The most common pain complaint of civilized man, headache pain may be mild and of short duration, or it can be severe enough to incapacitate the sufferer totally. Fortunately, the majority of headaches do not have a serious cause. In fact, chronic headaches are rarely caused by organic diseases such as brain tumors. Headache is one of the most common complaints of those who suffer with various types of TMJ problems.
The first well-known classification of headache pain was proposed in 1962 by the Ad Hoc Committee on Classification of Headache of the National Institute of Neurolgical Diseases and Blindness. This committee divided headache pain into three (3) basic categories: (1) vascular headaces; (2) traction-inflammatory headaches; and, (3) muscle contraction headaches. Because there are certainly more than three main types of headaches, in 1987 the International Headache Society developed more specific criteria to provide greater uniformity and reproducibility in the diagnosis of headache. This new classification system divided headache pain into 13 different categories, with TMJ and facial pain falling into category number 11: Headache or facial pain associated with disorder of cranium, neck, eyes, nose, sinuses, teeth, mouth, or other facial or cranial structures. However, for most doctors and patients, it is still useful to divide all headache pain into the three original categories.
Vascular headaches include classic (migraine with aura) and common (without aura) migraine headaches, cluster headaches, and several other less common vascular types of headaches. Although vascular headaches are probably the most investigated, this entire category may comprise only 6-8% of all headache pain.
Symptoms of the Classic Migraine (migraine with aura) include:
- Initially, a unilteral dull ache
- Intensifying pain in a crescendo fashion
- Paleness or redness of the skin of the face
- The pain pulsating
- The presence of an aura (seeing "stars," photophobia, tunnel vision) before the headache starts
Symptoms of the Common Migraine (migraine without aura) include:
- Similar symptoms to the classic migraine
- Lack of a prominent aura
- Occassionally, the headache is bilateral
Although these types of headaches comprise only about 2% of all headache pain, these are generally caused by severe diseases and disorders. Examples are brain tumors, aneurysms, infections, and neuralgias. Symptoms vary and can't be neatly categorized. However, often the pain of headaches in this category is very severe, increases when the sufferer bends over or coughs, and may be accompanied by other neurologic symptoms.
Muscle Contraction (Tension) Headaches
The most common type of headache is the muscle contraction or tension headache. It has been estimated that this type of headache accounts for 90 to 92% of all headache pain. Because this type of headache may vary from mild to quite severe in intensity, often its sufferers are misdiagnosed as migraine, sinusitis or even psychogenic (imagined) pain. The TMJ headache is a Tension type of headache.
The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. Sleeping difficulties are common: waking without feeling rested, restlessness and trouble getting to sleep. Those who clench or grind their teeth also develop muscle contraction headaches, especially during times of stress or during the night. When asking a patient to describe their pain, I often hear such descriptions as, tightness, drawing, band-like, or vise-like. Muscle contraction pain may last for hours, days, weeks or even months. Lastly, as with all pain problems, if you persistently suffer with headache and your doctor can't (or won't!) give you a reasonable answer, get a second or even third opinion.