Headaches • TMD related HA
Headache related to temporomandibular joint disease (TMD related HA)
It refers to a headache caused by temporomandibular joint disease.
Diagnosis: Temporomandibular joint disease (TMD) must be present with an evidence of a causal relationship with headache.
Symptoms: A headache begins after the onset of the TMD. When the TMD worsens, the headache also gets worse. Headache symptoms worsen when the jaw moves or when pressure is applied to the muscles involved in the TMJ. A headache occurs on the same side where it has symptoms of TMD. A headache related to TMD on one side of head can be triggered by jaw movements, grinding teeth, or chewing. The same headache appears when pressing on the side muscles or moving the jaw.
Cause: temporomandibular joint disease
Treatment: TMD treatment, Botulinum type A injection therapy
Migraine (Migraine)
Migraine occurs in women and men in a ratio of about 3:1, and is mainly observed in teens to 40s.
Symptom:
• Precursor symptoms: It seems that about 30% of migraine patients experience anxiety, depression, changes in taste or smell, overeating, and an increase or decrease in energy in the body about an hour to two days prior the onset of migraine.
• Prognostic symptoms: Migraine occurs for about 5 minutes or more within an hour of onset and it may accompany symptoms such as: blurry eyes, shimmering light, visual impairment that becomes sensitive to light, sensation disorder in which the face or part of the body is stinging, numbness, speech difficulty, weakness, symptoms of dyskinesia
• Main symptoms: Migraine may begin after the prognostic symptoms and can last from 4 hours to 3 days. A pulsating headache appears on one side with moderate to severe intensity, and the headache is worsened by daily activities such as walking or climbing stairs. Patients often feel nauseous or vomiting, and become sensitive to light or sound.
Cause: Although the actual cause for migraine has not been identified clearly, it is suggested that the main cause for migraine is the secretion and expansion of inflammatory substances in the cerebrovascular vessels due to various factors. Stress, sleep problems, food (cheese, chocolate, bananas, oranges, hot dogs, onions, ice cream, etc.), weather changes, before and after menstruation, pregnancy, taking contraceptives, alcohol, perfume, strong light, and certain drugs are known causes for migraine headaches.
Treatment: Trigger factor avoidance and drug therapy.
Tryptan, Ergotamine, Beta-blocker, Anticonvulsant, TrIcyclic-antidepressant, and Calcium channel blocker are used as drug therapy. Botulinum type A injection therapy has been reported to be effective for chronic migraine headaches, and its use is increasing under US FDA approval.
Tension type headache
Tension headache prevalence is similar in both men and women.
Symptoms: It lasts about 30 minutes to a week, and mild to moderate headaches that feel like pressing or tightening on both sides of head, and front to back parts of head, as if wearing a hat. You may become sensitive to light or sound, but there are no symptoms of vomiting or nausea.
Cause: Although it is not yet accurately known, emotional factors such as stress, anxiety, and depression are known as the main cause.
Treatment: There are cognitive behavioral therapy and drug therapy.
Painkillers, NSAIDs, TCA, SSRI, and SNRI are used as drug therapy, and Botulinum type A injection therapy is sometimes suggested.
Sleep Disorders • Bruxism
Sleep bruxism
It is primarily a repetitive jaw muscle exercise during sleep, which involves clenching or grinding teeth. It can also be seen during the day while awake, and over 90% of patients do not know that they are gripping or grinding their teeth.
Symptoms: Tooth structure wears and damage, oral soft tissue damage, jaw muscle pain, and temporomandibular joint pain.
Most sleep disturbances occur during non-dreaming, non-REM sleep, and occur mainly in shallow sleep in stages 1-2. According to research, series of events including increased heart rate due to activation of the autonomic nervous system, awakening during short sleep, increased alpha/delta EEG, and jaw muscle tension related to tooth grinding (bruxism) occur in sequence.
Diagnosis: oral examination, diagnostic model examination, temporomandibular disorder examination
Cause: There have been reports that daytime (diurnal) bruxism or clenching is related to the limbic system of the basal ganglia. The studies have suggested that the main cause for diurnal bruxism is due to stress or anxiety. About 20% of the population experiences diurnal bruxism and clenching. Nighttime (nocturnal) teething is identified as the subjective teething sound during sleep and occurs in about 10% of adults, about 20% of children, and about 3% of the elderly. Contributing factors include smoking, coffee, drugs, sleep disorder-related breathing, anxiety, and genetic predisposition, and it has been reported that the occlusal relationship between teeth has no special relationship with nocturnal bruxism.
Treatment: Stabilization device therapy, cognitive behavioral therapy, Botulinum type A injection therapy
Snoring and Sleep-apnea
Snoring: During sleep, the posterior soft tissue area of the palate, tonsils, uvula, tongue, etc. that make up the airway are stretched due to the relaxation of the surrounding muscles that supported the location, and the airway area narrowed, causing the airflow to vibrate during breathing. As the snoring appears.
Sleep apnea: This is a phenomenon in which patient cannot breathe for more than 10 seconds because the air passage is temporarily blocked due to relaxation of structures or muscles around the airways during sleep.
Symptoms: Daytime sleepiness and fatigue are common symptoms. If sleep apnea persists for a long time, it is reported that cardiovascular diseases such as hypertension, arrhythmia, and myocardial infarction increase 8 times more than healthy individuals.
Diagnosis: Head and neck X-ray, Lateral PA, snoring, sleep apnea questionnaire analysis, neck examination, obesity and blood pressure measurement, polysomnography
Treatment: Behavioral therapy, positive pressure (CPAP), device (MAD), surgery, etc.
• Behavioral therapy-sleeping on the side, prohibiting alcohol and smoking, reducing obesity, regular exercise
• Positive pressure-CPAP This is known to be the best method for sleep apnea, but it has the disadvantage of being inconvenient to use.
• Device Use-MAD This is used for patients with mild to moderate sleep apnea without serious cardiovascular disease. It is effective in patients who have difficulty wearing CPAP during sleep or patients who does not want to have a surgery.
• Surgical therapy-There is a surgical therapy in which the soft tissue of the throat is removed or the upper and lower jaws are surgically advanced to secure the airways.
