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A Dismal Headache

I can't begin to describe the pain. it's simply unbearable.
—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 the puzzle.

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 again.


What is TMJ? Simply put, it is a pain syndrome that leads to some or all of the following symptoms:
• Headaches
• Aching or stiff neck
• Aching or stiff shoulders
• Backaches
• 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.


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 treatment.

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 tooth-gearing problem.


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 evaluation.

"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.

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