Migraine, Face pain, TMJ
The approach that we use at the Clinic to treat migraine and headache is that used by Dean Watson. (https://watsonheadache.com) This approach explains how pathology in the upper neck area (C0-3) can cause headaches and migraines including aura, runny eyes, sensitivity to smell or light etc. Treating the pathology alleviates these symptoms. Not all migraines and headaches have neck pathology as a causal factor. In assessing a patient, reproducing and then clearing the headache is a basic prerequisite for stating that the approach is suitable for a patient.
Dean has proposed this theory after years of working exclusively with headache patients. Please note that the following description is my interpretation of Dean’s work and I recommend the Watson Institute for more detail.
The cervical spine has seven vertebrae. C0-3 refer pain into the face and head, whilst C4 and below refer into the shoulder and the arm. The mechanism for the joints to refer into the head is that of convergence.
It is well known that, when experiencing a heart attack, it is common to feel pain into the left arm. This is because the nerve from the heart and the nerve from the left arm CONVERGE onto the same intermediary neuron and then travel up to the brain. When the heart sends warning signals to the brain, signalling a problem, the brain can only tell that they come from the intermediary neuron and is unable to differentiate between the left arm and heart. Therefore, it sends warning signals to both, hence the left arm pain can indicate a cardiac problem.
It is this mechanism of convergence that is used to explain how neck joints can cause migraines. The brain stem and upper spinal cord have an area of grey matter called the Cervical trigeminal nucleus (CTN). It is called this as it has input from the Trigeminal nerve (Cranial nerve 5) and also from the first three cervical nerves. When there is noxious input into the CTN from a painful joint, the brain cannot distinguish the source of the input and so warning output can be in any of the areas that are in the CTN.
The Trigeminal nerve carries sensory information from the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose, the nasal mucosa, the frontal sinuses and parts of the meninges (the dura and blood vessels). The maxillary nerve (V2) carries sensory information from the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses and parts of the meninges. The mandibular nerve (V3) carries sensory information from the lower lip, the lower teeth and gums, the chin and jaw (except the angle of the jaw, which is supplied by C2-C3), parts of the external ear and parts of the meninges. The mandibular nerve carries touch-position and pain-temperature sensations from the mouth. Although it does not carry taste sensation one of its branches—the lingual nerve—carries sensation from the tongue (Wikki). So any of these areas can be stimulated via the CTN if a noxious input is received.
There are other factors influencing the system, and a thorough assessment is needed to ascertain whether mobilising the cervical vertebrae will help with migraines.