Dr. Katz, iHATEheadaches Blog

Holistic medicine is defined by the Canadian Holistic Medical Association, as

"A system of health care which fosters a cooperative relationship among all those involved, leading toward optimal attainment of the physical, mental, emotional, social, and spiritual aspects of health."

There are many types of headaches and cause of headaches. There are primary causes and secondary causes, genetic causes, hormonal causes and causes due to chemical imbalance and chemical hypersensitivities. In each of these areas there are specialist who treat headaches based on their specialty. If after seeing a host of practitioners and going through many diagnostic tests and then no cause is found, the sufferer becomes apprehensive, worried, despondent and made to feel that it's all in their head.

Neuromuscular dentist understand that there are other factors that may contribute to head,neck and fascial pain. Headaches of many types are associated with the fifth cranial nerve, the Trigeminal nerve. Migraines, sinus headaches,headaches cause by Temporomandibular dysfunction (TMD) or TMJ are also associated with the same nerve the fifth cranial nerve. Treating, TMJ,the jaw joints, can help relieve or prevent a lot of pain and the associated symptoms linked to the fifth nerve.

Pnupa, a college student over a period of a year, developed symptoms that included headaches,neck, shoulder and facial pain, ringing in the ears and tingling and numbness in her hands. After seeing a host of specialist and months of test, she was told no apparent cause could be found for her symptoms. She had trouble typing and she had to cut the number of classes she could attend at school because of her hand numbness. Carpal tunnel syndrome was ruled out.

She saw a pamphlet I had in my waiting room describing TMD and it's symptoms. "That's me "she said.

Together with her physician, a physical therapist and our treatment of her TMJ with appliance therapy, her symptoms have started to subside. Her hand pain has gone from a Maximum of five out of five to a two in intensity. She is thrilled that she can spend more time typing and working at school. Best of all she happy to know it was not in her head.

Not every headache is due to jaw or bite dysfunction. But being open minded to all the possiblities and working together can make make many chronically unhappy and pain stricken people, pain free and productive again.

How do you deal with stress? Some people get high blood pressure, some people get ulcers. Myself, I tend to clench and grind my teeth. I wasn't always aware of it.
A few years back, I was driving with my wife to a shopping mall. What's the matter she said. "Nothing, I said. Why do you ask." She told me that since we left our drive way my jaw muscles were contracting and expanding as I was grinding and clenching away. I had never realized it. She was right . I was worrying about something and was mulling it over in my mind not realizing that I was transmitting my anxiety and manifesting my tension by grinding and clenching.

Most people clench or grind occasionally but about 10% suffer from TMJ problems and those can set in suddenly. TMJ disorders can mimic migraine headaches, earaches, sinus infection and tooth aches. it can cause dizziness, ringing in the ears, and muscle pain that radiates down the neck and shoulders.

A clenched jaw can exert up to 300 pounds of pressure which can wear and crack teeth. Over time, these excessive and abnormal forces can cause degenerative changes in the jaw joint and muscles of the face, neck and shoulders.

Once Tmj problems set in, treatment can vary depending on the cause and the condition of the jaw muscles, jaw joint, bite, posture and working and sleeping habits. Treatments can include medications, anti-inflammatories, trigger point injections, physical therapy, changing working and sleeping habits, stress management and correction of a misaligned bite.

It's important that when you experience chronic headaches you see your physician to rule out other organic cause that might be causing your headaches. But many times your problem can be of dental origin and a trained dentist in the treatment of TMJ dysfunction and head and neck pain may be your avenue to pain relief.

We know how debilitating headaches can be and our goal is to relieve your pain and give you your life back.

Have you ever been told to stand up straight?
If you look in the mirror and see that your head is in a forward position , your shoulders are rounded in a down and forward position and your VDO, vertical dimension of occlusion, the distance between your upper and lower jaw when your teeth meet is reduced, your posture may be your pain problem.
Not only does this type of posture makes you look and feel older than your are, it also the cause for many head and neck pain and severe headaches. In addition, neck and back pain tends to be worse on the side that has the most loss of VDO. Studies have also shown that an increase in the VDO significantly increased range of neck motion and decreased neck and shoulder pain.

One of the things that you can do to help straighten you up is a very simple exercise. Take a pen or pencil and hold it with one hand on each end behind your back.
Walking or standing with a pencil in that position will bring your shoulders, head straight and give you a straighter appearance. Try it for ten minutes a day. In time it will make you feel better and will become your new posture if your bite is corrected as well.

More tips soon.

Whenever I see someone for headache or Tmd pain, I usually temper their expectations by letting them know that the cause of their symptoms have had years to develop and resolution of their problem will probably take time to resolve.

last Thursday was a very intense and stressful day for me. I was looking forward to the day's end. Jennifer was my last scheduled patient. I had given her a lower orthotic two week ago and she was back to check the appliance and for me to make any adjustments necessary.
Jennifer had been experiencing pain for over nine months on an almost a daily basis. Pain on the side of her head, on top of her head, eye pain, head and neck pain and very tender muscles of the neck and shoulders. She could not open her mouth very wide and her jaw deviated to the right when she opened. She had seen already seen a neurologist, an ear , nose and throat specialist, who had placed tubes in her ears to treat her symptoms, and a chiropractor without resolution.

Hi jennifer. You look great how are you feeling. I was hoping that she had gotten some relief from the orthtic. Her answer was loud and clear, "I feel great". She told me she had had only one or two headaches in the past two weeks but all the soreness on her shoulder and neck were almost all gone. Sure enough, checking all the muscles that were so painful before were now almost pain free. Her whole attitude had changed . She was happy and smiled a lot. I went on to TENS her and adjust her appliance. I let her know that I was overjoyed with the initial results we'd gotten but there was a lot of work still to be done.

My team let Jennifer know how happy we all were for her. We all felt wonderful that we
had been able to finally give Jennifer the relief she'd been looking for.
A wonderful way to end a hard day.

I mentioned to my wife about a week ago that I've been sniffling a lot lately in the office. My assistant also complained about some head congestion and she had gone to her doctor who recommended nasal spray for her problem.
Friday morning I came to work with a slight headache. I took some Advil and began to feel better. Then I suddenly got the aura I used to get when I had migraines years ago. Fortunately, It didn't last very long and there was no severe head pain. I was very surprised to have this type of headache return after so many years. I was happy that I felt better rather quickly and relieved because I was afraid I would not be able to work for the rest of the day.

At two o'clock Pam walked in, took a wiff, and said , "what is that smell?" It's such a heavy chemical smell. I can't sit in a dental chair if you don't get rid of that smell. I get bad headaches from chemical smells like that . Needless to say, I didn't smell anything.
We sometimes burn candles or use scented liquid in small bottles with fine sticks that absorbs the liquid and lets it evaporate to give the office a pleasant aroma. I suddenly remembered that we were using a new label and I had turned the sticks over this morning so that the half that had been in the bottle was now filling the air with its odor.

I had to laugh. I thought my headaches were returning or worse. My headache, sniffling and the slight headaches I had had the week before was coming from that new bottle of scent that was filling the air. It was Pam who opened my eyes. Sometimes the answers to puzzles are right in front of you if you take the time to ask the right questions and patiently observe the situation. Needless to say, out went the bottle. Work Monday was great . My head was clear
my nose dry.

I'm sure I'll remember this incident the next time I interview someone about their existing chronic or acute symptoms. Not everything is what it seems.
By the way my assistant is feeling better too.

"They're called Trigger Points, I said as I palpated the Sternocleidomastoid (SCM) muscle of the neck and got a sharp "Ouch" response from my friend who had been suffering from neck and head pain "forever". They can be the center of a lot of intense pain whose source may be far away from the immediate location of pain that you might be experiencing.


I've always been aware of muscle trigger points how they contributed to headaches and orofascial pain. But Trigger point therapy has for the most part been the treatment modality of physical therapist. I decide that I wanted to be more expertise at locating and identifying trigger points while performing my examination for head and neck pain. So I recently enrolled in the Janet G. Travell seminar series with a focus on myofacial pain and trigger point therapy at Bethesda physiocare center in Bethesda Maryland.

Trigger points as described by David Simons, MD, " is a hyper irritable spot in muscle.... with a hypersensitive and palpable nodule in a taut band." Applying pressure to these sore nodules or bands, for instance in the neck area, can then elicit pain patterns that a person might be experiencing in the TMJ region or on the head.
Dr. Simons along with Dr. Travell diagrammed referred pain patterns from trigger points from the cervical (neck) area to the head and orofacial regions. Two major muscle groups have shown significant pain patterns of referral to the head and neck region. The SCM, one of the primary controllers of position and balance of the head and the Trapezius muscle of the neck and back.
The Trapezius muscle refers pain that can extend to the side of the head, centering inn the temple and back of the eye socket and may include the angle of the jaw and lower molar teeth.

The guidelines of The American Academy of Orofacial Pain advises dentists to include examination of the neck during an initial examination to rule out neck dysfunction.

I thought this was enough of an introduction to trigger points to give my friend. There would be other opportunities for more information, so it was time to finish the neck examination and see if we would get any more "ouch" responses.
The goal by the way was not so much to get an "ouch" response but to learn and identify a problem and make the pain go away.

"Almost every morning I wake up with a headache," my neighbor was telling me "and I've had this headache all day. I've been to my doctor but he couldn't find anything wrong. And to make matters worse, I'm tired all the time. My doctor suggested I see a neurologist but I saw a neurologist a few years ago and he could find nothing either. I feel run down and my relationship with my wife is suffering, if you know what I mean." I felt a bit uneasy with this piece of information but it encouraged me to give my neighbor a bit of information that I felt could definitely help him.

It is well known across many studies that headache patients exhibit a two to eight fold risk of sleep disorders than the general population. The sleep disorder most implicated with headaches
is obstructive sleep apnea. Treatment of obstructive sleep apnea can improve and in some cases resolve headaches.

So I asked my neighbor Ed, "do you snore a lot." " Do I snore a lot? My snoring is so bad I have to sleep in the guest room. My wife can't sleep with me in bed. She says the pictures on the wall shake when I snore." I went through a list of questions with Ed and the answers he gave me convinced me that Ed probably had obstructive sleep apnea.

Ed was was sleepy all the time, sometimes falling asleep at his desk at work.
On a few occasions, he's had trouble staying awake driving home from work. He laughed when he told me how he fell asleep at a stop sign for a brief second and woke up when the police car behind him began to honk his horn. Besides the snoring, his wife also told him that when he slept he would have episodes where he would suddenly wake gasping for air. He said he had no memory of it at all. What was really concerning him now was the fact that he was developing high blood pressure and that he was forgetting things more often.

Putting all these symptoms together convinced me that part of his headache problem if not all might be due to obstructive sleep apnea. A problem that effects over 40 million Americans.
I briefly discussed how obstructed air flow can produce his symptoms and it would be wise to at least eliminate obstructive sleep apnea as a causative factor for his chronic headaches and fatigue. A simple overnight test known as a polysomnogram could give him the answer that could very well give him the relief he's been looking for all this time. I sincerely hope he follows through. Ed said he'd keep me informed.