For two years I have suffered from recurring headaches on the right side of my head near my temple and sometimes extending over my eye. They occur 1-2 times per month and last for 3 full days. I sometimes experience milder head pain in the same area on the same side at other times. Alcohol is a definite trigger of my head pain but not the only one.
This pain can be 100% relieved by placing moderate to firm pressure on my upper right gum between and around my front molars. It's like a switch--massage with pressure and the pain disappears.
I also suffer from mild seasonal allergies and I can also use the gum massage trick to loosen sinus congestion. Naturally, I conclude there must be a connection, but my doctors have treated me for migraines: 100 mg Topamax twice daily, which has helped reduce the frequency of episodes, and Relpax for treatment of migraines, which relieves the pain during an episode.
"Dr. Smita S" said in another post: "The maxillary nerve carries sensory information from the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa and sinuses. " Could I be suffering from maxilllary-nerve-related migraines? If so, what can I do about this?
I still suffer regularly with this issue and would be grateful for any insights into the root cause, particularly since I would like to have children soon, and may not be able to continue with these medications. Thank you.
How did the headaches start two years back? (Injury?)
How did you happen to find out about massaging the right upper gum?
Do you mean that the pain gets switched off or disappears as long as the massage is continued?
Even the effect on sinus congestion, if it can be objectively assessed, will be interesting. What do you mean by sinus congestion? The burning or pressure feeling inside cheeks/ nose?
Though the area of your pain and the 'massage-area' you mentioned are supplied by the maxillary nerve, it is not easy to explain why the pain goes away when you give 'pressure' stimulus to another area in the nerve territory. But it may be at the Central Nervous system level (spinal cord in this case) where the pain carrying nerves are 'moderated' by 'touch & pressure sensation' carrying nerves. (May be the ones called Wide Dynamic Range Neurons) This is why we press the area around an area of injury to lessen the pain.
Migraine is classified broadly into one with aura and the one without aura. By imagination progressing to scientific approval, all permutation-combinations have been playing in the nomenclature. Now you have 'maxillary-nerve related migraine?? Maybe it is described, but I have not come across such a terminology.
To diagnose "migraine' one has to rule out all 'causes' of headache. That will mean a visit to all the specialists sharing the field; eye specialist, dental surgeon, neurologist, ENT specialist, and even psychiatrist. Just a description of headache, without a full examination of head and neck, may not be enough for a valid diagnosis of migraine, though it is generally accepted.
Since you have seasonal allergies, you might have visited an ENT. Did you mention your headaches to him for his opinion?
Any medicine, be it Triptan or Topiramate, is given in pregnancy if the benefits outweigh the risks. You have to get advice from your doctor. But if you can handle the 'switch' why bother about medication :-)?
Thank you for your response. Let me try to respond to your questions here...
>"How did the headaches start two years back? (Injury?) "
-They just started without warning. No change in diet, environment, or anything else I could discern.
>"How did you happen to find out about massaging the right upper gum? "
-I can feel a sense of connectivity between the pain area and my upper jaw, a tingling sensation there. I sense an imaginary line running from my teeth to my temple during my episodes.
>"Do you mean that the pain gets switched off or disappears as long as the massage is continued? "
-Disappears as long as the massage is continued. Reappears the moment the pressure is released.
>"What do you mean by sinus congestion?"
-When I have a cold or allergies, sometimes it helps to relieve sinus pressure by massaging this same part of my jaw or other areas in the face to relieve the sinus pressure and get the fluid moving.
>"Since you have seasonal allergies, you might have visited an ENT. Did you mention your headaches to him for his opinion? "
-Yes--visited him for migraines since I am convinced they are related to the sinuses or nerves in my face. He looked in my nose with a scope and pronounced it the clearest he'd seen all day. Both the ENT and my PMP seem satisfied with my current medication, but I am very keen to find a root cause if I can, because my quality of life is still not great.
>"But if you can handle the 'switch' why bother about medication :-)? "
-One can only have a toothpick in one's mouth so many hours in a day. Also, my gums become sore!
Can you point to the location on the gum? (Dentists do it by counting the teeth from the centre. 1 is the first incisor tooth, 3 is the canine 4&5 are the premolars and the 6-7-8 are the molars.) In your situation it is the upper right gum, you have said.
An ENT may not be able to make out anything wrong in a nasal endoscopy, unless there is a change from normal appearance - in colour or shape or architecture. This doesn't come under what is expected from a 'routine' examination in ENT. Yours appear to be a 'functional' problem of the nerve probably (as opposed to 'structural' or 'organic') Incidentally, the word 'functional' is also used to indicate psycological reasons as well.
Did you mention your observation to a neurologist? (Now that the ENT has cleared). I wonder if he can devise a battery operated electric stimulator (something similar to TENS in lower voltage) instead of the tooth-pick exercise. But as of now, TENS should not be used in the mouth or on the trigeminal nerve (maxillary is a branch of the trigeminal) But a neuro should know better.
I get the most relief my pressing between and in front of tooth 3, 4, and 2 (in that order) and I get a minimal bit of relief from pressing anywhere in the entire upper right jaw. In fact, it feels good to apply pressure even after a migraine has receded sometimes, for a day or two.
I have not seen a neurologist, not knowing who to turn to next. Should I? How do I find one that will listen to my off-the-wall problem?
I agree your question is a bit difficult to answer. If you have a 'friendly neuro' (as opposed to a dry 'consult-investigate-prescribe medication / adv 'grin & bear it') things would move well. It will be a journey of both of you to find out what is wrong and if something simple can be done about it.
Since you are living a place far away, I am sorry I am not able to see you. Sensations, nerve conduction, referral of the pain etc come in the purview of the neurologist. If the neurologist is academically interested, and if he has time to spend with you, I think he may be able to help.
If it is not going to cost you much, see a neuro.
Another q: Any difference in sensation/ pain if you keep cold/ hot water on that side of mouth? Or are your teeth very sensitive to cold/ hot water?
Though I have not tried this, I don't believe temperature would make much impact. I will give it a try next time. My teeth are not temperature sensitive.
What is your academic feeling on the cause and effect relationship of this nerve link to my migraines? Is it possible that something related to the nerves in my face is CAUSING the migraine? Or is it more likely that I have common triggers like other people, like alcohol, allergies, foods, etc. and that somehow this nerve just happens to be some sort of pressure point, such as in eastern medicine, that cures the pain?
I enjoyed our discussion so much last winter that I thought I'd mention an interesting update.
I became pregnant shortly after my post, and quit taking Topamax. I was terrified that my headaches would become more persistent. However, I have been pleasantly surprised (thrilled!) to find that my migraines have been reduced to zero, with only mild head pain (still relieved by gum pressure, BTW) during hay fever season.
Many people tell me that pregnancy hormones could contribute to this. I have another potential explanation though: elimination of all alcohol from my diet. When I was suffering, a hangover guaranteed a migraine, though migraines followed an evening of sobriety too. My suspicion is that regular alcohol intake caused this periodic, severe head pain connected to the nerves in my face.
We will see what happens after I give birth and continue to abstain from alcohol. Then I may have my root cause.
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