Millions of dollars are spent each year to diagnose and treat headaches and facial pain--much of this expenditure is wasted.
Treatment outcomes are often very limited, with a high probability that the sufferer will seek yet another doctor, take more expensive tests, and purchase more medications in an effort to obtain relief. The true costs are elevated even further by the millions of hours lost from work or school as a result of ongoing pain.
In our experience, approximately 90 percent of the total pool of headache patients can be treated in the fashion described below, with a 90 percent probability of success. This success rate determination is based on my 26 years of experience with approximately 16,000 patients.
Certainly, the procedures described below are not applicable to those suffering from headaches with neurological and other causes such as tumors, infections, hypertension, and the like. However, less than three percent are believed to suffer from pain for these reasons. An additional 7-10 percent of headache patients have pain often described as vascular or neurogenic. This small group benefits to a lesser extent, or not at all.
Diagnosis requires evaluation by a dentist or physician with extensive training and experience in treating the physical causes of head and facial pain. Unfortunately, most doctors do little more than prescribe aspirin, Tylenol, NSAIDS, codeine related compounds, or medications with even worse potential side effects when they are confronted by chronic headache patients. However, this is far from ideal. Faculty at the University of Pennsylvania Headache Center have stated, "The bottom line is this--there is really no role for use of chronic pain medication in the management of headaches."
Other practitioners assume that chronic pain complaints are "due to stress", and refer the patient for costly diagnostic testing, psychotherapy or biofeedback without dealing with the treatable organic source of the pain.
This regrettable approach was brought to us a few years ago, when a woman was referred two years after severe daily headaches developed following child birth. Throughout the years that followed, she underwent psychotherapy to help her "understand" and "deal with the resentment" she was told that she had toward her newborn baby. After examining the woman, I suggested that the cause of her pain was probably a neck and TM joint injury. "Have you ever had a car accident?" I asked. "Yes", she replied, "on the way to the hospital when I gave birth." Minimal treatment relieved her suffering, and her relationship with her baby was no longer in doubt. How much misery could have been prevented, and how many thousands of dollars could have been saved if she had been examined sooner, after the onset of pain?
An even more dramatic case is described in the following letter written by a patient who was in pain for 32 years:
"I was in an automobile accident at the age of 14 years and have had severe headaches several days a week since then. I also developed serious face, neck and shoulder pain in recent years. At the age of 45, I am almost totally without any of the pain mentioned and am thrilled not to be plagued with this discomfort anymore." Following TMJ treatment, she has remained virtually pain free for the past 10 years.
Our approach to diagnosis and treatment of head and facial pain is based on the following protocol:
