Head Pain and Tinnitus: A Journey Through Neurology and Dentistry

I have a severe headache that feels like an explosion on both sides, and the ringing in my ears has become louder?

I have a terrible headache.
I thought taking a nap would help, but the pain woke me up.
I first went to a neurologist for an MRI, which showed no issues.
I visited an ENT specialist twice; the first doctor suggested I might need to see a dentist instead.
He suspected I had temporomandibular joint (TMJ) disorder.
Hearing and otoscopic examinations were normal.
At the second ENT visit, I told the doctor I had an MRI done last year.
He looked very young, like he was in his twenties, which made me doubt his experience.
Other doctors had many patients, while he had only a few.
I was in a hurry and didn’t want to wait too long.
He mentioned that since I had undergone detailed imaging, there shouldn’t be any major issues within one or two years.
I told him I had pain at the back of my head and asked if it was occipital neuralgia.
He said it was localized pain, not that, and diagnosed me with TMJ disorder, advising me to treat it.
He mentioned that my pain was referred pain.
I got a bite splint, and the doctor said to return in a year.
I asked if TMJ disorder could cause tinnitus or pain in the back of my head, and he said no, advising me to see an ENT specialist.
He noted I had some periodontal disease and recommended I visit a nearby dental clinic.
I checked several dental clinics; some said I should go to a larger dental office, as they could only clean my teeth and prescribe anti-inflammatory pain medication.
I went to a periodontal specialist who injected my gums and advised me to avoid hard foods.
The next appointment is already scheduled for two months later in September.
The dental clinic in Miaoli only did X-rays and teeth cleaning for me! I have had unilateral tinnitus for a year, running around to TMJ and dental specialists.
My gums have been swollen and painful for a long time; some say it’s due to deep bite issues, while others say there’s something in my front gums causing swelling from saliva.
I have a referral for a biopsy tomorrow.
My headache has worsened, and the tinnitus and ear pain are persistent.
When I press on the back of my head, I find pain points that shift; the original painful spot may not hurt anymore, but now pressing there causes pain while the adjacent area does not.
Several times, I’ve felt pain near my nostrils and pressed on them.
Before I got sick, I felt a tingling numbness on the side of my face, which felt strange.
However, I really feel something is off in my mouth; previously, my gums were raw and I applied medication.
Now, I have something growing on my lips; the ENT said it was something trivial, but I forgot what he called it.
He said it was nothing to worry about! Right now, my ear is very painful and itchy.
I just took some pain relief medication from the TMJ specialist, which helped a little, but it still feels like it’s going to explode.
I’ve had several ECGs done, suspecting a myocardial infarction, but everything was normal.
I previously had issues with autonomic nervous system dysfunction and visited several doctors.
Once, a doctor even called to refer me to a psychosomatic specialist, but I didn’t go.
There would be a record of it, and my husband doesn’t allow me to go.
The health center said I have anxiety issues; every time I visit, my heart rate is 80-90, and they suggested I see a psychosomatic specialist.
Sometimes, when driving or cooking, I feel like I can’t breathe or want to scream.
I have been traumatized by past experiences of being bullied and hurt, and I remember how those people treated me, even if it was 20 years ago, 13 years ago, or 6 years ago.
I can never forgive them; I will always remember.
Is my headache and tinnitus related to my psychological issues? Also, my right eye keeps watering; one doctor said it’s seasonal allergies, while another said it’s presbyopia.
I’ve been using eye drops for fatigue, but my eye is still swollen, painful, and itchy, with three layers of eyelids.
My husband suggested using a cold compress.
All my symptoms are on the right side.
I also have a dull pain inside my right rib cage, and my right buttock was X-rayed at an orthopedic clinic, where I received pain medication.
I asked the doctor if my past experience of being pushed to the ground during an argument with an ex-boyfriend was an old injury, and he said it wasn’t!

Lin Xin-Yi, 40~49 year old female. Ask Date: 2023/08/09

Dr. Jiang Junyi reply Neurology

Dear Ms.
Lin,
You mentioned issues related to "headaches and cranial noises," which may suggest tension-type headache, a form of myofascial pain.
Myofascia refers to the connective tissue that envelops the surface of muscles.
Tension-type headaches are caused by tightness in the head muscles.
Common manifestations include tight, constricting pain in the forehead and temples.
Tension-type headaches may arise from stress, anxiety, or poor posture leading to excessive muscle tension.
In terms of treatment, it is important to identify and address the sources of stress, engage in muscle relaxation exercises such as yoga, and pay attention to posture.
Pharmacological treatment typically involves muscle relaxants, anxiolytics, and mild analgesics.
Medications with serotonin components can help alleviate anxiety and reduce the intensity of pain.
Thank you for your inquiry.
If you have further questions, feel free to discuss them! Wishing you good health and peace.
Dr.
Jiang Junyi, Tao Medical Center, cares for you.

Reply Date: 2023/08/09

More Info

Understanding the complex interplay between head pain, tinnitus, and potential dental issues requires a comprehensive approach that encompasses both neurological and dental evaluations. Your symptoms, which include persistent headaches, tinnitus (ringing in the ears), and discomfort in the jaw area, suggest a multifaceted condition that may involve several underlying factors.

Firstly, the relationship between head pain and tinnitus is well-documented in the medical literature. Tinnitus can often be associated with various types of headaches, including migraines and tension-type headaches. The auditory system and the nervous system are closely linked, and disturbances in one can lead to symptoms in the other. For instance, the trigeminal nerve, which is responsible for sensation in the face and motor functions such as biting and chewing, can also influence the auditory pathways. This could explain why you experience ear-related symptoms alongside your headaches.

Your mention of temporomandibular joint (TMJ) issues is particularly relevant. TMJ disorders can lead to significant discomfort in the jaw, which may radiate to the head and neck, causing headaches. The pain you describe, particularly if it is localized to specific points, could indeed be related to TMJ dysfunction. This condition can also contribute to tinnitus, as the muscles and nerves around the jaw are interconnected with those in the ear.

The fact that you have undergone multiple imaging studies, such as MRI and CT scans, and that these have returned normal results is reassuring. It suggests that there are no significant structural abnormalities in the brain that would explain your symptoms. However, it is essential to consider that conditions like migraines or tension-type headaches may not always show up on imaging studies. These types of headaches can be triggered by various factors, including stress, anxiety, and even dental issues.

Your history of anxiety and stress is also crucial in understanding your current condition. Psychological factors can exacerbate physical symptoms, leading to a cycle of pain and anxiety. The symptoms you describe, such as feeling like you cannot breathe or experiencing panic-like symptoms, may be indicative of anxiety-related disorders. It is not uncommon for individuals with anxiety to experience physical symptoms, including headaches and tinnitus.

Given your complex symptomatology, it would be beneficial to approach your treatment from multiple angles. Here are some recommendations:
1. Neurological Evaluation: Since you have already seen neurologists, consider seeking a second opinion if your symptoms persist. A thorough neurological examination can help rule out any underlying conditions that may not have been previously identified.

2. Dental Assessment: A comprehensive evaluation by a dentist specializing in TMJ disorders may provide insights into whether your jaw alignment or dental health is contributing to your symptoms. Treatments such as occlusal splints or physical therapy for the jaw may be beneficial.

3. Psychological Support: Given your history of anxiety and stress, consulting with a mental health professional could be advantageous. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help manage anxiety and may alleviate some of the physical symptoms you are experiencing.

4. Lifestyle Modifications: Incorporating stress-reduction techniques such as mindfulness, yoga, or regular exercise can help manage both anxiety and headache symptoms. Additionally, maintaining a regular sleep schedule and practicing good sleep hygiene can improve overall well-being.

5. Medication Review: If you are currently taking medications for anxiety or other conditions, discuss with your healthcare provider whether these could be contributing to your symptoms. Adjustments or changes in medication may be necessary.

In conclusion, your symptoms are likely the result of a combination of factors, including potential TMJ issues, anxiety, and the interconnectedness of the nervous and auditory systems. A multidisciplinary approach that includes neurological, dental, and psychological evaluations will provide the best chance for effective management of your symptoms. It is essential to communicate openly with your healthcare providers about all your symptoms and concerns to develop a comprehensive treatment plan tailored to your needs.

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