Headache or Facial Pains
Headaches Are a National Dilemma
Over 40% of the U.S. population have suffered from
severe headaches at some point in their lives (Zeiger et al, 1977).
Over 550 million work days each year are lost because of headaches
(Sternbacks, 1986). In 1981, Lance and Drummond reported that in
1200 headache patients, migraines vs. muscle tension type, one could
not be distinguished from the other.
Until recently, treatments for headache sufferers
has been confined to various methods with marginal success.
biofeedback, and physiological approaches have helped a number of
individuals, but a number of individuals were not significantly
improved or they preferred to avoid long term drug, biofeedback
or psychologic care. Our main goal is to find and correct the cause
of the problem, not to suppress or cover-up the symptoms with drugs
or unnecessary surgery.
New research (Lynn, et al, 1991) has uncovered
more of the mysteries of the causes or sources of headaches. The
way muscles and bones move above the shoulders differs significantly
from the other extremities in many respects. This is an area where
right and left nerves, muscles, and vessels must work together.
This is essential because the right and left tissue systems are
affecting movements of single bones, in essence the mandible (lower
jaw) and the cranium (skull). The result of restoring normal physiologic
parameters to unbalanced systems was sustained pain relief.
Medical or Biochemical Aspects
When these synergistic or balanced antagonistic
tissue systems are unbalanced (asymmetrical motor neuropathic dysfunction),
then the right and left components or the elevator or depressor
components become dominant. This results in muscle hypertonicity
(spasm) at rest or ineffective performance during function. The
end product of constant resting muscle hyperactivity (spasm) is
decreased blood flow through regional vascular beds (vascular instability).
This causes a change in the metabolic path for the production of
energy from aerobic metabolism to anaerobic metabolism. The end
product of anaerobic metabolism is lactic acid, which is a spasmodic
itself and a localized tissue irritant thus causing more spasm and
pain, The neurovasomuscular system of the head and neck develop,
through life, into functional (efficient) or dysfunctional (inefficient)
patterns, much like a person learning to swing a golf club correctly
or incorrectly. There is no genetic predetermined pattern of function
or dysfunction. The neuromuscular pattern of function or rest, modulated
through the reticular activating system is one the body has adapted
to either with or without symptoms (pain or headaches). In the symptomatic
individuals, the body's adaptive mechanisms have fallen behind the
pathophysiologic dysfunctional patterns. The metabolic changes are
subtle, but the pain produced is significant.
Headache Relief Is Available
Today, new computerized technology affords specially
trained professionals the ability to discover and determine the
extent and location of abnormal neurovasomuscular patterns. In many
conditions, a computer designed orthosis is necessary to retrain
the compromised (neurovasomuscular) tissues. This orthosis promotes
tissue healing in much the same way as a cast allows a broken bone
to heal. Constant stabilization of dysfunctional tissue systems
results in restoring them to functional patterns. The metabolic
abnormalities are eliminated and therefore the pain is relieved.
Once these tissue systems are restored to normal functional patterns,
there are several options available to the patient to maintain long
term stability and pain relief.
This physiologic-based treatment has allowed at
least 80% pain relief in 95% of the patients treated. The opportunity
to experience life without headaches is the result of new computerized
technology and new treatment techniques.
What Causes MPD?
do not think of a person "catching"
a heart attach or cancer overnight. Similarly, most people do not
"catch" MPD. As a chronic degenerative disease it often
takes years to develop. Since we will not find a simple virus,
we must consider many different contributing factors.
Have you ever seen a jaw come walking into a dentist's
office by itself? We hope not! That jaw happens to be attached to
a whole person with a unique personality. This is why we must consider
many different aspects of the individual when discussing the cause.
We will divide these aspects into three groups: structural, emotional,
and biochemical. All of these components are disturbed to some extent
when a person suffers from MPD.
When diagnosing MPD, we will try to assess the
relative impact of each of these components. This will help to determine
the most effective course of treatment for you.
It may be that you were not aware of any symptoms
until you woke up one day with, for example, an excruciating headache.
To explain this, June Biermann and Barbara Toohey in their book,
Women's Holistic Headache Relief Book, developed their
Dam Theory for those "damn headaches."
They compare headaches to a dam, behind which there
is a reservoir. Rain, hail, sleet, snow, and various runoffs all
cause the water level behind the dam to rise. When too many of these
factors combine, the water spills over the dam, causing a devastating
flood in the valley below.
Similarly, many different lifestyle factors can
combine which could aggravate MPD - such as structural imbalances,
stress, fatigue, certain foods and drinks and even chewing gum.
Any one of these is a single drop in the bucket, but taken together,
they precipitate into a full-blown MPD condition.
There is always an underlying structural weakness
behind MPD. Nearly all of us have a structural weak spot somewhere
in our bodies. For some people, it is their stomach, and they are
prone to ulcers. For others, it is their heart, and they are prone
to heart attacks. For you, it is your jaw, and this is why you are
prone to MPD.
structural weakness stems from a condition which dentists call "mal-occlusion" (literally: "bad
bite"). This means that your upper and lower teeth do not
close together in the right way. Just as a table needs four legs
firmly on the floor for support, your teeth must fit firmly together
to support the muscles in your face for chewing and swallowing.
Your teeth are part of your skeletal system. They
are attached to your jawbone, or mandible, which is one of the 206
bones in your body. The mandible looks something like this:
You can see that your jaw is attached to your head,
or temporal bone, by your temporomandibular joints. These two joints
happen to be the most complex in your entire body. They are ball
and socket joints which have the unique capability of moving in
three directions simultaneously - up or down, forward or backward,
and to the left or right.
It is important to realize that both your temporomandibular
joints and teeth are part of the same bone. The position of your
temporomandibular joints is determined by the way in which your
upper and lower teeth close together. When your upper and lower
teeth are closed together, they are in occlusion.
Your occlusion dictates the position of your jaw in relation to
your skull. Dentists call this the craniomandibular
Malocclusion is when your bite is such that your
skeletal system is in disharmony with your neuromuscular system.
This means that your teeth are forcing the muscles of your face
and jaw into a strained and unnatural position.
The muscle activity of your face and jaw is extremely
complex. Think about it - simultaneously muscles move your lips,
tongue, cheeks, eyes, throat, the inner portions of your ear, and
In fact, neurologists have recently mapped out
which regions of your brain control the various parts of your body.
This diagram shows the control relationship between the cerebral
cortex and specific parts of the body:
Distortions occur because the amount of cerebral
activity dedicated to a part of the body is not proportional to
the size of that part, but to the precision with which it must be
controlled. Notice how much of your cerebral cortex is dedicated
to your face and neck. You see that the muscle activity in this
area is indeed complex.
or a "bad bite," can be
caused by something extreme, such as a whiplash injury or a blow
to the head. But even minor changes, such as a missing tooth
or a high filling, can result in MPD.
Imbalanced Chewing Forces
You probably never connected a missing tooth with
your headaches. Most people don't, which is why most MPD headaches
are so puzzling. Yet, if your teeth are not providing the proper
bracing support for your jaw against your skull, the muscles of
your face and jaw compensate by forcing your teeth to come together
for chewing and swallowing. Since you swallow at least once each
minute, this means your teeth close together over 1,000 times each
day and night. When the jaw must twist, or torque, in order for
the teeth to close together, the muscles are put into a strained
and unnatural position. This muscle spasm is the key to myofascial
Imagine if you had to sit on a chair which had
a nail poking out one side of it. Since you would not want to sit
on the nail (and probably prefer not to sit on the chair), you would
torque your body to one side and hold up one hip.
Balance of Forces
After a while, this position would become extremely
uncomfortable and certain parts of your body would start to feel
pretty sore. This is the same thing that happens to the muscles
of your face when they are forced into an unnatural position because
of your bite. Eventually the strained muscles become sore and painful.
Not only do the muscles of your face and jaw become
sore because of this constant strain, but they also shorten. This
can cause problems in the muscles of your neck, head, back and even
down into your chest.
Your head sits delicately balanced on top of your
neck because of a complex coordination of these muscles. Imagine
it as a baseball balanced on top of a pencil and held in place by
a number of rubber bands. Now imagine shortening just one of those
rubber bands; some would stretch, some would shorten, and the baseball
would be thrown off kilter! Similarly, when even a single jaw, neck
or shoulder muscle becomes shortened, all of the other muscles are
forced to overwork to keep the head balanced on top of the spinal
which are under constant strain can develop "trigger points." These
feel like knots, or nodules, which are painful when you press
Sometimes trigger points can be the source of referred
pain. Referred pain is when a pain originates in a part of the body
that differs from the area where it is felt. These can be tricky
to detect, because the painful area is not the source of the problem.
We are able to detect the real source of pain by mapping the referred
You see that people who suffer from MPD have a
structural imbalance in their jaw-to-skull relationship.
This is caused by a bad bite (malocclusion) which
has two consequences. First, it alters the position of your temporomandibular
joints and places excessive pressure on the nerve-filled area surrounding
them. Second, it twists, or torques, your jaw into a strained position.
This can affect the muscles in your face, head, neck, back and shoulders.
Muscles under constant strain are painful!
To correct this, the jaw must be brought back into
a muscularly balanced position. Before explaining how this is done,
let us discuss how chronic muscle stress affects you emotionally
MPD is often called "the great imposter."
No wonder! Because of the number and variety of symptoms it is difficult
to detect. How many people would think of visiting a dentist if
suffering from headaches, ear stuffiness, or neck pain? Consequently
many go from doctor to doctor trying to find relief. This can be
extremely frustrating--and costly! You may even begin to wonder,
"am I crazy?" Since MPD is so seldom recognized, people
who suffer from it often receive little support.
This is why an accurate diagnosis is so important.
It is the key to successful treatment. Below is an outline of a
diagnostic procedure. The doctor may use any or all of these procedures
to arrive at a diagnosis:
- An interview to discuss your medical history in relation to
your MPD condition, onset of pain, symptoms, and contributing
- A clinical examination to explore tenderness in the muscle
groups of your jaw, head, neck and shoulders, as well as your
teeth and bite, and other related factors such as ear blockage
- X-rays of your jaw joints in open, closed and rest position.
- Casts (models) of your teeth to obtain a record of your biting
and chewing pattern.
- Use of TENS
to relax the muscles of your jaw.
- An analysis of your jaw movements.
- An analysis of your muscle activity.
of jaw joint sounds.
TENS and other instruments that measure jaw movement
and muscle activity are widely used in dentistry. We describe these
more in our technology
Once all diagnostic information is collected, we
can determine the best course of treatment. Typically, treatment
will follow these steps:
- Relieve muscle spasm and pain. TENS is one
of the most effective ways to do this. Sometimes moist heat
packs applied to the face or muscle massage will also help.
Occasionally pain medication or mild muscle relaxant drugs are
- Stabilize the bite. When muscles have been
tight for a long time, it takes a while for them to relax. During
this phase, the bite can be temporarily corrected with the help
of a splint, or orthotic, which fits over the teeth.
This allows us to make easy adjustments of your bite until it
reaches a stable position. Once symptoms are relieved and the
bite is stabilized, then it can be permanently built to the
- Long-term management. There are various ways
that your bite can be corrected in a more permanent way. Below
are five approaches:
-- selectively reshaping the contours of the teeth to correct
the bite. This is a fairly simple procedure which can be used
when the bite has minor discrepancies.
Removable Overlay Partials
-- permanent orthotics which are designed to maintain an accurate
and stable bite.
Reconstruction -- adding
height to the teeth to provide structural support.
Orthodontics (Braces) --
when teeth are very healthy in both children and adults, they
may be moved to the correct neuromuscular position.
Orthognathic (Jaw) Surgery
-- in a very small percentage of cases,surgical realignment
of the upper and lower jaws may be required to correct the
What Is An
Orthotics are known by various names, such as splint,
or bite guard. The term orthotic is most accurate because
it means a mechanical appliance designed for orthopedic use.
Orthotics are also made in various ways. Typically
they are made of lightweight clear acrylic and fit over your lower
back teeth. Many people who suffer from MPD have back teeth which
are too short. The orthotic adds height to your teeth to provide
structural support. Providing support for your back teeth rotates
your jaw down and forward. With this support, the muscles do not
have to strain to bring your teeth together.
Orthotic Device in Place
What Will the Orthotic Feel Like?
The purpose of the orthotic is to change the way
the teeth close together so that the muscles are balanced. It is
hard to predict how you will feel at first. Sometimes it takes a
while to get accustomed to having something over your teeth.
Eventually, you will become very used to this new
position and it will feel strange when your remove the orthotic.
Your teeth will feel "lost". They will miss the support.
Many patients find that once accustomed to the orthotic, a headache
begins shortly after removing it. This usually stops once it is
replaced in the mouth. Again, this vividly shows that your teeth
must have this extra support in order for the muscles to relax.
Will People Notice That I'm Wearing an
When worn, the orthotic is barely noticeable. The
front portion is usually a thin, clear acrylic strip which most
people will probably never notice.
How Long Will I Wear an
This is difficult to estimate because each patient
is unique. Initially, we must check the orthotic frequently. As
your muscles are changing, they may wear or otherwise change the
acrylic surface of the orthotic. Gradually, your bite will begin
to stabilize and the orthotic will require less frequent checks.
Why Can't I Permanently Wear an
There are several reasons:
- It is usually made of acrylic which does wear down over time.
- Long-term wearing is not hygienic; it can become an irritant
to gum tissue.
- It fits tightly around your teeth and over time the orthotic
may move them.
Some orthotics have
been designed that are appropriate for long term use, and this is
something you may wish to discuss with your dentist.