MORNING HEADACHES ARE PRIMARILY RELATED TO TWO PRIMARY CAUSES: SLEEP DISORDERED BREATHING AND DISORDERS OF THE TRIGEMINAL NERVOUS SYSTEM WHICH CAN LEAD TO CHRONIC PAIN, DEPRESSION AND TMJ DISORDERS. TREATMENT OF THE SLEEP DISORDERS IN CONJUNCTION WITH TMJ TREATMENT OFFERS EXCELLENT RESULTS

    /24-7PressRelease/ - GURNEE, IL, September 03, 2008 - Morning headaches are a particularly annoying disorder that is particularly common in patients with TMJ disorders, sleep apnea and upper airway resistance syndrome. They can range from mild to moderate allowing the sufferer to still function to severe and excruciating where the patient becomes a victim of the disorder and cannot function or barely functions on a minimal basis. When these headaches occur on a daily basis or even several times a week that can change patients personalities and outlook on life. An excellent resource on Sleep apnea, and its treatment can be found at http://www.ihatecpap.com . It reviews the dangers of sleep apnea and treatment alternatives including CPAP, BiPAP and dental appliances. While CPAP is considered the Gold Standard of treatment for sleep apnea only about one third of patients tolerate the treatment compared to 90-95 % who prefer using oral appliances to treat their apnea.

The Symptoms of Tension Headache, muscle contraction headaches and Morning Headaches are all very similar and are probably different faces of the same disorder. Many patients who have severe headaches that they call migraines actually have severe variations of these same disorders; the most common tension headache symptom is mild to moderate generalized head pain. Tension headache pain is sometimes described as feeling like a tight band is strapped around the head. These are very similar to the headaches suffered by patients with TMJ disorders or either nighttime tooth clenching or bruxism (teeth grinding). The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) recognizes that sleep apnea is a TMJ disorder. They issued a report in 2001 CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS. It can be viewed at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf . Neuromuscular Dentistry is probably the most effective method of treating TMJ disorders. Information on Neuromuscular dentistry can be found at http://www.ihateheadaches.org and http://www.iccmo.org/ is the best site to find a Neuromuscular dentist.

Sleep apnea is another frequent cause of morning headaches in patients who snore. Women patients and thinner patients are more likely to have a sleep apnea diagnosis missed. These patients often they exhibit Upper Airway Resistance Syndrome where snoring can be minimal and instead of excessive sleepiness their chief symptoms are fatigue, chronic pain, depression muscle soreness and aching or fibromyalgia. The American Academy of Sleep Medicine now recognizes oral appliances as a first line of treatment for mild to moderate sleep apnea. They recommend that dentists treating sleep apnea be well versed in treating TMJ disorders. Dental Sleep Medicine is the science of treating sleep disordered breathing with oral appliances. An excellent site to find a sleep apnea dentist who can treat morning headaches, sleep apnea and TMJ disorders is http://www.ihatecpap.com .

Tension headache pain symptoms are worse in the scalp area, around the temples, and the back of the head. This is exactly the same area where patients with jaw and posture problems have pain. Morning Tension headache symptoms may resolve in as little as thirty minutes, or last as long as a week. Chronic daily headaches are similar in nature but are not primarily associated with waking from sleep. Other causes of morning headache include lack of sleep from insomnia or poor sleep schedule, tension-producing sleeping positions, stress, and even pillow choice. Changing sleeping positions or purchasing a new pillow may be enough to prevent a morning headache for some people. Dental appliances are extremely helpful for morning headaches and may be used to treat clenching and grinding. The NTI appliance has been approved by the FDA to treat and prevent migraines. It works by suppressing the grinding or clenching of the teeth by nociceptive input into the trigeminal system. Neuromuscular dental appliances relieve headaches by balancing inputs into this same system

A lingering tension headache at bedtime is often enough to trigger a morning headache. Tension headache symptoms can disrupt normal sleep patterns and stages due to insomnia or difficulty sleeping. Fatigue produced by these symptoms is enough to trigger a morning headache. Headaches associated with depression are often due to poor sleep and chronic pain. Living with constant pain causes depression and often make patients feel desperate. The difference between these patients and true depressive patients is that when the pain is gone the depression quickly follows.

The International Headache Society now uses the term "tension-type headaches" rather than "tension headaches." because there are so many causes. TMJ disorders and sleep disordered breathing should be investigated as a cause initially. Both of these disorders are very common, are associated with increased muscle tension and are easily and successfully treated for most patients. Other less frequent causes include colds and flu, primary depression, excessive caffeine consumption or caffeine withdrawal, eyestrain, smoking or with smoking cessation. Many of the other causes would worsen Sleep Disordered breathing including apnea or TMJ disorders. These include colds or flue, allergies, nasal congestion, poor posture, sinusitis, alcohol or drug use.

The excessive use of caffeine is frequently related to fatigue or tiredness from sleep disordered breathing and sleep apnea. It hen leads to headaches and insomnia which in turn cause fatigue and depression. These patients frequently have headaches from withdrawal from caffeine and periods of sleep can lead to those early morning symptoms.

The August 15, 2008 issue of the Journal of Clinical Sleep Medicine has an excellent article on Depression and Sleep-related Symptoms in an Adult, Indigenous, North American Population. In the study Sleep-related symptoms of insomnia, apnea and Restless legs were each, independently related to depression.

Migraines are now thought to be a disorder of the trigeminal nervous system. These are the same nerves that go to the teeth, jaws, jaw muscles and jaw joints as well as the lining of the sinuses and controlling blood flow to the brain. The trigeminal or fifth cranial nerves supply the largest input to the brain and are probably responsible for much of the central sensitization that occurs in migraines, chronic pain and fibromyalgia. Treatment of TMJ disorders with neuromuscular dentistry can treat the muscle pain and decrease the chronic pain that leads to central sensitization

Tension or morning headaches more than fifteen days a month for several consecutive months are considered chronic. Chronic tension headache symptoms are present almost constantly. The headache may begin as a dull morning headache and grow in intensity over the course of the day. Chronic tension headache symptoms may indicate clinical depression or anxiety, and should receive medical attention.


Unusual or sudden onset headache symptoms should always be treated as medical emergencies, and are not normal to tension or morning headache symptoms. Immediate medical assistance should be sought if headache symptoms include any of the following:
Onset is sudden and severe (a "thunderclap" headache)
Symptoms include double vision, confusion, seizures, or difficulty speaking
previously absent headache symptoms develop after age forty
headache is accompanied by new symptoms of fever, stiff neck, weakness, or numbness
headache symptoms develop after a head injury.

Morning headache may be a good indicator of depression and insomnia and is not specific to sleep-disordered breathing, according to the results of a telephone survey published in the Jan. 12, 2004 issue of the Archives of Internal Medicine. This does not determine the underlying cause of depression, which is often chronic pain or related to stress from disturbed sleep.

"The prevalence of morning headache in the general population is not known, although according to a Swedish study, 5% of the population awakens often or very often with headaches," according to Maurice M. Ohayon, MD, DSc, PhD, from Stanford University School of Medicine in California. "Clinical studies have reported a high association between morning headaches and obstructive sleep apnea syndrome and snoring." He also stated that "Morning headache affects one individual in 13 in the general population,"

Web MD reported from Headache. 2008;48(1):32-39, "A Swedish cross-sectional study (324 diagnosed obstructive/apneics compared with random sample of the general population classified as snorers [n = 448] and nonsnorers [n = 583])found that heavy snorers were more likely than nonsnorers in the population to have "headache at least once a week" vs. "morning headache" "

Dr Ira L Shapira is an author and section editor of Sleep and Health, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical Schools Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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