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Headaches are one of the most common pain problems which plague mankind. There are many categories of headaches, many of which are caused by temporomandibular disorders, grinding or clenching of the teeth or other craniofacial pain disorders.


The most common pain complaint of civilized man, headache pain may be mild and of short duration, or it can be severe enough to incapacitate the sufferer totally. Fortunately, the majority of headaches do not have a serious cause. In fact, chronic headaches are rarely caused by organic diseases such as brain tumors. Headache is one of the most common complaints of those who suffer with various types of TMJ problems.

The first well-known classification of headache pain was proposed in 1962 by the Ad Hoc Committee on Classification of Headache of the National Institute of Neurological Diseases and Blindness. This committee divided headache pain into three (3) basic categories:

(1) vascular headaches; (2) traction-inflammatory headaches; and, (3) muscle contraction headaches. Because there are certainly more than three main types of headaches, in 1987 the International Headache Society developed more specific criteria to provide greater uniformity and reproducibility in the diagnosis of headache. This new classification system divided headache pain into 13 different categories, with TMJ and facial pain falling into category number 11: Headache or facial pain associated with disorder of cranium, neck, eyes, nose, sinuses, teeth, mouth, or other facial or cranial structures. However, for most doctors and patients, it is still useful to divide all headache pain into the three original categories. Most headaches, except those caused by infections, tumors, aneurysms or trauma, have two common attributes: (1) tenderness of muscles of the head and (2) clenching of teeth. For these reasons, see Dr. Shankland’s web page entitled The NTI Appliance.

Vascular Headaches

Vascular headaches include classic (migraine with aura) and common (without aura) migraine headaches, cluster headaches, and several other less common vascular types of headaches. Although vascular headaches are probably the most investigated, this entire category may comprise only 6-8% of all headache pain.

    Symptoms of the Classic Migraine (migraine with aura) include:
  1. Initially, a unilateral dull ache
  2. Intensifying pain in a crescendo fashion Paleness or redness of the skin of the face
  3. The pain is generally becomes pulsating
  4. The presence of an aura (seeing “stars,” photophobia, tunnel vision) before the headache starts

    Symptoms of the Common Migraine (migraine without aura) include:
  1. Similar symptoms to the classic migraine
  2. Lack of a prominent aura
  3. Occasionally, the headache is bilateral

Traction-Inflammatory Headaches

Although these types of headaches comprise only about 2% of all headache pain, these are generally caused by severe diseases and disorders. Examples are brain tumors, aneurysms, infections, and neuralgias. Symptoms vary and can’t be neatly categorized. However, often the pain of headaches falling into this category is very severe, increases when the sufferer bends over or coughs, and may be accompanied by other neurological symptoms.

Muscle Contraction (Tension) Headaches The most common type of headache is the muscle contraction or tension headache. It has been estimated that this type of headache accounts for 90 to 92% of all headache pain. Because this type of headache may vary from mild to quite severe in intensity, often its sufferers are misdiagnosed as migraine, sinusitis or even psychogenic (imagined) pain. The TMJ headache is a Tension type of headache.

The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. Sleeping difficulties are common: waking without feeling rested, restlessness and trouble getting to sleep. Those who clench or grind their teeth also develop muscle contraction headaches, especially during times of stress or during the night. When asking a patient to describe their pain, I often hear such descriptions as, tightness, drawing, band-like, or vise-like. Muscle contraction pain may last for hours, days, weeks or even months. Lastly, as with all pain problems, if you persistently suffer with headache and your doctor can’t (or won’t!) give you a reasonable answer, get a second or even third opinion.

The good news is this: most of these headaches can be treated effectively by the use of various intra-oral appliances, all of which Dr. Shankland can provide. There’s no need to continue to live in constant or frequent headache pain when most of the time, the headaches can be treated. Contact Dr. Shankland’s office for more information about headaches.

NTI Appliance

The NTI (Nociceptive Trigeminal Inhibition) appliance is a remarkable intraoral appliance that was approved in 2001 by the US Food and Drug Administration for the prevention of migraine and tension-type headaches, bruxism and TMJ syndrome by inhibiting the trigeminal nerve’s activities in the jaw and head muscles. After an extensive FDA study in which Dr. Shankland was the head investigator, it was found that 82% of NTI users had a 77% average reduction in migraine events and 16% reported 85% to 100% reduction in migraine headaches. Further, significant tension-type headaches were relieved or totally eliminated just by wearing the small, NTI appliance while sleeping.

This safe and effective small appliance is in use in nearly every country in the world and has saved headache sufferers countless dollars in lost wages and costs for medications, hospitalization and disability due to headaches. Dr. Shankland is one of the world’s foremost authorities on the NTI appliance and has been using this device in clinical practice since 1999. For more information, go to or . If you or a loved one suffers with headaches and have not been able to receive relief with any other type of treatments, make an appointment with Dr. Shankland for an examination and consultation.