You ask. Our headache experts answer.
Migraine is a central nervous system disorder so the jaw
is not a primary cause. On the other hand, persistent jaw
pain can make daily headaches more likely, even if these
are not migraines. Remember, many people with jaw pain
are erroneously treated for “TMJ” when their primary
problem is clenching. A commonly overlooked cause of
clenching is a movement disorder of sleep known as sleep
related bruxism. In this syndrome, people involuntarily
clench their teeth while sleeping. They usually awaken
with feelings of jaw fatigue or jaw pain and their dentists
usually tell them they are chipping their teeth or wearing down the enamel. Bite splints can protect the teeth
but the muscles are still contracting during sleep, causing
pain. This condition is commonly treated with muscle
relaxers from the benzodiazepine class and others. Stress
management is also an important part of the treatment
plan. It is worth considering this diagnosis before agreeing to invasive surgery. TMJ surgery is not the way to
treat migraine.
Edmund Messina, MD, FAHS
Medical Director
Michigan Headache Clinic
East Lansing, MI
ARTHRITIS AND HEADACHE
I have had a headache every day for almost two
years. I have been to four different neurologists,
and none of them could give me an answer for the
headache. They tried almost every drug on the
market to no relief. Now I’m on a narcotic patch
and they seem to have calmed down. I also started
going to a pain center were I finally got an answer.
They say I have arthritis in my neck and that is the
reason for my headache. Is this common and how
do I cope with this? Any help would be appreciated
– Greg M.
reader mail
discovered on an MRI is often seen as we age, even in
people with no symptoms of headache or neck pain so it
may be difficult to say for certain that your headaches are
caused by arthritis in your neck. Also, narcotics will cover
up pain of any type but can make patients with headaches
worse very quickly, especially as they develop a tolerance to the dose they are using. I would suggest seeing a
headache specialist to confirm the diagnosis as chronic
narcotics are rarely a good choice for headache sufferers.
David S. Larsen, MD
Center for Headache Medicine
Chicago, Illinois
WEIGHT LOSS SURGERY
AND HEADACHES
Do you know if weight loss surgery would have any
effect on migraines or if losing weight would help
control my migraines? – Heather G.
I am not aware of any significant study which supports
weight loss surgery as a treatment for migraine, and we
certainly see a lot of headache patients who have lost 100
pounds and are still having headaches. The problem with
bypass surgery is the intolerance to nonsteroidal antiinflammatory agents and other medications. Many bypass
people do not absorb their migraine medications very
well. On the other hand, this type of surgery has been
shown to reduce the risk of type II diabetes, so it should
be taken seriously. We see fewer complications in bariatric
surgery patients who did not undergo the actual bypass
procedure. In general, the more fit you become, especially
with regular exercise, the easier your migraines will be to
control.
Edmund Messina, MD, FAHS
Medical Director
Michigan Headache Clinic
East Lansing, MI
Neck pain is a very common complaint of headache sufferers, especially migraineurs, who may experience neck
pain more often than they are nauseous with their headaches. However, cervical spine pathology (neck problems)
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