CHRONIC DAILY HEADACHES (CDH): MAYO CLINIC CONSIDERS CDH THE MOST DISABLING OF HEADACHES
How your headaches are defined may prevent you from having
effective treatment.
Living
with headaches is a fact of life for many headache survivors. According to Mayo Clinic “chronic daily headaches occur 15 days
or more a month, for at least three months. True (primary) chronic daily
headaches aren't caused by another condition.” This definition will artificially separate similar headaches
into different diagnostic groupings.
Chronic
daily headache is not a specific type of headache but rather a disabling
pattern of headache occurrence.
Johns Hopkins describes Chronic Daily Headache as “A patient who has
headaches as many days as not — at least 15 days a month — is said to have
chronic daily headache (CDH). CDH is not a specific type of headache, but
rather a descriptive term applied to any number of headache types. The two most
common types of primary headache are Migraine and Tension-Type Headache. Rebound headache or medication overuse
headache is a frequent occurrence in patients with CDH. The treatment actually becomes the
disease.
The
typical treatment offered by headache specialists and neurologists is a
prescription medication. When the
first is not effective the patient is often taken thru a series of single
medication trial followed by trials of multiple medications. This is similar to what happens to
patients who utilize OTC medications moving from drug to drug often mixing
prescription and non-prescription medications.
Tension-type headaches
are the most common type headache but they are often dismissed as being
relatively mild and tolerable.
These headaches often progress to Rebound headaches and/or migraine. Tension-type headaches should be considered
to be muscle contraction headaches.
According to Cleveland Clinic “They used to be commonly
referred to as muscle contraction headaches or stress headaches, but these old
terms have been abandoned.”
90 – 95% of all headaches are actually partially or
completely muscle contraction headaches.
There are Vascular/ Neurogenic components to all headaches as well.
According to the NHLBI of the NIH patients who receive
a diagnosis of TMJ have a 60-90% chance of experiencing satisfactory resolution
of symptoms but patients diagnosed with other types of headaches will probably
be condemmed to live in pain.
or muscle contraction headaches are considered episodic if they occur less than 15 days/month and chronic if they occur more than 15 days/month. They may las for 30 minutes to several hours or continue for days at a time. Because they are a type of headache referred from muscles they tend to have slow onset and are achy in nature. Patients often describe them as a taut band, pressure headaches, and usually they are bilateral and generalized in location. What is important to understand is that Tension –Type headaches can be part of a ongoing process that triggers migraines and other more severe headaches. Tension headaches can be as severe or even more severe than migraine headaches. Tension-Type headaches are considered a Primary headache but referred headaches from the neck muscles (cervical headaches or cervicalgia) and/or the TMJ (Tempormandibular Joints) and masticatory muscles are considered secondary headaches..
These secondary headaches are
examples of muscle contraction headache as are headaches related to trigger
points and taut bands in Fibromyalgia and Myofascial Pain and Dysfunction.
According to John Hopkins the
following is a list of causes of tension-type headaches. If you read the list it is almost like
saying a normal life is the cause of headaches. What all of these have in common is that they all provoke
muscle contractions secondary to stress.
· “Inadequate rest
· Poor posture
· Emotional or mental
stress, including depression
Tension-type headaches can be triggered by some type of
environmental or internal stress. This stress may be known (overt) or unknown
(covert) to the patient and their family. The most common sources of stress
include family, social relationships, friends, work, and school. Examples of
stressors include:
· Having problems at
home
· Having a new child
· Having no close
friends
· Returning to school
or training; preparing for tests or exams
· Going on a vacation
· Starting a new job
· Losing a job
· Being overweight
· Deadlines at work
· Competing in sports
or other activities
· Being a perfectionist
· Not getting enough
sleep
· Being over-extended;
involved in too many activities/organizations”
According
to the National Heart Lung and Blood Institute of the National Institute of
Health TMD Disorders :
“TMD has
been used to characterize a wide range of conditions diversely presented as
pain in the face or jaw joint area, masticatory muscle pain, headaches,
earaches, dizziness, limited mouth opening due to soft or hard tissue
obstruction, TMJ clicking or popping sounds, excessive tooth wear and other
complaints.
TMD remains
to be classified in the larger context of other muscle and joint disorders or
in the category of pain disorders (NIH Technology Assessment Conference, 1996).
About half of all cases are attributed to conditions linked to the muscles of
mastication” and “Pain linked to
the TMJ and/or muscles of mastication constitutes the essential criterion for
case assignment. It often qualifies as “aching”, “throbbing”, “tiring” and
exhausting.
These are
the same symptoms found in tension headaches and both are associated with
similar proportions of female to male patients. These disorders are also associated with sleep disturbances
that tie them to a wide variety of other disorders.
The National Institute of Health and PubMed.gov provide the
largest database in the world of headache publications. These publications universally agree
that regardless of the type of headache a patient has almost 100% are caused or
mediated by the Trigeminal Nervous system. The Trigeminal Nerve is often called the Dentist’s Nerve
because it innervated the teeth,the periodontal ligament and gums, the jaw
muscles, the jaw joints and many associated structures. The Trigeminal Nerve also
controls the blood flow to the anterior two thirds of the meninges of the
brain.
Why do TMJ patients do better than other headache
patients? Only dentistry treats
headaches by changing input to the brain.
While migraines are often thought to be caused by chemical imbalances
within the brain only dentistry attempts to correct these chemical inbalances
by eliminating noxious input to the Trigeminal Nervous System.
Neuromuscular Dentistry is probably the single most
effective method of controlling noxious (nociceptive) input to the brain.
