Headache Treatment

The American Headache Society (in which Dr. Shirazi is a member of) has classified headaches into three main groups.

Those groups are:

1 – Primary Headaches

(The vast majority of headaches: Tension Type, Migraine Type, and Cluster Type headaches)

2 – Secondary Headaches

(Less than 10% of headaches, caused by either: bleeding in the brain, a tumor (a tissue overgrowth in the brain), meningitis and/or encephalitis (inflammation of the tissues that surround the brain, increasing cranial pressure). These headaches will not be discussed further here.

3 – Facial Pain, Cranial Neuralgias and other headaches

At the TMJ & Sleep Therapy Centre of Conejo Valley and Los Angeles, a comprehensive evaluation is performed to evaluate for the specific cause or causes of the headache. We have a large network of physicians, chiropractors, therapists and other healthcare providers that we work with and refer to in order to get the maximum benefit for our patients.

Dr. Shirazi is a licensed Dentist, Acupuncturist and Sleep Technologist, using all of the resources available to get maximum benefit for his patients. Our Patient Testimonials Page offers many people hope and encouragement.

Dr. David Shirazi discusses headaches


Tension type headaches are the most common of all headaches, found in all age groups and are nearly equal in prevalence among men and women. They typically are expressed with pain in the front of the head and base of the skull

Tension-type headaches typically have pain that radiates in a band like fashion on both sides, from forehead to base of the skull. Pain often starts or radiates to the neck and upper back (trapezius) muscles.

Often times, patients are either unaware of their jaw pain or clenching of their teeth at night, and only notice the headache itself. This is commonly seen in our practice with patients with Jaw issues (clenching teeth at night, clicking/popping, and jaw pain).

Jaw issues can also be a cause of forwarding Head Posture (FHP). FHP has been strongly associated with Tension-type headaches and Jaw issues.


Forward Head Posture occurs when there is a Jaw issue, an airway issue, or other
orthopedic imbalance(s), or even a combination thereof.

This FHP puts extreme pressure on the neck itself; for every inch of FHP, the neck must carry an extra 10 lbs. (the average weight of a human head) which causes a lot of strain on the body.


This weight on the neck can cause pain and/or numbness up to the head and down the arms to the fingertips

Again, the cause for all this could be related to an underlying Jaw issue or Sleep Breathing Disorder. A Jaw disorder can determine the neck and therefore head position, and vice versa.

At the upper neck level, there is an important nervous structure called the Subnucleus Caudalis, which is essentially an extension of the Trigeminal Nucleus, the source of all Migraines. It has been documented that chronic tension-type headaches can eventually lead to Migraine headaches. Chronic neck pain and/or tension can cause antagonistic signaling of the Subnucleus Caudalis.


The term migraine is originally derived from the Greek word hemicrania, which means “half of the head.” And, for 70 percent of the time, the migraine is one-sided or occurring on one side of the head. A migraine is considered a vascular headache because it is associated with changes in the size of the arteries in and outside of the brain. These vascular changes are ultimately caused by the Trigeminal Nerve/Ganglion.

The distention of these vessels contributes to the pain of migraine. The nerves around the blood vessels release chemicals, which cause inflammation eliciting pain signals into the brain/head. The Trigeminal Nerve/Ganglion receives its information from the Jaw, mouth, face, teeth (figure 8), and all over the body (through the subnucleus caudalis).

If nociceptive (pain) signals can be significantly reduced or eliminated to the Trigeminal Ganglion the result seen is a reduction or elimination of Migraines. What’s most important, however, is obtaining an accurate diagnosis, of which there may be a need for multidisciplinary care.


Common Migraines are the most common form as described above, accounting for 70% – 80% of all migraines. Common Migraines do not have aura’s associated with them.

Classic Migraines, accounting for the rest, are associated with aura. Auras are visual disturbances (outlines of lights or jagged light images) that precede a migraine; these warning symptoms may occur anywhere from a few minutes to 24 hours before the migraine. The visual changes are common in one or both eyes. They may occur in any combination.


* Seeing zigzag lines
* Seeing flashing lights
* Other visual hallucinations
* Temporary blind spots
* Sensitivity to bright light
* Blurred vision
* Eye pain


* Loss of appetite
* Nausea
* Vomiting
* Chills
* Increased urination
* Increased sweating
* Swelling of the face
* Irritability
* Fatigue


Cluster Headaches are characterized by severe, unilateral pain that is around the eye or along the side of the head , seen 5-8 times more common in men than women. Cluster Headache attacks last from 5 to 180 minutes and occur once every other day to up to 8 times daily.

Attacks are associated with tearing on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead, and facial sweating, drooping eyelids or eyelid swelling.

Most people get their first cluster headache at age 25 years, although they may experience their first attacks in their teens to early ’50s, where they typically will begin to automatically reduce.


(1) Episodic: This type is more common. There may be 2 or 3 headaches a day for about 2 months and not another headache for a year. The pattern then will repeat itself.

(2) Chronic: The chronic type behaves similarly but it occurs chronically.

Cluster headaches have strongly been correlated with obstructive sleep apnea. Typically CH occurs between 9 pm and 9 am and is worse during REM sleep, where sleep apnea is at its worst.

Furthermore, the most commonly accepted treatment for onset of CH is inhalation of medical Oxygen. It is abortive for over 70% of cluster headaches.


Facial Pain, commonly called atypical facial pain, was first introduced by Frazier and Russell in 1924. It has since been renamed Persistent Idiopathic Facial Pain (PIFP). PIFP refers to pain along with the territory of the trigeminal nerve that does not fit the classic presentation of other cranial neuralgias (Pascual, 2001). The duration of pain is usually long, lasting most of the day (if not continuous).


The primary symptom of cranial neuralgia is recurrent pain in the same area of the head, face or scalp. The severity of pain can vary greatly. The pain may fade, but is likely to return and it often occurs along the length of the affected cranial nerve. Depending on the type of neuralgia involved, the pain may be described in many ways, including sharp, excruciating, burning or shock-like with only the lightest touch to that part of the face or scalp needed to trigger it. In addition, some patients may also experience itching, numbness and muscle weakness.


The causes Neuralgias are many, starting most commonly with compression, irritation or a distortion of cranial nerves or upper cervical roots by a structural distortion; other possible causes are herpes infection, diabetic neuropathy, Tolosa-Hunt Syndrome (a painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure), or they may have a Central Origin, meaning from the Central Nervous System, which implies it can be ‘referred’ or ‘sensitized’ pain from the TMJ.


One of the possible causes of other headaches is a Sleep Disordered Breathing issue such as Obstructive Sleep Apnea causing hypoxia, or decreased level of oxygen. The low level of oxygen eventually changes the vasculature inside the brain leading to headaches.

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