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There are a variety of causes of headaches. Some of the most common include migraines, tension, sinus pressure, and TMJ. If you have had chronic headaches, you have probably tried a variety of treatments. As a chiropractor, I have treated hundreds of patients with headaches and observed much misunderstanding and misdiagnosis. In this article, I will discuss some of the most common misdiagnosed headaches and what to do about them.
Tension headaches are the most common type of headache. Tension headaches result from muscle tension, usually in the neck muscles. These can be thought of as neck headaches. Tension headaches are often correctly diagnosed but often poorly treated.
Migraine headaches are commonly diagnosed. However, I find that they are often over-diagnosed. That is, patients are often told they have migraines when they do not. Additionally, many patients diagnose themselves with migraines—often incorrectly. A few key symptoms (not all the symptoms) that help to diagnose migraines are: one-sidedness (most migraines are only on one side of your head at a time), light and sound sensitivity (i.e., you want to go into a dark room with no sound), or an aura (a sensation that you are about to get a headache) that lasts for 10–30 minutes. These key symptoms can be accompanied by non-specific symptoms of nausea, vomiting, or anorexia (loss of appetite), and they can be excruciating.
Sinus headaches are commonly self-diagnosed—and usually incorrectly. A sinus headache is caused by pressure built up in the sinuses. This happens when you are sick—specifically, with a sinus infection. You will have a runny nose, postnasal drip, and pressure behind your nose. It will seem as if you have a very bad cold. I can’t tell you how many people have no sinus or cold symptoms—none—yet think that they have a sinus headache.
So what kind of headaches do many of these non-sinus or non-migraine sufferers have? TMJ headaches. TMJ stands for tempormandibular joint (the name of the jaw joint). The condition is called TMJ dysfunction or TMD (tempormandibular dysfunction). Basically, your jaw apparatus is out of balance and the jaw muscles are in spasm. TMJ headaches are a type of muscle-tension headache. If you have temple headaches, you probably have TMJ headaches. I don’t care how many people (or doctors) tell you that you have migraines. TMJ headaches are misdiagnosed most of the time! (You can have both types of headaches as well.) The good news: you can find a very effective treatment for TMJ headaches in this chapter.
Less common headaches: There are other causes of headaches including cluster headaches and something called “just headache.” Really! I have had a few patients whose neurologists have told them they have “just a headache.” There are headaches caused by medications, hormones, and more.
TMJ headaches are usually bilateral (on both sides of your head). One side may be worse and may radiate pain to the eye, but both sides often hurt. This is important because migraines are usually one-sided. Additionally, TMJ headaches are very common, perhaps more common than true migraines. But most doctors (medical doctors and chiropractors) don’t look for them. If you don’t believe me, ask any doctor how often he diagnoses TMJ. Most will say rarely or never.
I will often explain to patients that there are two levels of TMJ headaches: short term and chronic. What do I mean by this? Short-term headaches are usually fixable. A person may get hit in the jaw, have a temporary dental problem, or chew gum regularly. These patients usually respond well to treatment and will often fully heal. In other words, their headaches stop.
However, our goal in treating the chronic TMJ headache patient will often be different. People who have TMJ headaches for years do so because they are holding stress in their jaw muscles. These are the people who grind their teeth at night and will benefit from night splinting (mouth guards). The problem for them is that it is hard to get rid of stress. It just keeps coming back. As a result, our goal for these patients is to help them to maintain a better quality of life by limiting the frequency and intensity of their headaches (even though they may not fully stop having headaches). This reduction in frequency and intensity is still a success. If a patient can consistently control their headaches with treatment, resulting in having fewer and less intense ones, then their quality of life greatly improves.
Tension headaches are usually neck headaches caused by neck muscle spasms and the joints locking up. (TMJ headaches are also tension headaches because the jaw muscles are in spasm. However, TMJ headaches are in their own category because they have their own treatment as described above.)
When your neck is causing your headaches, chiropractic is often the best option. This is because your neck is locked up (as described in the chapter on chiropractic). When this locking up happens, pain can radiate up your head and give you tension headaches. Simply stated, reversing the neck “lock-up” is a big step in correcting these headaches
Additional treatments include heat for muscle spasm, cold for swelling (see chapter on cold vs. heat), massage, muscle stimulation, stretching, neck exercises, and lifestyle modifications including correct ergonomics and correct sleeping posture (correct use of pillow).
Every condition is either an illness or injury. In other words, you are either sick or hurt. It is beyond the purpose of this article to discuss medical treatment (drugs, etc.) for migraine headaches. See your medical doctor for medical treatment of migraines. Chiropractors, on the other hand, can often help when your migraine has a mechanical (injury) origin.
The mechanism isn’t fully clear, but anecdotal reports from many patients suggest this is the case. Migraines often have various triggers such as stress, alcohol, or chocolate. One way chiropractic helps is by addressing one of the triggers of migraine. Your neck being “locked up” and needing an adjustment is a common trigger. (Patients complain of their neck being locked up and soon a migraine develops.) So taking care of your neck can often prevent migraines. This is an indirect treatment for migraine, but a direct treatment for your neck being locked up (which solves the migraine by eliminating the trigger).
There may be other reasons chiropractic treatment helps with migraine as well. The good news is that many migraine sufferers get relief with chiropractic care.
Additionally, I have repeatedly seen TMJ headaches misdiagnosed as migraines by chiropractors, medical doctors, and by patients themselves. You owe it to yourself to get checked out for TMJ. Start with the self-test in the TMJ section above.