Dr. Scott Greenberg discusses Prolotherapy for Jaw Pain, Face Pain, and Headache.
Patients who present with sinus pain and pressure or who describe constant pain in the jaw, temple or temporomandibular joint should be evaluated for referred pain. Referred pain or the sensation of pain in an area distant from its origin is commonly seen in patients whose leg pain originates from the back or in an amputee who suffers from phantom limb pain. While sciatica is diagnosed more frequently than referred jaw and facial pain, its occurrence is quite common.
Many cases of jaw and facial pain and headache unresponsive to traditional measures such as analgesics, night guards, bite plates, or antibiotics for sinusitis can be traced to the occiput, cervical facet joints, cervical interspinous ligaments, and the trapezium.
Patients should be fully evaluated by physical examination including but not limited to the strength of the arm and hands, integrity of the cranial nerves, sensory nerves and deep tendon reflexes, and range of motion of the neck. Furthermore, careful evaluation of the cervical facets, occiput, interspinous ligaments, and trapezium should be performed by a physician skilled in diagnosis and treatment of such injuries. Injury in the latter regions, caused either by trauma, overuse, or degeneration is often responsible for causing headaches, jaw aches, and facial pain.
Cervicocranial syndrome (Barre-Lieou syndrome) can also occur from injury to the cervical facet joints. This syndrome is often manifest by a variety of findings such as vertigo, tinnitus, visual blurring, nasal stuffiness, and facial numbness.
Radiological studies such as plain radiographs and MRI may be useful in some cases of referred head, face, and jaw pain but often diagnose incidental findings that do not contribute to a patient’s pain syndrome. Findings such as degenerative disc disease, herniated cervical discs, or spinal arthritis may be incidental, as a significant percentage of the population (over 60% in some studies) demonstrate similar findings and remain asymptomatic. The author strongly believes that a careful physical examination with clinical correlation is paramount to diagnosis and treatment of referred pain problems and can help to spare the patient from the cost and inconvenience of further diagnostic studies, treatments, and unnecessary medications.
Treatment of referred pain should be directed to correcting the source of the problem. While analgesics, antidepressants, and anti-inflammatory drugs can help to temporarily eliminate chronic pain, they do not cure the underlying pain problem. In those with injury into the cervical facet joints, interspinous ligaments, trapezium, or occiput will likely benefit or be cured by Prolotherapy injections. Prolotherapy injections, placed directly into the fibro-osseus junction trigger the immune system to permanently rebuild and reorganize collagen tissue, thus regrowing damaged tendons and ligaments. Once this process is completed, the integrity of the joint is restored, and the patient’s chronic pain should be alleviated. Prolotherapy injections are the only documented treatment to restore joint, ligament, and tendon damage without surgery and can permanently cure the origin of referred facial, temporal, and jaw pain.
Prolotherapy for headaches, vertigo, tinnitus, ear pain, jaw pain, and neck pain
A Patient case from Stanley King Hei Lam, MBBS, PGDIP, MSM(OTAGO), FHKAM(FM), FRACGP, FHKCFP
Ms. A is a 30 year-old financial planner, with a five year history of headache, vertigo, tinnitus, ear pain, jaw pain, pain on wide-opening of mouth, and neck pain. She also describes a pins-and-needles sensation of the hands and forearms during sleep or prolonged use of a computer. She has difficulty concentrating on her work when she has the attacks. She had seen a lot of doctors for help. Her cervical MRIs were unremarkable. Previous treatments included Physical therapy and chiropractic manipulation, each with only temporary, partial relief of the symptoms. She has very poor sleep and was labeled by some doctors to have psychosomatic disorder. So a low dose of antidepressants was given. She was also seeing ear, nose, and throat surgeons for severe allergic rhinitis and sinusitis with facial pain and had been put on intranasal steroid spray for one year with partial relief of the nasal symptoms. She also had gritty and itchy eyes with occasional tearing of eyes with a sense of fullness of the eyeball. She worried that she had glaucoma. She was referred to ophthalmologists for a thorough eye examination, which was normal. She was then labeled to have allergic conjunctivitis and was put on Sodium Cromoglycate eye drops again with partial and temporary relief of the symptoms.
When I first examined her, she had a significantly forward head position with her ear lobe at the level of her sternum.
She had FRSrt C2/3 and C3/41, which means there is non-neutral dysfunction with a restriction for extension and for rotation and side bending to the left between C2 and C3, and between C3 and C4. The left facet joint between C2 and C3 and that between C3 and C4 do not close completely. Overall, she had very lax cervical ligaments. Her TMJ had clicking and the lower jaw deviated to right. Very gentle mobilization of the neck using muscle energy technique was done to realign those neck segments and the TMJ, this brought immediate relief of her vertigo and headache. My diagnosis for her was Barre-Lieou Syndrome.2 Since Prolotherapy is still very new to people in Hong Kong and Asia, she had never heard of this kind of treatment. She was advised to go to the internet and look at certain websites to get information on Prolotherapy. She came back one week later as her symptoms returned, but this time she received her first Prolotherapy treatment without fluoroscopic guidance in my clinic. (See Figure 7.)
A 15% dextrose solution in lignocaine (lidocaine) was used to treat both the superior and inferior nuchal lines, the interspinous ligaments from C2 down to T1, the facet joints of the cervical spines, the origin of the levator scapulae at the medial and superior border of the scapulae, the mastoid processes and the angles mandibles, and the bilateral TMJs. She felt immediate relief of the headache, nausea sensation, and fullness of head after the injections. Her vertigo subsided one day after the procedure. She followed up four weeks later and stated that her headache, vertigo, tinnitus, nausea and vomiting, fullness in head, and numbness over her upper limbs had subsided. Surprisingly, her allergic rhinitis and conjunctivitis improved a lot. Her sleeping quality also improved and she no longer needed her antidepressant. She is now pain and medication-free after her second Prolotherapy treatment. She was taught the correct typing posture and self stretching techniques. I am hopeful she will remain pain free.
Isaacs ER, et al. Bourdillon’s Spinal Manipulation. Sixth Edition. Woburn, MA. Butterworth-Heinemann Inc. 2002.
- Hauser R, et al. Prolo Your Pain Away! Third Edition. Oak Park, IL. Beulah Land Press. 2007.
Read the full article at the Journal of Prolotherapy.