Although the specific diagnosis of migraine is defined as a chronic neurological disorder characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms it is often by our dental patients used as the general term for facial pain with often also no response to the prescribed medication. This experience I share with many colleagues and yet I have to tell you about the 36 years old man, who was referred for chronic left side facial pain he had suffered for 18 years, half of his life. He had visited many doctors and he had also been taking a lot of medication during the years.
The pain occurred almost every day and was described by the patient as migraine on the left side of his face covering the left side temple and cheek area. Mandibular movements were normal. A panoramic X-ray did not reveal any pathology and showed a temporomandibular joint condylar symmetry.Static pain could be provoked for closing of his mouth. During our conversation it became obvious that a left side latero-protrusion was an often used position for bruxism, which also could be confirmed by marked facets of his left side front teeth.
After information about the possibility to initially wear a stabilization splint part time ( during day time working hours ) in order to avoid his unilateral abuse of the left side mm temporalis and the deep portion of masseter he decided to try. The stabilization splint was designed around the retruded position of his mandible, inserted without any adjustments and checked after another 6 weeks. At that time the young man announced that he had been completely free from any facial pain since the day after the insertion of the splint. It had been worn during the day except for chewing. He also showed an oral stability without the splint in his mouth.
In conclusion: When the dental patient is telling about his or her migraine that is not responding to the, by the medical doctor, prescribed medication DO PERFORM A FUNCTIONAL EXAMINATION OF THE STOMATOGNATHIC SYSTEM. There might be a chance to help the patient and not only his or her teeth.