Medical Definition

Migraine is a severe headache, which can last anywhere from two hours to two days. This headache is accompanied by disturbances of vision and/or nausea, extreme pain and vomiting.

Dr. Raman: What follows is a description of Migraine from the perspective of medicine . When you read this account you will notice the following important points:

  • Migraines are diagnosed simply through reported subjective symptoms
  • There are no medical tests – blood test, x-ray exam etc. to diagnose it.
  • The cause of this condition is considered to be serotonin release….but the cause of that release is attributed to many factors…as you will see below.
  • The glaring omission is the muscles of the head and neck that are either fatigued or in spasm. While the listed factors can contribute to an episode, they are often minor factors ….’the straw that breaks the camel’s back’….that get the “credit” for causing the migraines. The Neuro Muscular cause…the poor alignment of the lower jaw to the upper jaw…..exists all the time….and so doesn’t get the “credit” it really deserves for causing this condition.
  • The other point you will notice is the lack of real solution to migraines. Correcting the Neuro Muscular imbalance…by correctly aligning the bite….takes away that major cause… allowing one to deal with stress, bright lights, loud noise or any of the other aggravating factors in stride. On the other hand, the medical “solution” is to take prescription drugs…with their various side effects and the unending expense…..for ever.
  • It is actually ironic to hear of “migraine prevention” protocol which is to take prescription drugs daily!
  • The Neuro Muscular approach to solving the Migraines is to correct the bite so that prescription drugs are not needed any longer. Once the bite is corrected, it stays corrected….unlike taking prescription drugs that wear out in a few hours.

Medical Description

Migraines affect over 23 million people, with roughly 75 percent of them being women. Migraines begin with the release of serotonin; a biochemical substance stored in the blood platelets produced naturally in the body. When serotonin is released, the blood vessels constrict (narrow). As serotonin is expelled by the kidneys, its level in the brain is depleted, causing the blood vessels to dilate (expand). This dilation causes pain in the surrounding nerves, which can lead to migraines.

There are two predominant types of migraines – common migraine and classic migraine. The common migraine develops slowly and may be preceded by tiredness, cravings, yawning, depression, irritability and anxiousness.

The common migraine usually occurs on one side of the head. The classic migraine develops in four stages – prodrome, aura, headache and post-headache. During the prodrome stage, the person may feel fatigued, irritable, have decreased concentration or experience depression. This stage will develop about 24 hours prior to the aura stage. The aura stage is a slowly expanding area of blindness surrounded by a sparkling edge that increases to involve up to one half of the field of vision of each eye. In addition to the aura, the migraine sufferer may see flashing lights, colors or zig-zags of light, experience a prickly or burning sensation and/or muscle weakness on one side of the body. The third stage is the headache itself, which is usually a severe throbbing pain on one side of the head that is often exaggerated by bright light or noise and may be accompanied by nausea and vomiting. The fourth stage is post-headache, which is characterized by exhaustion and fatigue.

The classic migraine may occur on one or both sides of the head. The other types of migraines are: hemiplegic migraine, which involves muscle weakness or partial paralysis lasting less than an hour; ophthalmoplegic migraine, which involves temporary eye inconveniences, such as droopy eyelid and pupillary changes, lasting from several days to weeks; basilar artery migraine, which involves neurological spasm lasting for about six to eight hours; and status migraine; which involves a severe migraine attack, lasting longer than 24 hours.

What Causes A Migraine

Serotonin release, resulting in a migraine, can be triggered by a number of factors. These factors can be stress-related (such as anger, depression, shock, excitement or changes in routine), food-related (such as chocolate, cheese, red wine or fried foods), or sensory-related (such as bright lights, strong odors or loud noises). Additionally, migraines can be medication-related (medicines including nitroglycerin, lithium and certain anti-hypertensive, anti-inflammatory and broncho-dilating drugs), or hormone-related (such as menstrual periods, hormonal treatments or birth control pills). Patients often have a family history of migraine.

Dr. Raman: While these factors can contribute to a migraine episode, the biggest contributor is a poor bite relation…from the lower jaw being poorly aligned with the upper jaw. This in turn results in a constant effort by the muscles of the jaw (muscles of mastication) and in turn the muscles of the head and neck… each time the jaws are brought together. This occurs about 2000 to 3000 times each day when you swallow and of course, during chewing. In turn, these muscles become fatigued or go in to spasm (similar to a ‘charlie horse’). Lactic acid, carbonic acid and other metabolite build up in these fatigued muscles due to increased pressure on capillaries preventing normal blood flow. This is a primary trigger of Migraines.

A more recent theory of migraine causation is the role of CGRP in generating and maintaining the migraine headache. Calcitonin Gene-Related Peptide is a protein that transmits pain signals along the trigeminal nerve into the brain stem and the brain. Three new injectable mono-clonal antibody ‘drugs’ have been approved recently. Erenumab (Aimovig™) works by targeting CGRP’s receptor, fremanezumab (AJOVY™) targets the CGRP molecule itself and galcanezumab (Emgality™) binds to CGRP and blocks its binding to the receptor.

The cell bodies on the trigeminal ganglion are the main source of CGRP. So would it not make sense to lessen the production of CGRP rather than using injected drugs to block it after it is produced? That is why Physiologic NeuroMuscular Dentistry works! By calming the input in to the trigeminal nerve by aligning the jaw in such a way that it is effortless for the jaw muscles to bring the teeth together. The structural discrepancy is diagnosed and corrected and thus calming the trigeminal nerves and their cell bodies so they produce less CGRP.

Migraine Headaches Symptoms

The symptoms of a migraine may include:

  • Throbbing or dull aching pain on one or both sides of the head
  • Nausea
  • Vomiting
  • Diarrhea
  • Changes in how a person sees, including blurred vision or blind spots, zig-zags of light or light flashes
  • Sensitivity to light, noise and odors
  • Tiredness
  • Confusion
  • Nasal congestion
  • Feeling cold or sweating
  • Stiff or tender neck
  • Anxious or restlessness
  • Lightheadedness
  • Tender scalp
  • Cold hands and feet
  • lactic acid

Dr. Raman: Each one of these is also a symptom of TMD (Temporo Mandibular Dysfunction). TMD is very effectively and predictably treated with Physiologic Neuro Muscular Dentistry.

Migraine Headache Treatment Options

When treating TMJ, here are the items we look for to provide the best experience.


No tests are available to reliably diagnose a migraine. The doctor will make a determination, based on a physical examination and a thorough medical history, including triggers, symptoms and family history.


Treatment for migraines is directed at preventing attacks (prophylactic or preventive therapy) and alleviating them when they occur (abortive therapy). Prophylactic therapy includes:

  • eliminating the controllable triggers, such as chocolate or red wine
  • improving the person’s physical, mental and emotional health by exercising, biofeedback, relaxation techniques, rest and stress reduction
  • taking medications to prevent the onset of an attack

The most widely used preventive drugs are beta blockers, such as propranolol hydrochloride (Inderal), nadolol (Corgard), timolol maleate (Blocadren), atenolol (Tenormin) and metoprolol tartrate (Lopressor, Toprol-XL). Beta blockers have an indirect effect on serotonin, preventing dilation of the blood vessels and decreasing overstimulating impulses from the brain. Other preventive medications include calcium channel blockers, such as verapamil and diltiazem hydrochloride (Cardizem), antidepressants, such as Elavil, aspirin and antiserotonin agents. Preventive medications must be taken every day, whether there is a headache present or not. They will not be helpful if taken only when an attack strikes. Abortive Therapy Once the migraine has set in, there are two methods of reducing the pain: non-drug and drug-based methods. The non-drug methods include:

  • lying in a dark quiet room with a cold compress or rag on the forehead
  • massage or acupuncture
  • using visualization techniques to direct blood flow away from the head putting pressure on the temples

The drug-based treatment includes medicines such as aspirin, acetaminophen (Datril, Panadol, Tylenol), ibuprofen (Advil, Medipren, Motrin, Nuprin), naproxen (Naprosyn), naproxen sodium (Anaprox), diflunisal (Dolobid), ketorolac (Toradol), sumatriptan (Imitrex) and ergotamine tartrate (Ergostat).

Dr. Raman: What is glaringly lacking from the above list of treatments is a real solution. Through a scientific approach of measuring the electrical activity of the muscles of mastication (Electromyography – EMG) similar to measuring the electrical activity of the heart through EKG, the proper bite relation is diagnosed. Then by correcting the bite relation the Migraine attacks can become a thing of distant memory!

Questions to Ask Your Doctor

  • What type of migraine is it?
  • Is this a symptom of another condition(s)?
  • What can be done to prevent a reoccurrence?
  • What medications can be taken to relieve the pain?
  • What are the side effects of the medication?
  • Should I keep a supply of migraine medication at home?
  • How long before the pain subsides?
  • Are there things that should be avoided (such as food, bright lights, exercise, etc.)?

Dr. Raman: These are the suggested questions to ask of your physician. I would add the following: Are there any real solutions that would help me avoid Migraines without having to take prescription drugs for the rest of my life? Or inject myself with CGRP blockers the rest of my life? What are the consequences of putting all these powerful drugs in to my body forever?

If the answer you get is less than satisfactory, let me suggest that you contact us. The first step is an evaluation. This is to see if the malocclusion (poor bite relation) is a primary cause of your Migraines. Only if I have confidence that I can help you, would you be accepted for treatment. If malocclusion is not a primary cause in your particular case, then I will inform you of that. I don’t wish to waste your time, your money and my time.

What do you have to lose…..except your Migraines!