It is estimated that 45 million Americans suffer from chronic headaches, making it one of the most common disorders for which people seek treatment. Although there are many things that can cause headaches, we will limit our discussion to its relationship to the TMJ (jaw joints) and its surrounding structures. While most people relate TMJ disorders to clicking or popping noises within the joint or limited mouth opening, headaches is often not thought of as a primary symptom of TMJ dysfunction.

WHAT ARE THE RED FLAGS OF HEADACHES?

Chronic headaches do affect the quality of a patient's life, but in most cases are not related to serious diseases or terminal disorders. There are some warning signs, however, that a headache could be related to something serious.

i⤠New headache in patient over 50 years of age
i⤠Sudden onset of a new or different type of severe headache
i⤠"Worst" headache a patient has ever experienced
i⤠Headache that gets progressively worse over a period of days or weeks

i⤠Headache brought on by exertion (coughing, sneezing, exercise)

i⤠Headache with fever, nausea, vomiting or stiff neck
i⤠Headache that awakens the patient from sleep
i⤠Headache with abnormal communication or coordination, weakness or numbness, mental confusion

Any of the above factors should be thoroughly checked out by a physician and not dismissed as nothing.

ANATOMY OF THE TMJ

The TMJ (temporomandibular joint) is merely the joint that connects the lower aw to the upper jaw or skull. It allows someone to open and close the mouth and is vital to chewing, swallowing and talking. The lower jaw has a condyle, the ball, which fits into the fossa or socket making a ball-and-socket arrangement. In the back of the socket are blood vessels and nerves which go to all the head, neck, and facial muscles. If the jaw is in a faulty position as is often the case in TMJ Disorders, those blood vessels and nerves get compressed and do not function properly. This compression occurs nearly 2000 times a day when a patient swallows.

Furthermore, the branches of the nerve that send information to the brain from the upper and lower jaw often have receptors around the major blood vessels in the brain thus triggering the headache commonly referred to as a migraine. It is often this inflammation around the blood vessels which is causing the migraine. This is more likely to occur if the jaw is in the wrong position and the nerves are triggered inappropriately.

BRUXISM: THE GNAWING AND GNASHING OF TEETH

Many people grind their teeth at night, annoying their bed partners and causing considerable damage to their teeth, jaw joints and surrounding structures. Bruxism is both a cause and effect of a TMJ disorder. As the teeth get worn down, the lower jaw can progressively move backward into the socket and compress those blood vessels and nerves. While this is occurring, the muscles of the face and jaw are in constant spasm, particularly the temporalis muscle, which a patient feels in the "temple" area. Many bruxers awaken with headaches from this constant muscle activity and in many cases, they last all day. Bruxism is often the result of the brain's desire to move the jaw to a healthier position to avoid those blood vessels and nerves. We now know from observing children with airway compromises that bruxism is also the body's way of trying to keep the airway open. Adults who suffer from sleep disordered breathing or obstructive sleep apnea often exhibit the signs of bruxism. The lack of oxygen in these cases also can cause the patient to awaken with a headache.

SOLUTIONS: TMJ DIAGNOSIS AND TREATMENT

Patients who suffer from chronic headaches are often at wit's end with their condition. Many seek care from doctor after doctor with no answers. Many are told it is all in their head and they need psychiatric care. Depression and hopelessness often accompany the headaches as a patient struggles to find answers. Drugs are often recommended as a solution but carry considerable risks. Long-term use of medications can lead to intestinal breakdown, or even kidney or liver failure with time. The side effects often leave a patient unable to function at home or at a job, which further increases the depression and hopelessness. A diagnosis of TMJ disorder is often welcome relief to the headache patient. Not only is treatment easy, noninvasive and nonsurgical, it addresses the true cause of the headaches: a structural problem.

Autor: Dr. Dawne Slabach

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