November 29, 2011


Included in the classification of vascular disorders that arc often confused with masticatory pain arc migraine headaches. Migraine is an idiopathic, recurring headache disorder that occurs in attacks that may typically last from 4 hours to as many as 3 days. This headache is usually unilateral, moderately severe, and pulsating in quality. Migraine is generally aggravated by routine physical activity and may be associated with nausea, photophobia, and phonophobia. It is not uncommon for the migraineur to seek a dental consultation for relief from what is perceived to be dental or masticatory musculature pain.
Migraine with aura has similar characteristics, as does migraine without aura. The difference in this case is that the headache is normally preceded by a preheadache neurosensorial disturbance. This may be a series of idiopathic. Recurring neurological symptoms, which usually develops over a 5 – to 20 – min period and may last less than I hour. “Nausea is the complaint of the vast majority of patients; vomiting, in addition to nausea, occurs in just over one half of the patients. These gastrointestinal disturbances usually start sometime after the onset of the pain but occasionally precede the headache”
A typical aura may consist of visual disturbances, hemisensory symptoms, hemiparesis, dysphasia, or combinations of these phenomena. Gradual development, duration of less than 1 h, and complete reversibility characterized thc aura, which is associated with this form of headache. Differential diagnosis of migraine headache includes myalgia, myositis or myofascial pain of the masticatory musculature. TMDs, and tooth pain.

Lower half Migraine

Other forms of facial pain of vascular origin may include migraine of the midfacial region sometimes called lower-half migraine. Patients with this form of vascular pain report pain in the jaw and neck pcriorbitally and in the maxilla. There may be tenderness of the carotid artery therefore, this disorder is known as carotidynia (Fay, 1932). As with migraine, this condition predominately affects women. The symptoms are of a dull pain with superimposed throbbing that may occur once or several times weekly. Exacerbations may last minutes to hours. Differential diagnosis includes TMD, pain of the myofascial pain, and masticatory musculature and dental pain.

Cluster Headache

The presentation of cluster headache is classic. Cluster headache consists of attacks of severe, strictly unilateral pain in and around the eye and/or temporal region. This temporal, periorbital pain is frequently confused with a masticatory or dental pain. The attacks may last from a few minutes to as much as 3 h. The attacks occur from once every other day up to eight times per day. They arc associated with one or more of the following: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. Attacks occur in series lasting for weeks or months. These are the so-called cluster periods. These periods are separated by periods of remission, which may last months or years. Cluster headache predominately affects men in a ratio of 5:1 to women. This is in contrast to migraine, which predominately affects women in a similar ratio. Differential diagnosis of cluster headache includes dental infection and acute pain of the masticatory musculature.


headacheA headache is a pain in the head. There are different types and causes of headaches.

Sinus Headache

A sinus headache causes pain in the front of the head and face. The pain is caused by swelling in the sinus passages that are behind the cheeks, nose and eyes. The pain is worse when bending forward and when first waking up in the morning. You may have nasal drainage or a sore throat.

Tension Headache

A tension headache is caused by muscle tension in the head and neck. Signs of a tension headache include a dull or constant throbbing pain above the eyes and across the back of the head. The pain may spread to the whole head or move into the neck and shoulders. The muscles in these areas may feel tight.

Migraine Headache
A migraine headache is caused by the swelling of blood vessels in the brain.

Things that may trigger a migraine include:
• Bright or flashing lights, loud noises or strong smells
• Certain foods or drinks such as:
─ Hard cheese
─ Processed meats such as bacon, hot dogs and deli meats
─ Wheat bread or grains with gluten
─ Additives such as artificial sweeteners or MSG
─ Caffeine found in coffee, tea, soft drinks, and chocolate
─ Red wine or other alcoholic drinks
• Changes in the weather or air pressure
• Eye strain
• Hormone changes in women such as during a monthly period
• Medicines such as birth control pills
• Oversleeping or not getting enough sleep
• Skipping meals or going too long without eating
• Smoking or being around smoke
• Stress

Migraines cause severe pain, vision changes, and nausea or vomiting. Light, noise or some smells may worsen these signs. The pain may begin around the eye or temple and tends to be on one side of the head, but it may spread.

There may be warning signs before a migraine called an aura. Warning signs may include:
• Sudden tiredness or frequent yawning
• Visual changes such as blind spots, seeing bright lights, lines or other things that are not there, or blurred vision
• Tingling in an arm or leg

Cluster Headache

A cluster headache causes severe head pain. The headaches occur in groups or clusters. They happen 1 or more times a day over a cycle of weeks or months. At the end of a cluster cycle, the headaches will suddenly stop. They often do not come back for 6 months to a year or longer. It is not known what causes a cluster headache, but there are things that may trigger one including:

• Changes in the amount of daily sunlight during the spring and fall
• Glare from light
• Alcohol
• Smoking
• Certain foods
• Some medicines

Your Care

Your doctor will do an exam. Your care will be based on the signs and type of headache you have. As a part of your care you may need to:

• Take over the counter medicines such as acetaminophen, aspirin, or ibuprofen for headaches, as your doctor orders. Do not give aspirin to children. If over the counter medicines do not help your pain, talk to your doctor about prescription medicines.
• Apply heat or cold to your neck or head.
• Get enough sleep.
• Relax, reduce stress and use good posture.
• Eat a healthy diet and do not delay or miss meals.
• Avoid eyestrain.
• Avoid smoke and alcohol.
• Keep a headache diary or calendar to help find and avoid triggers.

Call your doctor right away if:
• Your headache occurs with a head injury.
• You have slurred speech, change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss.
• You have a headache with a fever, stiff neck, nausea and vomiting.
• Your headache is sudden and severe.
• Your headache gets worse over a 24-hour period or lasts longer than one day.
• Your headache is severe and is near one eye with redness in that eye.
• You have a history of headaches, but they have changed in pattern or intensity.
Talk to your doctor or nurse if you have any questions or concerns.