MIGRAINE ATTACKS ARE no ordinary headache. They can cause intense pain and sickness, lasting hours or even days, making it impossible to do anything but rest in a dark, quiet room. And for millions of women, these debilitating attacks aren’t just an occasional experience but a recurring ordeal.
Women suffer from migraines three times as often as men, with episodes that are more prolonged and intense. “It’s far more common than most people realize,” says Anne MacGregor, a specialist in headache and women’s health. Despite various treatment options, migraines remain the leading cause of disability-adjusted life years (DALYs)—a measure of disease burden that accounts for time lost to ill health—for women between the ages of 15 and 49. While there’s still some mystery around how migraines work, one reason for this sex difference is hormones.
For the 11 years I was practicing general dentistry, about five patients came into my practice each year with severe temporomandibular joint (TMJ) disorders that were impacting their daily lives. This type of jaw pain was debilitating, but I hadn’t learned anything about treating it in dental school. I felt like the medical and dental communities had failed these patients.
Priya Mistry is a jaw expert and treats patients with TMJ.
I wanted to do better for them, so I asked to shadow a TMJ expert. I watched as he evaluated patients’ posture and leg length. He taught me how the jaw — along with the feet, hips, and spine — is essential for posture. His patients told me he had saved their lives because they had so much jaw pain before seeing him.
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By the end of the first day, I knew I wanted to take over his practice. I had a 2-year-old and a 2-month-old at the time, so he was skeptical. But I worked under him for three years and brought the practice when he retired in 2021. Now, he’s like a second dad to me.
Since then, I’ve learned a lot about jaw health — including that seemingly harmless things can really impact your jaw. Here are five common things you should avoid if you want to foster good jaw health in yourself and your kids.
Avoid resting your head on your hands
Many people rest their heads against their fists when they’re looking at the computer during the day. This puts a lot of lateral pressure on the temporomandibular joint, which is designed mostly for back-and-forth movement. Even 20 minutes here and there adds up and can strain your jaw muscles or joints.
I caution my patients against chewing pens, gum, or fingernails
Humans aren’t meant to be chewing constantly. Chewing on items throughout the day — like pens, fingernails, or gum — means you’re overusing your jaw muscles. You wouldn’t do bicep curls all day, right? Chewing on gum or other items is like doing that for your jaw and can lead to overuse injuries.
Don’t even get me started on popular jaw strengtheners, which people chew on to try to get a more defined jawline. Those things scare me and I would recommend everyone steer clear.
Don’t use your teeth to open things
Lots of people grind their teeth at night without realizing it, which can weaken the teeth. When you use your teeth to tear open a plastic package or anything else, it puts a lot of pressure on the teeth. Sometimes, it’s the straw that breaks the camel’s back, and your tooth can crack or chip.
It’s easier said than done, but try to reduce stress
Lots of TMJ problems happen because people clench or grind their jaws. When we’re emotionally stressed, we clench even more than normal. During the pandemic, referrals to my practice skyrocketed, and my mentor and I fully believed it was because of stress. If possible, try to find ways to reduce and manage your stress and relax your jaw.
I advise parents to wean babies off pacifiers by 6 months
Pacifiers and thumb sticking can cause the mouth, palette, and jaw to grow in all sorts of wrong directions. That’s why I like to see babies stop using pacifiers by 6 months. Pacifiers interrupt healthy tongue posture (in which the tongue is touching the roof of the mouth). That can lead to mouth breathing and other health concerns that could be avoided by kicking the pacifier early.
Jaw health and tongue position can play a huge role in overall health. Taking small actions to take care of your oral health now — and getting help if you experience issues like clicking, popping, or mouth breathing — can help you stay healthy.
Half of Women Reporting Moderate-to-Severe Disability
“Menstrual migraine is prevalent, especially in the perimenopausal years,” Ailani told Elsevier’s PracticeUpdate. “These women face disability and should consider preventive treatment, but most were only taking acute, non-migraine-specific treatment. If you are seeing women who have migraine, ask if they have attacks associated with their menstrual cycle, and be aware that these can be more disabling and harder to treat.”
Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application
TL:DR Medication Effectivenes
Triptans (in order of effectiveness but all close.)
Elettriptan (Relpax – about $50 per Rx)
Zolmitriptan (Zomig $20)
Sumatriptan (Imitrex $15)
Rizatriptan (Maxalt $10)
NSAIDS/OTC’s
Diclofenac Potassium 50 mg (Cataflam $15) slightly more effective than Naproxen Sodium 550 mg (Aleve or Anaprox DS $10), Excedrin or Tylenol
Kerotolac 10 mg (Toradol $15) slightly more effective than Diclofenac (Kerotolac may have more side effects than Diclofenac.)
Forest Plot of the Odds Ratios and 95% CI of Medications From Canada (CA), the United Kingdom (UK), and the United States (USA) in Country-Specific Analysis
Quantitative MRI reveals how muscles in the neck are involved in primary headaches, according to research presented November 29 at the 2023 RSNA annual meeting.
In his talk, Nico Sollmann, MD, PhD, from University Hospital Ulm and University Hospital Rechts der Isar in Germany presented findings suggesting that increased T2 values of the trapezius muscles could be an objective imaging biomarker for myofascial involvement in primary headache disorders.
Trapezius muscle segmentations show (A) segmentation masks of the bilateral trapezius muscles (red areas) in a 25-year-old female and (B) in a 24-year-old male. Images and caption courtesy of the RSNA.
CNMRI: Neurology, Sleep Medicine, MRI 