Many of us grind or clench our teeth from time to time – either because of stress or by habit. Normally it won’t cause any harm but when it starts to happen on a regular basis, bruxism can lead to headaches or even migraines.

Dr Elliot Shevel, South Africa’s pioneer in the field of migraine surgery and the medical director of The Headache Clinic, says bruxism is a common problem and a common cause of headaches and migraines.

Two recent studies focused on grinding patterns in migraine patients and the incidence of headaches related to occlusion (the way the teeth of the lower and upper jaws fit together when the jaws are closed) and bite-force imbalance (malocclusion).

Grinding patterns

The first study, published in The Journal of Craniomandibular Practice, showed that a large number of migraine sufferers who grind their teeth usually grind over a large area of the mouth, particularly in the molar region. The study involved a total of 80 women who had been diagnosed with migraines and 52 women with no history of migraines.

The results showed a significant difference in the distribution of grinding patterns between the two groups. The proportion of grinding area at all sites was significantly larger in the migraine group.

Bite patterns

The second study, published in the Medicina oral Patologia Oral Cirugia Bucal, used a digital occlusal anaylser to evaluate the bite. After their bite was adjusted and optimised, the migraine suffers reported a decrease in headaches.

“Many people grind their teeth at night while they sleep. The most common symptoms are a constant, dull headache during the day and jaw pain,” says Dr Shevel.

After Chantelle Binneman* gave birth to her only child in early 2012, her migraines, which she had had since the age..

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The study, recently published in European Journal of Neurology, found that nearly 50% of chronic headache sufferers also suffer from Medication Overuse Headaches, and that these patients had significantly higher headache disability and anxiety scores than the general population.

The researchers employed a double-blind pragmatic cluster randomized controlled trial, carried amongst 50 general practitioners in Norway. A brief intervention (BI) for Medication Overuse Headaches in primary care was examined. The brief intervention was com- pared to business as usual (BAU) and population controls, and patients were followed up after 3 months.

The primary outcomes of the study were measured by the headache and medication days per month after the 3 months. Headache disability and the Hospital Anxiety and Depression Scale (HADS) were also measured as secondary outcomes.

According to Dr. Elliot Shevel, South Africa’s migraine surgery pioneer and the medical director of The Headache Clinic, the results clearly show that the brief intervention was significantly better than business as usual after 3 months regarding primary outcomes. The Medication Overuse Headache patients had significantly higher headache disability and anxiety scores than the population controls,” he says. “This shows an association be- tween these variables.” The main conclusion of the study was that patients with Medication Overuse Headaches are a highly disabled group where anxiety and depression are important comorbidities.

Dr Shevel explains that the disability, anxiety, and depression are very frequently a con- sequence of the underlying pain, in other words, they are secondary to the pain. The best way therefore to treat the disability, anxiety and depression, according to Dr. Shevel, is to identify and treat the underlying pain. Once the source of the chronic pain is identified and treated, the secondary symptoms diminish or disappear spontaneously, and do not need further treatment. This is the approach used at The Headache Clinic, and has proven an incredibly successful method of treatment.

“Dr Shevel says that “the best method of treating Medication Overuse Headaches is to treat the original headache. When the original source of the pain is successfully treated, the Medication Overuse Headache spontaneously subsides. The reason for this is that the pain of the Medication Overuse Headaches comes from the same source as the original headache – when the pain source is treated, both the original headache and the Medication Overuse Headaches are treated simultaneously”.