gnathologic problems
otorhinolaryngology problems
oculistic problems
temporomandibular joint desorders
muscle problems
postural syndroms
snoring and sleep apnea problems
diagnostic equipments
orthodontic problems

Enrico Grappiolo, M.D., M.S.
Headaches, in their various etiological forms, plague many people and may severely change the quality of their life. If best treated, they may be reduced and sometimes recover; therefore, it is extremely important to learn to pinpoint the causes of this painful disorder and see a specialist to determine, case by case, the type of headache you are afflicted with, the risks for your overall health, the trigger causes and which treatments exist for headache management and recovery.
In most cases, headache pain disappears easily: a short rest and an analgesic will be enough. In a few cases, however, the pain is rather recurrent and becomes so wearing for headache sufferers, that it might significantly change their lifestyle.
It is therefore important to consult a doctor because, although the causative factors of this disorder are not yet quite clear, the remedies do exist: it is sufficient to understand which is the trigger cause of headache.
An examination by your dentist gnathologist will then become important because some forms of migraine and "tension-type headache" - the latter being the most frequent - are predictive of bad mastication which, in medical terms, is known as "oromandibular dysfunction".
Malfunction of the mandible may modify both the spatial posture of the head and swallowing, these actions being governed by muscle groups and tendinous insertions, head and neck joints and by the scapulohumeral girdle which, when overstrained, become painful.
Dental malocclusion causing an anterior or simply bent or sideway-turned head posture, will cause abnormal contraction of neck and mandible musculature which - it's worth reminding - in a few cases insert into the temporalis. This chronic muscular fatigue will result in a not well localized aching pain which, in our case, may be located midline in the head, temples, forehead and nape. For example, overstraining of the sternocleidomastoid, a postural muscle of the head, will cause a referred pain in various areas of the head.

A gnathologic treatment aimed at restoring normal activity of these muscles may often be successful. Furthermore, a tissue has recently been found connecting a small muscle at the base of the skull, which inserts onto the first cervical vertebra and the dura mater, i.e. the fibrous membrane forming the outermost covering of the brain. The result would be that - when tense - it might produce an irritative spine at endocranial level triggering a migraine-like headache.

The sternocleidomastoid muscle (violet) may cause a referred pain in all areas marked in red. Its stimulation (compression) in points T may trigger a referred pain
Tests conducted on this anesthetized muscle seem to have obtained headache pain remission. This muscle called rectus capitis posterior minor, is an active part of the chain of muscles involved in head posture on the neck. We have then seen that if the face and neck muscles are continuously overstrained to keep the head and mandible in particular non-physiological postures, this may trigger headache through various mechanisms. But this is not all. Headache pain caused by neck disorders, especially involving the intervertebral disks and the cervical vertebrae have been long since known. These headaches are reported as follows: "pain localized in the neck or in the posterior part of the head spreading to the forehead, eye, temples, upper part of the head and ears: it is triggered or exacerbated by particular movements of the neck or by a protracted poor postural behaviour". Specific X-ray examinations often reveal pathologic signs such as: postural, flexion- -extension anomalies, fractures, neoplasms, congenital anomalies and rheumatoid arthritis.
Musculus rectus capitis posterior minor
Cluster headache, too, - so called because it occurs in particular periods and with recurring frequent episodes causing a stuffy or watering nose, sneezes, eye reddening - may be symptomatic, caused by osteoarticular lesions involving the first two vertebrae of the neck. This stresses the importance that everything must be properly working, without causing injury to the head-bearing structures. Migraine and tension-type headaches may be reduced by a gnathologic treatment. Therefore, a dental examination becomes even more important to diagnose whether a prospective oromandibular dysfunction may affect the dynamics of the cervical spine which might cause or worsen painful conditions of the neck musculature and trigger headaches. In case of a headache caused by not severe general diseases or brain lesions, the doctor will attempt to understand the nature - either vascular or muscular - of the trigger factors, because a headache triggered by the latter may have more chances of reduction if a dental treatment is performed. In conclusion, although it is true that headache, myofacial or pericranial muscle pain have a multifactorial etiology, your dentist may help pinpoint the causes of your disorder. Moreover, in case of a cephalalgic edentulous patient, the dentist will first suggest an occlusal mobile or temporary rehabilitation if his/her posterior teeth are missing, or a periodontal treatment aimed at providing stability and non-painfulness of the dental elements or he will remove the teeth macroscopically hampering the mouth function. The dentist will instruct these patients not to aggravate TMJ instability, in case they had to undergo a prosthetic treatment or cures that might overstrain the temporomandibular joint, like for example extraction of the wisdom teeth or long-lasting sessions for devitalization of a molar.
Self test on headaches
Do you feel headache on waking up?
Do you have a referred pain in your nape?
Do you have a referred pain midline in your head?
Do you often suffer from cervical pain?
Do you often have a wryneck?
Do you have a receding chin?
Have you got puffed cheeks and a round face?
Do you find it hard to wide-open you mouth, for ex. at your dentist's?
Are all your molars missing at least in one quadrant (upper or lower)?
Do you keep your teeth clenched also during the day?
Do you have neck and nape perspiration, during your sleep?
Do you have stuffed ears, like when you go high up in the mountains?
If you have scored more than 6 "YES", your headache may be at least partly suggestive of dental disorders

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