Letters NICE on headaches

Dental occlusion problems are a major cause of headache

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6892 (Published 17 October 2012) Cite this as: BMJ 2012;345:e6892
  1. Anthony Kilcoyne, specialist in prosthodontics1
  1. 1SmileSpecialist Centre, Haworth, Keighley BD22 8NL, UK
  1. anthonykilcoyne{at}gmail.com

As a dental specialist, I see many people who have headaches because of changes to their dental bite or temperomandibular joint over time. These changes are often associated with habitual clenching or grinding of teeth when asleep and sometimes during the day.

This National Institute for Health and Clinical Excellence summary overlooked dentally related causes (or potentiators) of headache and migraine, which are increasingly being treated by removable and reversible dental appliances or more permanent correction of dental occlusion problems.1 2 3 4

We now routinely ask patients about headache symptoms. It is not surprising that activation of the masticatory muscles, such as temporalis, where forces can be as high as 100 kg or more during clenching, can push people past their “threshold” and cause symptoms such as headaches to dominate.

A simple removable dental appliance could be a drug-free solution for a large proportion of people with headache. It is worth remembering this when considering a differential diagnosis and possible treatment or referral options in people who present with headache.


Cite this as: BMJ 2012;345:e6892


  • Competing interests: None declared.


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