11 year old girl with chronic headache

Can really use some advice...
about 5 weeks ago my daughter started suffering from a chronic headache.
She had stiffening in her neck and pain on the base on her head, sides along the temples and radiated up to through the top of her head. All OTC pain meds do nothing. No effect at all. We have been to the ER...with a little relief (headache went from a 9 to a 5)…
The MRI was clear. We have been to a neurologist who prescribed predisone...that did nothing
Now she is on nortryptaline every night (25 mg) and going to the PT and chiropractor on a regular basis for the last week. THe headache has moved...and now is focues on the front of her head and around her temples.
No fever...but she does get dizzy occasionally
The headache never goes away, but does get worse throughout the day. Goes a little bit in cycles but is always there (around a 7).
We just started her on amoxicillin yesterday, to rule out a sinus infection...
ANY SUGGESTIONS???? PLEASE HELP she is a super active girl and I hate to see her in such a state
She was diagnosed initially with trigeminal migraine, but then a cervogenic headache?? (hence the PT and the chiropractor)

Thank you so much
I will defininately look into this
we just got her a mouth guard for sleeping but it is so uncomfortable with her braces
She constantly grinds her teeth and clenches all through the night

Emma,

The short answer is yes, jaw and tmj problems absolutely cause headaches in the temples, above and in the forehead and neck pain. I will post more detailed info later when I have time.

Robin

Hi, Emma,
Sorry for the delay in my reply. I am crazy busy right now with school starting. I'm a teacher and the first several weeks of school are always crazy.

Here is a link to a post that I wrote that explains how TMJ tension in muscles can cause pain in the forehead.
https://www.healingwell.com/community/default.aspx?f=31&m=4020674&g=4028148#m4028148

My sense is that, since all of the other tests have ruled out a cause for your daughter's headaches, the orthodontic treatment is causing her headaches. She is probably in a stage of the orthodontic treatment when her occlusion (her bite, the way her teeth meet) is off and it is affecting her muscles. It could also be that the night guard is not adjusted correctly, which will actually increase the grinding and clenching rather than relieving it, and make the pain worse.

Her orthodontist may not be educated in TMJ. It is a specialty area that requires special training.

If you happen to be in the Portland, Oregon area, I can give you the name of my TMJ specialist. Otherwise, you could try doing a member search under "Patient Resources" on the Academy of Orofacial Pain website:
https://aaop.clubexpress.com/content.aspx?sl=1451399511

Best wishes to you and your daughter in finding help.

Robin

Just removing the braces at this point may not help, as the teeth may have been moved to a place that is causing muscle pain and headaches. I can't say if the teeth will revert back to where they were and relieve the pain or not. Plus, presumably she has a problem with her teeth/bite that prompted braces in the first place.

I think you are going to have to either find a TMJ specialist who can then work with her orthodontist, or perhaps find an orthodontist who has a better understanding of TMJ issues. One possibility is to have braces on just the bottom teeth and a splint (similar to a night guard) on the top teeth. Then you can switch and do braces on the top teeth and a splint on the bottom. This would provide bite stability while the orthodontic treatment is going on. The splint would need periodic adjustment as the teeth move.

A night guard you buy over-the-counter is unlikely to provide relief and may make things worse. She needs a custom splint fit to her teeth and mouth.

Hi,
I took her to a TMJ specialist,
He replied that she is a candidate for TMJ, small mouth, underbite, etc..
and the pain does make sense but it is not located at the specific muscles in her mouth
suggested an OTC bite guard, to be replaced every week or so...he did acknowledge that it was too soft,
but that with her braces it might be the best option..
he suggested waiting a week or so then maybe doing top only braces, or bottom only like you suggested
the neurologist went a different direction said it was migranosis...but that could be caused by the TMJ like pain?
I don't know, very confusing... Is the only way to diagnosis this correctly to do a CT scan and look at the bones in the skull?

Hi Emma, it's hard when one of our kids are having problems. What is the specialist recommending for treatment? I think you had mentioned before she was on nortriptyline, is she still on this?