variations
on the same story every day. Fortunately Ms. Johnson's story
has a happy ending. Her condition was properly diagnosed as
temporomandibular joint dysfunction syndrome (TMJ). Then an
effective treatment plan was developed. (Chapter 10 will explain
what this treatment is like.) Today Ms. Johnson has her life
back and is living pain-free. She is also teaching school
What is TMJ? Simply put, it is a pain syndrome
that leads to some or all of the following symptoms:
• Aching or stiff neck
• Aching or stiff shoulders
• Earaches, ear fullness, ringing in the ears, or pain
associated with the ears
• Jaw pain
• Popping or clicking in the jaw joint
• Facial pain
• Numbness in the fingers and toes
• Vertigo (dizziness)
• Undiagnosable tooth pain
These symptoms are caused by spasms, or charley
horses, in the muscles of the head, neck, shoulders, and back.
The spasms are triggered by a gearing conflict in the teeth.
This gearing problem is unrelated to how the teeth look.
By far the most common symptom is headache.
Usually, but not always, it is the severity of headaches that
drives a person to seek help. But the patient typically experiences
other symptoms as well. The severity of symptoms often varies.
A person may experience severe headaches, but only mild neck
stiffness or backache. A few patients have some of the other
symptoms but no headaches at all.
LOOKING FOR RELIEF
If you are a headache sufferer or frequently
experience any of the other symptoms, you may have sought
help from numerous medical specialists. Depending on your
symptoms, you may have been under the care of a chiropractor,
a naprapath, or a massage therapist. Many people will obtain
some relief for short periods of time. But when the symptoms
return, the frustration and anguish mount.
Some undiagnosed TMJ sufferers, particularly
those who experience debilitating headaches that prevent any
semblance of normal life, may use potent pain relievers. While
this therapy will sometimes relieve the pain, a patient may
become physically or psychologically addicted to the medication.
Even though this kind of therapy rarely helps the TMJ sufferer,
extreme discomfort and hope lead the person to continue the
People who live with chronic pain often become
depressed. As they travel futilely from specialist to specialist,
they may become more depressed. Eventually many people are
referred to psychotherapists for their depression. Ironically,
they are then told they probably suffer from headaches because
they are depressed! Eventually many people lose hope; some
even attempt suicide.
Rarely does TMJ lead people to anything as
extreme as suicide. But they may try so hard to help themselves
that they feel defeated and helpless. This is particularly
common in people who attempt to cope with TMJ symptoms by
using various stress-management techniques. While stress affects
TMJ's symptoms, the ultimate cause is physiological—a
Barry Stern had no doubt that in some way he
was the cause of his own symptoms. "I've taken up every
self-improvement program in the book," he said while
giving his history. He had been suffering for about two years
before he sought professional evaluation and help. His main
symptoms were neck and back stiffness and pain, although he
later experienced numbness in his extremities and buzzing
in his ears.
Because Mr. Stern attributed his muscle aches
and stiffness to stress, he began a vigorous exercise program.
"The jogging I did helped me in many ways," he said.
"In fact, it became almost like an addiction. I felt
more relaxed, but the neck and shoulder pain didn't get better.
Sometimes it got worse, but I kept running anyway."
While in training for a marathon, Mr. Stern
began to experience numbness in his extremities and later
buzzing in his ears. At that point he was also practicing
meditation and still believed that all his symptoms were caused
by life pressures that he didn't handle well enough. He might
have gone on believing that indefinitely if he hadn't mentioned
these problems to a physician specializing in sports injuries,
whom he was consulting for ankle problems. The sports medicine
physician referred him to a neurologist, who gave him a thorough
examination and, finding nothing wrong, referred him for TMJ
"I'm glad to know I don't have neurological
problems," said Mr. Stern, "but I've just about
run out of hope about learning how to handle all these strange
symptoms. I guess I don't handle life as well as I should."
Mr. Stern's treatment took about eight months,
and all his symptoms are gone today. He also was relieved
of the self defeating belief that he brought the pain on himself
by being too weak to cope with day-to-day pressures.
You may be a person who has lost, or all but
lost, hope of getting any relief from chronic pain. You may
also experience guilt over having the symptoms at all. Many
patients feel like failures and believe they are weak. I can't
offer you guarantees. I wish I could. But I can tell you about
TMJ and what can now be done to correct the problem. This
book will explain the condition and lead you through an explanation
of the symptoms, the diagnosis, and the treatment.
First, it's important to understand the reasons
that underlie this often baffling pain syndrome.