Yes, a severe toothache can lead to a headache. The main reason for this is that the nerve pathways from our teeth and head converge at the same 'relay station' (the trigeminal-cervical complex) in the brainstem. Intense and persistent pain signals from the tooth can overwhelm this shared center to such an extent that the pain spreads to other nerve pathways, transforming into a widespread pain felt throughout the head.
Common non-dental causes of toothache
Toothache does not always stem from a problem with the teeth; sometimes, a problem elsewhere in the body can be felt as pain radiating to the teeth (referred pain). Common non-dental causes of toothache include
Headaches and neurovascular disorders
Certain types of headache, particularly when affecting branches of the trigeminal nerve (the nerve responsible for sensation in the face), can mimic a toothache.
- Migraine: Migraine pain can sometimes be felt only in the lower part of the face or in the teeth (upper and lower jaw), and this condition may be referred to as 'facial migraine.'
- Cluster headaches: These are severe, one-sided pains that often radiate to the upper back teeth and are frequently accompanied by autonomic symptoms (watery eyes, nasal congestion).
- Tension-type headache (TTH): These headaches, which feel like a band around the head, can also cause pain radiating to the teeth.
- Chronic paroxysmal hemicrania (CPH): A rare type of headache that typically begins as a throbbing or piercing pain in the upper jaw teeth.
Sinus Problems
- Sinusitis (Sinus Infection): As the roots of the upper teeth are very close to the maxillary sinuses, fluid pressure or infection in the sinuses can cause a dull, aching, or throbbing pain in the upper back teeth. This pain usually worsens when bending the head forward or coughing.
Temporomandibular disorders (TMD) and muscle pain
- Jaw joint and muscle problems: Trigger points in the chewing muscles (such as the masseter and temporalis) can refer pain to the teeth. For example, a problem in the temporal muscle may cause pain in the upper teeth, while a problem in the chewing muscles may lead to pain in the back lower teeth.
- Teeth grinding or clenching (bruxism): Constant strain on the ligaments supporting the teeth can result in tooth sensitivity and pain.
Nerve disorders (Neuropathic pain)
- Trigeminal neuralgia: A sudden, severe pain resembling an electric shock, triggered by mild stimuli such as brushing the teeth or touching the face, affecting one side of the face.
- Occipital neuralgia: This pain, caused by irritation of the nerves at the back of the head, can radiate to the teeth due to connections with the trigeminal nerve.
- Shingles: Shingles, a viral infection, can affect the nerves and cause toothache.
Other systemic and serious health issues
- Heart attack and angina: Pain originating from the heart can sometimes radiate to the lower jaw and teeth. Jaw pain that worsens with physical exertion, in particular, may be a sign of a heart-related problem.
- Oral and throat cancer: Some tumors can cause symptoms resembling toothache by directly causing pain or by pressing on nerves.
- Diabetes: While uncontrolled blood sugar levels increase the risk of tooth decay, nerve damage caused by diabetes can also affect pain perception.
- Vitamin deficiency: Vitamin B12 deficiency, in particular, has been linked to toothache.
- Substance abuse: The use of substances such as methamphetamine can cause tooth and jaw pain.
Toothache: How does it cause headaches and neurovascular disorders?
Triggering of chronic headaches
Severe and sudden (acute) pain in the teeth or dental surgery acts as a stressor (tension factor) on the body. This situation may lead to the recurrence or reappearance of chronic headaches (such as migraines) that are already present in the patient but are currently dormant.
Central sensitisation
Injuries or operations in the mouth and face region send a flood of signals to the pain centers in the brain via the trigeminal nerve, which carries sensation from the face. This intense barrage of stimuli causes the nervous system to become 'over-sensitive' to pain; as a result, the system begins to perceive even mild stimuli that would not normally cause pain as severe pain.
Pain remapping
Central sensitization resulting from dental trauma or pain can cause a kind of 'relocation' in the areas of the brain where pain is perceived. As a result of this mechanism, migraine attacks developing following dental trauma may be referred to the areas where dental pain was previously felt, as if there were a problem with the tooth.
Neural convergence and spread
Sensory nerve pathways from the teeth, masticatory muscles, and the neck region converge at a common center in the brainstem known as the 'trigeminal-cervical complex.' Due to this neuronal interaction, intense and persistent pain signals from a tooth can be transmitted to other nerve pathways at this common station, resulting in a widespread pain pattern felt throughout the head.
Co-occurrence of conditions and muscle tension
Disorders affecting the temporomandibular joint and teeth (TMJ) often tend to occur alongside migraines and tension-type headaches. The patient's involuntary clenching of the teeth (bruxism) or changes in chewing habits due to toothache lead to excessive tension in the facial and head muscles; this can directly trigger or exacerbate muscle-related headaches
How can a tooth-related headache be distinguished from a normal headache?
Distinguishing between tooth-related pain and primary headache disorders (migraine, cluster headache, etc.) is quite difficult due to the fact that these conditions can mimic one another. However, there are key clinical features that can help distinguish between these two conditions:
The nature of the pain and its triggers
- Tooth-related pain: Typically involves sensitivity to hot or cold, is triggered by sweet foods, or tends to worsen when pressure is applied to the tooth (chewing/percussion). Inflammation of the nerves inside the tooth (pulp) usually causes a dull, constant ache or throbbing pain.
- Headache-related pain: For example, a migraine may present with an episodic, throbbing pain that can mimic a toothache. In conditions such as trigeminal neuralgia, however, the pain is of a sudden and very brief nature (lasting seconds), triggered by harmless stimuli such as brushing the teeth or touching the face, and feels like an electric shock.
Presence of autonomic symptoms
While rarely seen in ordinary toothache, the following autonomic symptoms accompany pain in headache groups known as Trigeminal Autonomic Cephalalgias (TACs) (e.g., cluster headaches):
- Watery eyes and redness of the eyes (conjunctival injection).
- Nasal congestion or discharge.
- Drooping of the eyelid (ptosis) or sweating on the face. The simultaneous occurrence of these symptoms with the pain strongly suggests that the source is a neurovascular disorder rather than a dental issue.
Migration and spread of pain
- Tooth-related pain: Generally confined to a specific tooth or area.
- Headache-related pain: The sensation of toothache may migrate from one tooth to another or shift sides within the mouth. Furthermore, if the pain persists despite dental treatments (fillings, root canal treatment, extraction) or if the location of the pain changes following these interventions, a non-odontogenic (non-dental) cause should be suspected.
Postural changes and response to medication
- Sinus-related pain: If pain felt in the upper teeth worsens when bending the head forward, coughing, or sneezing, it is likely caused by sinusitis.
- Specific drug response: For example, a type of headache known as Chronic Paroxysmal Hemicrania (CPH) can mimic toothache, but the most typical distinguishing feature is the absolute response to a drug called "indomethacin." If the pain responds to this drug, the diagnosis is confirmed as CPH.
Variations in the clinical examination and diagnosis
A key tool in determining the source of the pain is a local anesthetic test done by the dentist. If the pain completely stops when the dentist anesthetizes the painful area, the source is probably the tooth, but if the pain continues, the source may be referred pain or some type of headache. Furthermore, the lack of any pathology (such as a cavity or abscess) on dental X-rays to account for the pain also suggests that the pain is not dental in origin.
When to see a doctor about toothaches and headaches?
- Any kind of toothache: Always see a dentist if you have short, sharp pains, throbbing aches, or mild but persistent pain.
- Persistent dull pain: A dull pain that lasts for days may be a sign of a serious infection or an abscess.
- Unsuccessful treatment: If the pain continues after treatment such as root canal treatment or tooth extraction or spreads to other teeth, this indicates that the pain may not be tooth-related and needs specialist assessment.
- Gum and jaw symptoms: Contact us if you experience swelling or redness of the gums or pain in the area of your wisdom teeth.
- Heart trouble: Jaw or tooth ache while active that disappears with rest may be a warning of a heart attack or angina.
- Giant cell arteritis: If you're over 50 and suddenly develop pain in the temples, changes in vision, or pain in the jaw when chewing, you should seek urgent medical attention to prevent loss of vision.
- Mouth and throat cancer. Any sore that does not heal in a week or two, unexplained numbness, swelling inside the mouth, or persistent pain at the back of the throat should be checked by a doctor.
What to do if you have a headache from your tooth?
The treatment of tooth-related headaches focuses entirely on the dental problem (odontogenic cause) that triggers the pain. Treatment methods include the following:
Treatment of dental problems directly
If the head pain is a direct result of a dental condition, treatment of the tooth will alleviate the symptoms:
- Repair of decay and damage: Decay, cracks, or broken fillings in the tooth enamel are repaired with fillings or crowns.
- Treating infection and abscesses: If the pulp layer inside the tooth becomes inflamed or an abscess forms at the tooth root, a root canal is performed to remove the infected tissue. If it cannot be saved, extraction is preferred.
- Extraction of impacted teeth: The surgical removal of wisdom teeth that cannot erupt (particularly because of a lack of space at the back of the upper jaw) relieves the pain caused by the pressure that these teeth exert on surrounding tissues.
- Gum diseases: If the symptoms are caused by gum inflammation, the root planing technique may be used to remove plaque under the gums.
Temporary treatment to the temporomandibular joint and muscles
If the headache is associated with a toothache (especially tension-type or myofascial pain), the following methods are used:
- Mouth guards (night splints): To avoid pain from the strain on the ligaments that support the teeth due to teeth grinding or clenching (bruxism), a night splint and patient education are recommended.
- Trigger Point Injections: Local anesthetic injections may be effective for pain that originates from trigger points in the muscles and radiates to the teeth or head.
Medication and differential diagnosis
Although the pain may appear to be tooth-related, it may actually be a headache disorder. In such cases, medical treatment is administered instead of dental treatment:
- Diagnosis and treatment with medication: For example, the use of indomethacin in cases of suspected Chronic Paroxysmal Hemicrania (CPH) serves both as a diagnostic tool and a treatment; if the patient responds fully to this medication, the pain is not caused by a tooth but by a neurovascular disorder.
- Neurological assessment: For conditions such as trigeminal neuralgia, anticonvulsant medication or microsurgical techniques may be required.
F.A.Q:
Can a toothache give you a headache?
Yes, a severe toothache can certainly cause a headache.
What does a toothache headache feel like?
Usually it is a dull, throbbing, or pressure-type headache and is usually on the same side as the bad tooth. It can mimic a tension headache or migraine and is often worsened by chewing.
Can a cavity really cause headaches every day?
Yes. When a cavity has reached the nerve (pulpitis), it may be irritated on a daily basis and cause a headache every day until the tooth is treated.