Migraine: The Headache Monster!
It’s the most potent and painfully devastating headache known to mankind. As everyday common headaches go, it’s a Monster! Pain, relentless throbbing headache pain behind or up over the eyes, usually dominant to one side, pain in the forehead, throbbing pain in the temples, pain in the back of the head radiating down into the neck and shoulders, nausea, sometimes even vomiting, visions of sparkling spots or electric flashing jagged lines, temporary blind spots that seem electrically “fuzzy” on the edges and seem to steadily grow larger in the field of vision over several minutes, extreme sensitivity to bright light, or to loud noises or certain odors, feelings of bodily weakness and fatigue, irritability or depression, waking up with a headache in the morning or with tired, sore jaw muscles, tingling in the fingers, hand, lower arm or corners of the mouth, occasional problems with speech, or problems with balance or handwriting abilities, confusions and/or inability to concentrate! These are all common symptoms of that throbbing, debilitating headache that, when it reaches its full strength, traditionally lasts for up to 3 days; that mysterious and vicious specter of intense headache pain – the migraine!
But here is truly spectacular news! After centuries, even millennia, of these types of headaches mercilessly persecuting mankind, we have at last discovered what causes migraines, and much more importantly, we now know how to permanently cure them! The Monster has finally been caged!
- Methods of Treatment (Including the New Way)
- Self-help Techniques: (Address the “effects”)
- Avoidance of “Triggers”: (Address the “effects”)
- Medications: (Address the “effects”)
- Maxillofacial Orthopedics/Orthodontics: (The real answer; the first true cure that corrects the “cause”!)
- “Self-help Techniques” (Address the “effects”)
The term “Self-help techniques”, is a bit of a misnomer. They consist of things like trying to lessen the pain of a migraine attack by means of using a cold compress over the forehead or ice packs, or trying to rest or sleep the headache off in a dark quiet room, or using self relaxation techniques or avoiding things that the patient knows can trigger a migraine attack (red wines, sharp cheeses, or certain types of commercially processed luncheon meats). The trouble is, although you can administer these techniques yourself, the aren’t much help!
- Avoidance of “Triggers” (Address the “effects”)
When migraineurs (patients that suffer from chronic recurrent migraine headaches) are getting close to suffering another attack, certain internal and external things or events called “triggers” can hasten the onset of the attack making it appear as if these “triggers” are the actual cause. Not so! These things merely precipitate a migraine attack that is already pending. They are specific to each patient, so migraine patients need to try to avoid triggers known to be specific to them. Common triggers include: red wines, fatigue, fasting, too much sleep, too little sleep, changes in the weather (usually a front coming through), chocolate, too much stress, periods of relief immediately after a stressful time, hormonal therapy, citrus fruits, aged cheeses, processed luncheon meats, cheap champagnes, caffeine withdrawal, a sudden stop after long term use of pain killers or other types of medications, aspartame, monosodium glutamate ( a flavor enhancer in Chinese foods), bright or flashing lights, loud noises, certain pungent odors, birth control pills (BCP’s), and of course, the number one trigger of all time for women – menses! Obviously some triggers are unavoidable.
- Medications (Address the “effects”)
Drugs are sometimes a short term question but in no way a long term answer!
Taken in larger doses, or taken frequently over a long enough period of time, even non-prescription medicines are toxic. Almost all medicines are basically poisons. Used properly, when indicated, they’re wonderful. But medication management is critical, especially long term medication management. And long term management of any drug can be extremely difficult, especially long term management of pain killers. Ask any physician. There is no such thing as a drug without serious unwanted “side-effects”. Nevertheless, when medications are needed, they are needed.
- Medication Types:
- OTCs: (Over-the-counter, Non-prescription Medications)
These medicines include aspirin, acetaminophen, ibuprofen and naproxen. Sometimes some of them are combined with caffeine to increase effectiveness. These meds can be helpful for milder headaches (T-type, or “tension-type”, formerly referred to as “muscle contraction” type headaches) and even, at times, for migraines if taken early enough at the onset of an attack. But generally OTC medications prove ineffective for extremely severe headaches and are usually not powerful enough for major, heavy-duty migraine attacks. Frequent long term use of these types of medications can prove harmful.
- Prescription medications:
The triptans (Imitrex, Maxalt, etc.) are currently the most commonly prescribed drugs for migraine. However, they reduce the pain/nausea of the migraine headache in only about 75% of the patients. Another problem with these types of meds is that they are contraindicated in patients with coronary artery disease, high blood pressure, a history of stroke, or other peripheral blood vessel disorders! They also cause other serious side effects and are incompatible in patients taking certain modern antidepressants, (Prozac, Effexor) and they can cause a condition called “serotonin syndrome.” Heavy, long term use of these types of medications can also prove harmful.
- Preventive Medications
When conventional OTCs and prescription meds prove ineffective for the seriously involved long term migraine patients, physicians resort to desperate attempts to prevent the migraine from even starting by using long term daily doses of other types of medications that are not even painkillers. Drugs like certain cardiovascular medicines, certain anticonvulsants, and specific antidepressants, all of which are powerful ‘drugs’. Again, heavy long term use of these types of medications can also prove harmful.
- OTCs: (Over-the-counter, Non-prescription Medications)
- Maxillofacial Orthopedics/Orthodontics
- The Real Cause and the Permanent Cure! The Modern Miracle Breakthrough!
- Dr. J.D. Bartleson, a Mayo Clinic neurologist and a Board Certified Specialist in Headache and Pain Medicine stated in an article appearing in the October, 2014 issue of Minnesota Health Care News…
- “Emerging evidence suggests that migraine headaches arise from a disturbance in pain pathways that affect the head, face and neck!”
- We now know, without a doubt, just exactly what that “…disturbance in pain pathways that affect the head, face, and neck,” turns out to be; it is a long misunderstood, overlooked, and very sneaky problem deep in the human jaw joint sockets known as a chronic compression nerve damage model. It is referred to by the rather cumbersome name of…
- “Temporomandibular joint pain-dysfunction syndrome” or just plain “TMJ” or “TMD”! (“TMD” stands for “Temporomandibular Disorders.”)
- The Proof!
- The highly specific scientific research literature now proves that this TMJ breakdown/pain condition is the cause of chronic recurrent T-type and migraine headaches beyond a doubt.
- The extensive series of highly sophisticated neurological mechanisms and chemical reactions involved in the long complicated process of generating migraines that have been pieced together over the years and which we now better understand also prove this.
- The consistently and highly successful treatment techniques now used in properly treating this initial “TMJ” or “TMD” pain condition, in turn have been observed to also permanently eliminate this often attending terrible and painful chronic recurrent migraine headache condition. This also proves it without a doubt. (Note: the operative word here is “properly”!)
- And it all resolves itself down to a matter of a crooked bite! Incredible!
Migraine: The Cause
Older dentists and physicians called it “TMJ.” The more recently educated health care professionals now call it “TMD” (Temporomarndibular Disorders). By either name, it has always been a confusing, controversial, and mostly misunderstood condition. Everybody agrees that the TMJs (temporomandibular joints; the joints of the jaw socket back by the ear where the horseshoe-shaped lower jaw attaches to the sides of the skull in a ball and socket type affair) can sometimes become dislocated, shredded apart internally, and for some reason can generally suffer an anatomical breakdown of varying degrees in their normal internal structural integrity. As a result, the patients involved in this joint internal breakdown condition can suffer tremendous pain. They can suffer jaw joint pains, jaw muscle pains on chewing, they can suffer facial pains, they can suffer internal ear pains, and they often suffer neck muscle pains, and these are a collection of pains that can vary in intensity, location, frequency, and duration. But here’s the big thing. We now know for a fact that this “TMJ” internal jaw joint breakdown condition can also cause them to suffer chronic recurrent headaches! Like the other known “TMD” symptoms listed above, these headaches can vary in intensity, location, frequency, and duration, with the 2 to 3 day long migraine headache attack being the final end stage of this long TMJ breakdown/pain continuum. Just where the patients find themselves on this TMJ breakdown/pain pathway, that ranges from just 1 or 2 milder headaches every 2 to 3 months or so all the way to those unfortunate individuals who suffer from more severe headaches and terrible migraine attacks almost every day for years, is a product of: their gender, (women suffer from this TMJ breakdown/pain pathway far, far worse than men); it is also a product of how severe the joint breakdown in their jaw sockets is, how long they’ve had it, and how early it started (it can easily start in children 5, 6, or 7 years of age). It is also affected importantly by the fit of their bite, as well as a number of other complex factors. Here’s something even more amazing. Other than the culpability of this “crooked fitting bite” condition, there has never been any other known, demonstrable cause for this chronic recurrent headache (migraine or otherwise) problem! Yes, other medical conditions can cause headaches, but then the medical diagnostic process can determine just what those other conditions or diseases are; a process called “differential diagnosis.” (And now for the final shocker!) People that suffer chronic recurrent headaches, without any other contributing medical condition to account for them, have an extremely high chance (as in the upper 90% range) that it is all due to the fact that they are suffering from this TMJ breakdown/pain pathway. If they have chronic recurrent headaches accompanied by occasional, or frequent migraines, or migraine-type headaches almost exclusively, the chances that it is all due to this TMJ breakdown/pain pathway are almost 100%!! The health care world has been caught totally off guard by these findings, and by and large is not ready to accept this amazing breakthrough! Mother Nature couldn’t care less. It is what it is; ready or not! And yes, it is in fact a very complex TMJ damage/neurological “disturbance” pathway that we have only just lately figured out. But complexity does not preclude veracity. That’s why this TMJ breakdown/chronic recurrent headache, facial pain pathway has laid so long undiscovered. There are many complicated, convoluted and intricate neurological steps in the TMJ breakdown/pain pathway process leading to the exhibition of chronic recurrent headaches. But now we have just about all of these steps figured out. As a result, we now know how to eliminate the TMJ breakdown/pain migraine headache pathway at its starting point, and as a result thereby eliminate the migraine headache itself once and for all! Read on, and I’ll tell you how we do it. It’s a matter of the application of plain old common sense.
Migraine: The Cure
It has been discovered that the TMJ breakdown/pain pathway is initiated by a misaligned set of jaws due to an improperly fitting bite! This causes the lower jaw to bite too far back. This can result in the rounded back ends of the lower jaw (bony, ball-shaped ends called “condyles”) being repeatedly jammed backwards into the upper back-most recesses of their own right and left jaw sockets on the sides of the skull back by the ears. This is anatomically improper. They are jammed back that way by the fit of the upper and lower teeth at full chewing bite. This improper, backwards driving type of bite slowly over time shreds those condyles loose from their own little constraining internal joint ligaments that are designed by Nature to prevent this, and thereby gradually allows the lower jaw to forcibly close just a little bit too far backwards, a little too hard, for too long a time. The fit of the upper and lower teeth at full chewing bite is called “full occlusion.” This overly backwards jamming fit of the bite causes the right and left rounded bony ends of the lower jaw (condyles) in turn to injure and bruise a discrete and delicate little nerve and artery bundle that resides deep in the internal lining of the upper back soft tissue recesses of the bony dome of the human jaw sockets . For a small piece of anatomy, this little nerve/artery bundle has a very large name. Science refers to it as the “auriculotemporal neurovascular bundle!” Even though it is relatively small as nerve bundles go, it is still a very important one (a peripheral branching part of the biggest, most extensive cranial nerve complex in the entire head called the trigeminal nerve). The initial bruising and damage to this little jaw socket nerve complex might be so subtle and gradual at first that when the condyles (the bony balls on each right and left end of the lower jaw), start to impinge into its territory and begin the repeated process of “bruising” these tissues, due in turn to being driven in there by the improper fit of the teeth during chewing; at first it may not hurt right in the jaw socket per se during biting, chewing, or the grinding of the back teeth during sleep. Yet nevertheless, that bruising can sometimes cause all sorts of intra-cellular chemical changes to gradually occur in those damaged nerves that slowly spread up these nerves into the brain, and as a result of a long complex series of naturally occurring chemical and neurological steps that we are finally beginning to understand, begin to show results symptomatically in the form of chronic recurrent headaches. As previously stated, they can be headaches of any variety, frequency, location or intensity with the terrible migraine headache representing the ultimate “end of the line” manifestation of this multi-faceted headache continuum. The body constantly trys to fight off and control this complicated headache process. But many times, especially in women, the condition steadily gains dominance over the years, unless something is done to eliminate the source. We now know how to eliminate, (not merely hide) that source!
Successful treatment of the TMJ breakdown/pain/migraine condition consists or permanently realigning the patient’s bite from one that is improper (joint socket damaging), to one that is more anatomically correctly aligned (jaw socket healing and protecting). This is accomplished, over a period of months by means of having the patients temporarily wear certain special types of easily employable, intra-oral, removable “appliances”, (any intra-oral device worn and fit to the teeth like a retainer, bite guard, or dental brace is called an “appliance”). Biting on these specially designed “appliances” or “bite guards” to realign both the fit of the teeth of the bite, and as a result the closing alignment of the entire lower jaw itself, forces the entire lower jaw to shift slightly more forward during chewing. This then effects a new lower jaw chewing position that operates the lower jaw just a few critical millimeters away from its old, habitually existing, too-far-backwards, improper biting position. This technique of treatment with these removable “appliances” (sometimes also called “splints”) consists of a new way of creating a slightly more forward, much more anatomically correct lower jaw chewing position. This then in turn also results in a chewing bite that doesn’t keep forcing the lower jaw and its internal socket bony condyles, into being jammed backwards too far into their own jaw sockets any more by the former, incorrectly fitting bite. This then in turn results in the forward clearing of the fit of those bony condyles in their jaw sockets at that “intra-oral-appliance-corrected” full chewing bite position in a way that totally prevents the repeated internal jaw socket nerve and artery compression, bruising and damage. That is when the headaches totally stop! Stop the repeated jaw socket nerve damage; stop the repeated headache pain. It’s that simple!
Surprisingly, organized Dentistry has not always known exactly how to do this. In fact, realigning the entire lower jaw forward several millimeters, for any reason, and changing the fit of the bite of the teeth to keep it working correctly there, was a feat that at one time, in the not too distant past, was generally considered all but impossible, except if done surgically! However, in these modern times we now know how to do this procedure easily, efficiently, and painlessly with these special, European-invented, little removable retainer-like intra-oral devices, which are actually called “Functional Appliances”. People can wear contact lenses every day to correct their vision. They can wear lifts in their shoes to relieve pains in their feet, hips and lower back, and to also correct their gait. They can wear little devices comfortably in their ears to improve their hearing. Likewise, people can easily wear “Functional Appliances” in their mouths that “snap” on their teeth to correct the fit of their improper bite. The use of these newer European-designed intra-oral removable Functional Appliances comprise a new technique in orthodontics originally designed for the correction of anatomically incorrect (lower jaw fitting back too far) jaw alignment problems in children. Now, this well recognized children’s orthodontic technique also doubles over in modern times as the ultimate adult, advanced, chronically, painful TMJ/TMD, and chronic recurrent migraine headache treatment technique that proves to be vastly superior to older methods. The spectacularly successful results we now see on a consistent basis in migraine patient treatment with these techniques, as well as on all other types of chronic recurrent headache patients, prove it. (These results are truly incredible!)
For patients suffering from this TMJ breakdown/pain/migraine headache pathway scenario, once proper mandibular (lower jaw) repositioning and realignment treatment begins with the daily use of these properly made, correctly worn, and expertly managed little intra-oral removable devices (bite guards or “splints”), we generally see 75% to 90% reduction in headache and neck ache symptoms during the first month! Often in younger adults and adolescents we observe this level of improvement within the first week, and in pre-pubertal children, often within the first several days! Getting the fit of the teeth and jaws working together in a fashion that is anatomically correct is the secret. Keeping it that way is a whole different set of treatment details. That is the treating clinician’s job. Yet with the proper modern knowledge of how to do this, it’s a relatively easy job. We do this everyday.
Migraine: The Controversy
This new break through in understanding of both the cause and the permanent cure of chronic recurrent migraines and other types of headaches has ironically met with great and widespread resistance from many members, not all to be sure, but nevertheless many members of the health care professions of both Dentistry and Medicine, surprisingly most often from the academics! That is because the migraine headache cause (TMJ/TMD), the cure (Functional Jaw Orthopedics/Maxillofacial Orthopedics), and the reasons for the initiation of the entire TMJ breakdown/pain/headache pathway itself, all turn out to be almost total scientific surprises, and involve things that are the complete opposite of what many people in this business have always thought. Too bad! That’s just the way it goes sometimes. There’s so much new and modern technical information out there growing so fast that nobody can keep up with everything! But from this point on in the TMJ/TMD argument (sometimes referred to as “Jaw Wars,”) there is no going back. The health care professions simply have to learn to catch up with those who have figured it all out, i.e. from the practitioners who have the direct, first hand experience of doing it!
To successfully diagnose, treat, and permanently eliminate major chronic recurrent T-type/Migraine headache and jaw muscle pain problems in patients suffering from chronic TMJ breakdown/pain/migraine headache pathways, the treating clinician involved must have an extensive background in: orthodontics, especially the newer European style of “functional” orthodontics that can permanently reset the fit of the backwards-jammed lower jaw, and re-align it back out forward by 2-3 millimeters (where it originally should be) and keep it functioning there permanently. It is a modern technique predicated on using certain types of those small, properly made, intra-oral removable “bite guards”, “splints,” and/or “European-style Functional Appliances,” (that sort of look like little retainers). Also the treating clinician needs an extensive background in TMJ/TMD therapeutics, and must be familiar with all of the many time-worn controversies that exist in this field (some practitioners can really get “hot under the collar” about all this TMJ/TMD stuff. Just ask them!). Finally, the treating clinician needs a basic understanding of the advanced neuroscience behind the TMJ breakdown/pain/headache continuum and how it causes what it causes, and why it responds the way it responds with proper corrective treatment. But just hang on a minute! All this new type of lower jaw re-alignment type treatment for chronic recurrent headaches represents a “pretty big dance.” Not every TMJ/TMD patient needs treatments this elaborate. As for those simpler cases of “mild” TMJ/TMD problems accompanied by only occasional, less severe headaches that occur only once every 1 to 2 months or so; patients experiencing this lesser level of involvement should just stick with their pills. These sophisticated, more modern, highly advanced jaw/bite re-alignment treatment techniques described above are “medical overkill” for them. What these newer more modern breakthrough yet easily employable jaw/bite re-alignment treatment techniques are designed for is to not only bring relatively quick headache pain relief, but also to permanently cure the much more severely involved, long term TMJ breakdown/pain pathway headache, neck ache and facial pain patients whose lives are dominated by years of suffering from this terrible condition. There are millions of them! Both Dentistry and General Medicine are going to have a hard time choking all this down, but that’s because they’ve been stuck in their old ways for so long. That’s their problem. It happens all the time in science. We should just be grateful that we’ve at last figured it all out! Finally, complete and permanent migraine relief! Hallelujah!
Terrance J. Spahl, D. D. S.
St. Paul, Minnesota