Pain: Is it All In Your Head?
What headaches can teach us about our health
This week is about pain. (Spoiler alert: it’s not just about body parts!)
Leading pain expert, Rachel Zoffness, joins me on the podcast to discuss the anatomy of pain. Listen here!
Submit your questions about pain and pain management for this week’s Q&A here!
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Let's talk about your head.
I'm not talking about your head as a metaphor for wellbeing or any woo-woo stuff like that. Today, I'm literally talking about your head.
Headaches are one of the most common complaints I see. So let's discuss a common head case.
I recently saw a woman in her 60s who came in to see me for a severe headache that had been persisting for several weeks. Fear gripped her as she suspected the worst—a brain tumor. Her anxiety was palpable as she shared her concerns, hoping for some reassurance and guidance.
Do I need a brain scan? she asked me.
“Let’s first think this through,” I suggested. "Have you had any fever, chills, sinus pressure?"
"Do you have any known sick contacts?"
“Any facial numbness or weakness, nausea, vomiting, visual disturbances, gait issues, pain, numbness, or weakness in your limbs?”
“Is there anything else going on in your life?”
My patient welled up with tears. I’m moving my mother into assisted living. It’s been hard.
I put my pen down. “I understand.”
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I examined the patient's head, ears, eyes, nose, throat, neck, and performed a full neurological exam. All normal. But when I placed two fingers on either side of the patient's jaw (aka temporomandibular joint) and asked her to open and close her mouth, I heard a popping and clicking sound.
Ouch! Is that my ear?
“It’s actually your jaw.”
It was clear what the problem was: TMJ (temporomandibular joint) disorder or "bruxism" as the primary cause of her debilitating headaches.
Awareness of the facts and medical data:
The jaw is the strongest muscle in our body.
TMJ is a common condition that affects the temporomandibular joint, which connects the jawbone to the skull. It can cause pain, tenderness, and difficulty in jaw movement.
Stress-related bruxism, characterized by grinding or clenching of teeth, is often associated with TMJ and can lead to a variety of symptoms, including headaches.
The nerves that supply sensation to the jaw muscles also serve the middle ear. Tense jaw muscles—plus resulting joint constriction—can cause pain that feels like the ear itself.
Acceptance of the things we cannot change:
Accepting the connection between stress and TMJ helped my patient better understand the nature of her condition—and then to focus on implementing strategies to manage it effectively.
Agency over the areas we do have control:
I recommended these four exercises to help relax the jaw muscles:
Chin tucks. Tuck your chin into your neck, hold it for at least 3 seconds, and extend it back out again.
Jaw stretches. Completely relax your jaw and then slowly open your mouth as far as possible.
Resistance on the chin. Put your thumb under your chin and place some resistance on the area. Holding resistance, slowly stretch your mouth open as far as it can go, hold it for approximately 3 seconds, and then close your mouth.
Zig-zag stretches. Close your mouth. Shift your eyes to one direction, and extend and stretch your jaw in the opposite direction as far as possible. Do not move your head or open your mouth. Repeat on the other side.
Pain control with Ibuprofen, a heating pad, and muscle relaxants as needed (consulting your medical provider for specific advice).
To address the root cause, it's crucial to tackle stress:
Engage in relaxation exercises like deep breathing, meditation, or yoga to reduce overall stress levels.
Close your eyes and slowly inhale for 5 seconds. Hold your breath for at least 5 seconds, and slowly exhale. Repeat 5 times.
Ideally get up from your desk every 20-30 minutes, stretch your neck, jaw, and shoulders, and take some deep breaths. You'll discharge adrenaline and release muscle tension.
Dental interventions: Your dentist may recommend a mouthguard or splint to help protect the teeth and jaw joint from further damage.
Move more. When static, your body tenses. When in motion, your body warms up and muscles grab less.
Limit caffeine. When consumed in excess it can accentuate muscle tension.
Consider physical therapy. The PTs who deal specifically with jaw tension can work wonders on TMJ, headaches, and even migraines.
In short, managing headaches requires a multifaceted approach, addressing the physical and emotional aspects in tandem.
Today on the pod! Dr. Rachel Zoffness explains the nuances of pain and pain management.
Dr. Zoffness is an Assistant Clinical Professor at UCSF and leading global pain expert who is revolutionizing the way we conceptualize pain. She explains that hurt (pain) and harm (damage) are not the same—and that pain is never purely biological. Similarly, treating pain is never just about pills. It’s about addressing the social-emotional context around it.
Pain is an inevitable part of life, but it’s not just about body parts!
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.