Severe Continuous Headache. Look for Trigeminal Nerve involvement

DIANA: Hi, for the past 2 1/2 weeks, I am experiencing major headaches about every other day. They are always right in the center of my head and don't go away unless I take a strong Ibuprofen dosage. And sometimes come back a few hours later. Sometimes I don't get them until night time, but I have woken up with them occasionally. I suffer from migraines off an on ,but typically that would be once every couple of months. Never this often. I'm also extremely exhausted all day long. I wake up tired, and I go to bed tired. Also experiencing a lot of anxiety, more so than normal which was triggered around the same time. I don't feel depressed so I don't think it's that, but I'm not sure. Not sure what triggered all of this, but I can't get over it. My doc did blood work on my thyroid, vit D, and one other thing (I can't remember) and it was all normal. She wanted me to take migraine medicine to stop the headaches but I wasn't comfortable taking it. Plus I wanted to find out why it was happening, not just take the pain away. I'm scared it may be a tumor or something similar. I'm 29 and have 2 small children.

Dr Shapira response: Diana,
I am sorry to hear you are having some much pain. Checking thyroid function is a good step, but it is important to look not just if you are in the normal range but where in the range are your numbers. Normal is a range for a population not an individual. If you are at the bottom of the normal range it could still be a problem.

I would suggest having a sleep study since your tiredness is a major problem.

I obviously cannot diagnose on the internet but frequently neuromuscular dentists use "spray and stretch techniques" that can quickly relieve the pain and diagnose a muscular orgin. I normally start with a consultation and can relieve most pain using those techniques, This helps to understand where the pain is coming from.

Other possible treatments to stop a continuous headache are SPG blocks that work well for autonomic pain and trigger point injections. Stopping the pain is usually easy but more importantly it lets us understand where it is coming from and learn more about the nature of the pain.

There is very little history to this pain, and I would like to know much more about the onset and any unusual events a week or two before it began.

An aqualizer oral appliance is also an inexpensive way to evaluate whether the pain is jaw related.

Most of my patients are fitted with a 24 hour diagnostic orthotic if it appears there is trigeminal nerve involvement in the headache. This is true for the majority of severe continuous headaches as well as headaches and migraines in general


















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i am experiencing extremely severe headaches and also suffer from migraines but these severe headaches are totally different from a migraine

Angie: i was diagnosed with tmj maybe 20 years or so ago. i wear a "dentist fitted" night guard every night since the tmj diagnosis. i am experiencing extremely severe headaches and also suffer from migraines but these severe headaches are totally different from a migraine. i have even used migraine medications but these have yet to come close to helping with these severe headaches. could the tmj issue be the culprit here??? these headaches are hurting in the jaws, temples, across the forehead, terribly behind the eyes and in the back of my head and neck. an mri recently showed nothing abnormal in the head or neck? i have even tried muscle relaxers and prednisone, no relief. i do not have health insurance but am willing to sell my house or at least my car to get some help{jk}. but seriously, what could be causing these headaches? who would be the best doctor to see? i have been to a neurologist, a dentist, natural healers, you name it, i've been there. can you he lp me with this before i go crazy? thank you and i painfully look forward to your reply.


Dr Shapira Response:
Dear Angie

I do not think there is a "Best Doctor" You did not say if your night guard improved your condition. If it does than consider a 24 hour orthotic. A night guard treats a 24/7 problem just at night.

The normal MRI is good news. I know patient's often want to find a problem on an MRI but ruling out serious organic disease is good news.

I normally spend an hour or two reviewing history before initiating treatment treatment and utilize numerous modalities to address specific portions of the problem.

A diagnostic neuromuscular orthotic is an excellent point to start treatment as it can often give miraculous results. I see long distance patients in my office, Ideally 4 days in a row. Come to town Sunday night and I will see you as a first patient Monday for exam and consultation, diagnostic work-up and delivery of an orthotic in the afternoon. I will then see you for adjustments over the next three days. If you are interested in pursuing treatment at my office I would like a lot more information prior to your visit.