What is it?
Migraine is a neurological condition that runs in recurring attacks. An untreated attack can last for hours, sometimes close to two or three days. The pain is mostly on one side of the head, beats like a pulse and gets worse with ordinary movement such as walking or climbing stairs.
Nausea and an inability to tolerate light and sound come with the attack. You want to stay still in a dark, quiet room. In some people, bright lines, zigzags or a passing blurring of vision appear before the pain; this is called aura and it usually lasts less than an hour.
The point where this meets dentistry comes from the sensory pathway. The same nerve carries sensation from the face and from the teeth. When migraine pain spreads to the upper jaw, the temple and the area around the eye, you feel the pain in your tooth. If examination and tests show no cause in the tooth, no irreversible work is carried out on a healthy tooth.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Inherited tendency and a sensitive nervous system
Migraine is linked to a tendency that often runs in families. Pain and sensory pathways in the brain answering stimuli at a lower threshold than usual makes it easier for an attack to start.
- 02
Sleep, meals and hormonal changes
Sleeping too much can start an attack just as sleeping too little can. Skipping meals, going without fluids and hormonal swings tied to the menstrual cycle are commonly reported triggers.
- 03
Sensory and environmental triggers
Bright or flickering light, strong smells, noise and changes in air pressure start an attack in some people. Triggers vary from person to person, which is why the list is drawn up individually.
- 04
Load coming from the neck and chewing muscles
Signals from the neck and chewing muscles are processed in the brainstem in the same area as the migraine pathways. Constant muscle tension does not create an attack directly, but it can be a load that makes attacks more frequent.
How does it progress?
- 1
Warning phase
Hours, sometimes a day before the attack, you may notice yawning, a strong appetite, restlessness, a stiff neck or heavy tiredness.
- 2
Aura
Not everyone has this. There may be bright lines or a blind spot in your field of vision, tingling in a hand or the tongue, or trouble finding words; it usually passes within an hour.
- 3
The painful phase
Throbbing pain, nausea and sensitivity to light and sound are marked. Because movement makes the pain worse, you want to lie down.
- 4
Recovery
Once the pain has gone, exhaustion, poor concentration and a feeling of fullness in the head can linger for about a day.
How is it treated?
Migraine is not treated in dentistry. For this condition the place to go is a neurology clinic. Keeping a headache diary for a few weeks before you go makes the assessment easier: note the time the attack started, how long it lasted, which side it was on, what came with it and which medicines you took that day.
What to expect at neurology is a detailed history and a neurological examination; if the picture is not typical or there are new findings, imaging may be requested. Treatment to stop an attack and preventive treatment to make attacks less frequent are separate decisions. The choice of medicine, its dose and how often it is taken are the doctor's decision.
The dentist's role is to notice and to tell things apart. The teeth in the painful area are assessed by their vitality, their response to biting and percussion, and radiographs. If no cause belonging to a tooth is found, root canal treatment, root end surgery or extraction is not put on the table and you are referred to neurology. If there is a clenching habit as well, that is dealt with as a separate heading.
- A headache that starts unusually suddenly and reaches its worst within a short time
- Aura appearing for the first time, or a neurological symptom lasting longer than an hour
- Fever, a stiff neck or confusion added to the headache
- The pattern of the pain changing, the pain steadily worsening, or starting for the first time later in life
How is it prevented?
- Keep your sleep, meals and fluid intake steady, and take care not to skip meals.
- Keep an attack diary for a few weeks and work out your own triggers.
- During an attack, rest somewhere dark and quiet and stop looking at screens.
- Track the number of days you take a painkiller and tell your doctor if it is rising.
Frequently asked questions
- Can a migraine be taken for toothache?
- It can. Because the same nerve carries sensation from the face and the teeth, migraine pain can be felt in the upper back teeth. What sets it apart is that the pain comes and goes in attacks and is accompanied by nausea and sensitivity to light and sound. Tooth-related pain is usually linked to heat, cold or biting.
- Nothing was found wrong with my tooth, so why is the pain felt there?
- Where pain is felt may not be where the problem is. The brain can refer signals arriving along the same nerve pathway to neighbouring areas. In that case the right step is not to work on a healthy tooth, but to take the headache to a neurology assessment.
- Does a night guard prevent migraine?
- A night guard is used to reduce the muscle load from teeth clenching; it is not a treatment aimed at migraine itself. If you have a clenching habit, the extra pain coming from the muscles may ease, but preventing the attacks is not to be expected from it. The decision on migraine treatment is made by neurology.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.