Lauren Levi DMD MS

What is migraine?

​

Migraine is a debilitating neurological condition. It may occur on one side of the head or bilaterally (though more commonly migraine is unilateral). Migraine is often characterized as being moderately to severely painful and can be episodic (occurring less than 15 days a month for three months) or chronic (occuring more than 15 days a month for three months)

​

Migraine is often described as:

• throbbing

• pulsating

• pressure

​

Migraine is often accompanied by: 

• nausea

• vomiting

• photophobia (sensitivity to light)

• phonophobia (sensitivity to sound)

• osmophobia (sensitivity to smell)

• dizziness

• brain fog

• fatigue

• pain around the eyes and cheeks

​

Migraine can also be present with: 

• ear fullness

• sinus pressure

• nasal congestion

• neck pain

​

Migraine typically lasts longer than tension-type headaches with a duration anywhere from several hours to three days. Migraine may be both chronic and acute, with chronic migraine lasting greater than 15 days a week for more than 3 months in the year.

​

Aura

​

Migraine can also be accompanied by an aura. Aura is a reversible visual, sensory or other neurological symptoms that may precede a migraine. They usually last 5-60 minutes. 

​

How is migraine diagnosed?

​

Migraine is diagnosed by a detailed history and physical examination. Sometimes imaging and labs may be ordered to rule out other causes. 

​

Migraine Treatment 

Migraine treatment is multidisciplinary, and treatment often is determined based on chronicity of the disease, meaning, episodic and chronic migraine are treated differently. There are multiple treatment options for migraine including:

• Abortive and preventative medications

• Nutraceuticals

• Neuromodulation

• Botox injections

• Behavioral modification including biofeedback, dietary changes and lifestyle changes

• Physical Therapy 

• Sleep hygiene modification

​

​

Sinus Headaches

​​​

The term "sinus headaches" is often used to describe headaches that are thought to be caused by inflammation or congestion in the sinuses. However, this term is somewhat misleading and may not accurately reflect the true nature of the headache. Did you know that most headaches that are thought to be sinus headaches are actually migraine? Research has shown that up to 90% of people who self-diagnose with sinus headaches actually have migraine. Headaches are attributed to sinus disease are called rhinogenic headaches. These headaches are caused by inflammation or irritation of the nasal passages or sinuses.

​

Understanding the Misnomer

1. Symptom Overlap:

• Facial Pain and Pressure: Symptoms such as facial pain and pressure may be associated with both sinus disease and migraine, leading to confusion. Many people with migraine experience pain in the face, including around the sinuses, which can mimic the symptoms of sinus disease.

​

• Accompanying Symptoms: Migraine may be accompanied by symptoms seen in sinus disease like nasal congestion, post-nasal drip, and sinus pressure. This overlap can complicate the differentiation between the two conditions.

​

2. Rhinogenic Headaches:

• Definition: Headaches attributed to sinus disease. These headaches are caused by inflammation or irritation of the nasal passages or sinuses, and they may include symptoms such as nasal congestion, post-nasal drip, and sinus pressure.

​

• Distinguishing Features: Rhinogenic headaches can be distinguished from migraine by specific features such as purulent nasal discharge (thick, yellow or green mucus) and other diagnostic signs of rhinosinusitis. Rhinosinusitis often involves infection-related symptoms that are not present in migraine. Interestingly, rhinosinusitis often presents without facial pain.

​

3. Diagnostic Challenges:

• Misdiagnosis: The overlap in symptoms between sinus congestion and migraine often leads to misdiagnosis resulting in inappropriate treatments and delayed management of the condition.

​

• Accurate Diagnosis: Proper diagnosis is crucial for effective treatment. Differentiating between headaches attributed to rhinosinusitis and migraine requires a thorough assessment of symptoms, medical history, and possibly imaging or diagnostic tests to identify or rule out sinus infection.

​

4. Importance of Proper Treatment:

• Targeted Therapy: Misidentifying migraine as a headache attributed to rhinosinusitis can lead to treatments that do not address the underlying cause. Effective migraine management involves a multidisciplinary.

 

In summary, while the term "sinus headaches" is commonly used, it is often a misnomer as many of these headaches are actually migraines. Understanding the distinction between rhinogenic headaches and migraine is crucial for accurate diagnosis and effective treatment, ultimately leading to better management of the condition and improved patient outcomes.

​

Migraine and TMD

​

Migraine and temporomandibular disorder (TMD) are indeed closely related, and their relationship is often bidirectional, meaning that each condition can influence or exacerbate the other. Understanding this relationship is crucial for effective diagnosis and management of both conditions.

​

Bidirectional Relationship

​

1. Migraine and TMD Co-occurrence:

• Migraine: This is a neurological condition characterized by recurrent, severe headaches that often involve other symptoms such as nausea, sensitivity to light or sound, and sometimes aura (visual disturbances). Migraine can be triggered or aggravated by various factors, including stress, hormonal changes, and physical strain.

​

• TMD: Temporomandibular disorders encompass a range of conditions affecting the temporomandibular joint (TMJ) and surrounding muscles. Symptoms can include jaw pain, clicking or popping sounds in the TMJ, and restricted jaw movement.

​

2. How Migraine Can Affect TMD:

• Facial Pain: Individuals with migraine may experience pain that extends to the face, including the jaw, TMJ, and teeth. This pain can overlap with or exacerbate TMD symptoms. 

​

• Muscle Pain: Pain associated with migraine can affect the muscles of the head and neck, which may extend to the jaw muscles and contribute to TMD symptoms.

​

• Bruxism: Individuals with migraine may experience bruxism (teeth grinding) during episodes, which can contribute to TMJ dysfunction and TMD.

​

• Stress and Behavior: Migraine patients might engage in behaviors such as jaw clenching or teeth grinding as a response to stress, further aggravating TMD.

​

3. How TMD Can Affect Migraine:

• Pain Referral: Pain from the TMJ and surrounding muscles can sometfimes refer to areas that overlap with migraine pain zones, making it challenging to differentiate between the two conditions.

​

• Inflammation and Muscle Dysfunction: TMD-related inflammation and muscle dysfunction can contribute to headaches or exacerbate existing migraines. The chronic pain from TMD can increase overall pain sensitivity, potentially leading to more frequent or severe migraine attacks.

​

Clinical Implications

1. Assessment and Screening:

• For Migraine Patients: When evaluating patients with migraines, it is important to assess for symptoms of TMD. This includes asking about jaw pain, clicking sounds, or difficulty in jaw movement. Understanding the presence of these symptoms can help in providing a comprehensive treatment plan.

​

• For TMD Patients: Similarly, patients presenting with TMD symptoms should be screened for migraine. Symptoms such as headache frequency, location, and associated features (nausea, light sensitivity) should be explored to determine if migraine is also present.

​

2. Treatment Considerations:

• Multidisciplinary Approach: Effective management often requires a multidisciplinary approach, involving orofacial pain specialists, neurologists and sleep medicine doctors. Coordinating care between these specialists can improve overall patient outcomes.

​

• Therapeutic Strategies: Treatments may include pharmacological options, physical therapy, stress management techniques, and lifestyle modifications. For instance, addressing stress and muscle tension through relaxation techniques, trigger point injections, botox or occlusal orthotics may benefit both migraine and TMD management.

 

In summary, the close relationship between migraine and TMD necessitates a comprehensive approach to diagnosis and treatment.