Migraines have become one of the most well known headaches because of their debilitating nature and the number of people affected by them. Approximately six percent of men and 17 percent of women have experienced a migraine headache. Although the causes for migraine headaches are not fully understood, treatment options have improved dramatically over the years. Frequently patients describe headaches as migraines that are not true migraines. Dentists will often give a diagnosis of migraine to headaches that are severe but actually are not migraines.
The two main classifications of migraine headaches are with aura and without aura.
An aura is defined as sort of a pre-headache sensory warning that a migraine is imminent. Aura signals may include flashes of light, blind spots in your vision, and even tingling sensations radiating down your arm. Most people experience migraines without aura. Some auras can affect other senses such as taste, smell or hearing.
In general, migraine headaches are severe and debilitating headaches that last anywhere from four to 72 hours. In most cases, they are pulsating and unilateral, presenting on one side of the head. Other symptoms of migraine headache include:
- Sensitivity to light and noise
The combination of these symptoms frequently causes the migraine sufferer to want to find a dark, quiet place to lie down until they recover.
There is no consensus on the actual causes of migraine headaches, but there are a number of theories. Some possible causes for migraines include:
An interesting theory presented at the American Association for the Study of Headaches was that all headaches are a combination of neuromuscular headaches and vascular /neurogenic. Headache severity is not what determines the diagnosis of migraine. Since all headaches are actually a combination of multiple causes that we are looking at in different proportions.
- Vascular problems – Caused by blood vessels expanding and contracting inappropriately
- Serotonin – A common neurotransmitter that passes messages between nerve cells
- Neurogenic causing secondary vascular changes
There are many neurotransmitters that can affect pain besides serotonins including epinephrine and nor-epinephrine. The same neurotransmitters are also implicated in depression.
- Nerves –The gradual or acute irritation of nerves, particularly the trigeminal nerve, which controls many jaw, sinus and facial functions can result in migraine or migraine-like pain. The nervous system is actually a large switchboard and branches of the trigeminal nerves can turn other nerves on (excitatory) or off (inhibitory) The reticular activating system serves like an amplifier increasing the effect of the trigeminal nerve on the brain as a whole
Pain is actually felt in the limbic system, the same part of the brain where we feel emotions. So we can be happy, sad, miserable, excited, or “in pain.” It is hard to have positive feelings when we are in pain. Pain can be described as a negative emotional response to noxious stimulus. Pain is an emotional response to a stimulus. This is an extremely important aspect of all treatment.
Dr. Hans Selye and his General Adaptation Syndrome as discussed in his book the Stress of Life, explains how stress and tension has physical effects on the body. While science has discovered many of the underlying biological processes since Dr Selye first explained his theories, the underlying principles still apply and form a coherent whole when applied with current scientific advances.
Additional information about Dr. Selye can be found at http://www.icnr.com/articles/thenatureofstress.html
Many dentists combine all three causes into a unified theory since these factors interact with each other in normal neuromuscular and neurovascular behavior. During a headache, serotonin levels have been shown to drop, which may cause the trigeminal nerve to release substances that cause the vessels in the affected area to dilate inappropriately, causing the pain.
There are several external and internal stimuli that may trigger the onset of migraine headache, such as:
- Food and allergies
- Stress especially worry or anxiety
- Bright lights or loud noise
- Physical exertion and/or sexual activities
- Noxious input into trigeminal nervous system from teeth, jaws, jaw joints and jaw muscles
The jaw muscles and relation of the mandible to the maxilla (lower jaw to upper jaw) also control the airway, and improper airway control can also affect pain. This is especially true at night when sleep apnea, hypopnea, UARS or upper respiratory airway resistance syndrome occurs. Sleep apnea or airway disturbances are a major cause of morning headaches along with nocturnal clenching and grinding of the teeth (bruxism). Clenching and grinding of the teeth may actually be a symptom of a compromised airway. Another common problem in patients with airway obstructions or restrictions is difficult swallowing and/or choking easily.
By identifying and isolating as many of these triggers as possible, your doctor or neuromuscular dentist may attempt to eliminate or limit the number and severity of migraines that occur.
Medication is frequently used to treat migraine headaches. As with other headache types, treatment with medication usually falls into two categories:
- Abortive – These pain-relieving medications are taken during the headache in an attempt to stop or minimize the pain.
- Preventative – These maintenance medications are taking on a regular basis to try to prevent the onset of migraine headaches.
NMD is most effective in eliminating migraines in a preventative fashion. By increasing the health of the trigeminal nervous system and decreasing noxious input to the brain. Patients having side effects from medications frequently turn to neuromuscular dental treatment as a drug free alternative treatment. Patients often combine drug treatment with NMD treatment for better results than can be achieved with either therapy alone.
The most common medications for treating migraine headaches are triptans such as Imitrex.
Other common medications include Topamax, Fioricet, Toradol, Midrin, Maxalt, Relpax, Zomig, Frova, Acular, Axert, Anaprox, Orudis. The list is long as are the risks and side effects associated with these potent medications.
Make sure you speak to your dentist if you are on other medications to ensure that there are no complications with drug interactions.
Other alternative treatment options include:
- Neuromuscular dentistry
- Physical therapy
- Chiropractic or osteopathic adjustments
- Allergy treatments
- Diet changes stress counseling
Migraine headaches are often debilitating. If you suffer from frequent migraine headaches, seek medical attention in order to pinpoint and alleviate the underlying causes. Lifestyle changes such as avoiding triggers, improving your diet, and getting exercise may also help minimize the frequency of migraine headaches.
Neuromuscular dentists frequently work with neurologists and other doctors addressing the migraines in a preventative fashion to avoid the attacks, saving these powerful drugs for times when there are breakout migraines. Many patients completely eliminate the need for medication after working with their neuromuscular dentists.
Contact our iHATEheadaches dentists in an area near you for information on migraines and migraine headache treatment.