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An Overview of Headaches
Any ache but a heartache; any pain but
in the head.
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"
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.
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
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
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
Have a medical work-up for headaches first.
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.
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.
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.
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
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
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.
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.
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
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
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
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
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.