‘Mystery Headaches’ Can Be Treated If You Find the Cause

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“Dear Pharmacist,

Your recent column on trigeminal neuralgia gave me some great information. I’ve suffered for years with head pain. Do you have anything else to share?”
–C.N., Los Angeles

After I wrote that column, I heard from many people with migraines, headaches and facial pain. Some of you had undergone surgery and bought a mini-pharmacy to no avail. A few were told, “There’s nothing more I can do for you.” I can’t imagine living with chronic pain from migraines, TMJ (temporomandibular joint) syndrome, headaches, atypical facial pain or trigeminal neuralgia.

If your pain does not respond to antidepressants, triptans, painkillers (including oxycodone, morphine, tramadol), common anti-seizure meds (like carbamazepine, gabapentin, phenytoin) or surgery, it’s possible that the primary cause of pain has yet to be uncovered. There are excellent pain specialists scattered all over the country who do remarkable procedures so please don’t ever give up.

I interviewed Dr. Edwin Ernest, who in 1982 documented “Ernest Syndrome,” a painful condition that includes facial pain that radiates from the jaw joint to the ear, cheek, teeth, eye or throat.  It can cause a temple headache, too. He has expertise in head and neck pain and a background in dental medicine.

Dr. Ernest writes monthly articles for Practical Pain Management Journal (ppmjournal.com). He explained that muscle attachment injuries may cause or contribute to TMJ pain, eye pain/pressure, migraines, toothaches, ear pain or headaches (one-sided or bilateral).

Some people get headaches that move around and change intensity; others experience electrical shocks in their head or face that may be confused with trigeminal neuralgia. If you’ve suffered from whiplash, sports injury, a fall or another minor trauma, you may have damaged the muscles and tendons in your head, triggering a painful condition that’s hard to diagnose, but relatively easy to treat. Headaches and nerve pain can easily occur from an inflamed muscle or tendon, a herniated disc, nerve root irritation or misaligned bite.

Assuming that all standard medical tests (like MRI, CT scans, etc.) are normal, then consider these problems, as well as Ernest Syndrome, facet joint disease, an injured SCM (sternocleidomastoid) muscle:

–Temporal Tendonitis- It’s a migraine mimic and includes temple headaches with pain radiating over the ear to the back of the head; sensations of a swollen cheek, toothache, ear pain and the feeling your eyeball may pop!

–Splenius Capitis Muscle Syndrome- headaches radiating from the back of the head. Pain/pressure behind or above the eye; pain in the cheekbone or neck, shoulder and arm.

Clearly, headaches and facial pain syndromes crop up from all sorts of issues, so finding a compassionate, bright doctor is crucial. Such a doctor could be a neurologist, anesthesiologist, dentist, endocrinologist or acupuncturist, among others.