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Marshall James Nev, PLC | When a Toothache Is Really a Headache in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

When a Toothache Is Really a Headache
 

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Sometimes what feels like a toothache is really headache.
This is the story of one of our patients.

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A patient came in as an emergency dental patient. She had fallen in the kitchen and had broken part of her left front tooth. The pain was excruciating.

An x-ray revealed that the tooth had had a root canal and that the tooth was not fractured. I placed her on some prednisone and gave her something for pain.

She called back over the weekend as she was continuing in severe pain. We placed her on an antibiotic which did nothing.

We again saw her on Monday and she was still the same.

Sensing that there was nothing wrong with the tooth, even though she had just fallen on it, we began to think pain referral (see What is Myofascial Pain? to recall what referred pain is). The extreme example of referred pain is someone having a heart attack and feeling a pain or numbness in the left arm.

To prove this thought, we anesthetized the front tooth with a local anesthetic. Guess what? The pain remained the same. So we needed to figure out which muscle was referring pain to the front teeth.

In this case, the pain was being referred from the temporalis muscle. And since the tooth was in the midline, the trigger points were in the left and the right temporalis muscle.

After injecting a local anesthetic into the trigger points in the temporalis muscle, the pain went away. So the toothache was really a headache!

The picture below shows the trigger point as X and the red is where the pain is felt.

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So, if we had not known about referred pain, the patient would have lost a perfectly good tooth and had would have had to have a $3,000 bridge placed, and they would still have a toothache!

Footnote

The masseter muscle also refers pain to the teeth as shone below.

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—Dr. Ney

 

 
 
Richmond Dentist | When a Toothache Is Really a Headache. Marshall James Ney is a Richmond Dentist.