Treating some headaches in children may be a simple matter of getting them to quit chewing gum.
A new study suggests that excessive gum chewing may be an important but under-recognized trigger for headaches in older children.
The researchers, led by Nathan Watemberg, MD, Child Neurology Unit and Child Development Center, Meir Medical Center, Tel Aviv University, Israel, believe that excessive gum chewing causes headache not through the ingestion of aspartame from the gum, as has been previously suggested, but by putting undue exertion on the temporomandibular joint (TMJ).
"We feel that the mechanical burden is the culprit, as the amount of aspartame in the gum is small and, as this substance is present in sodas and other diet products, one would expect aspartame to be well associated with headaches, which is not the case," Dr. Watemberg told Medscape Medical News.
He advises that doctors make a point of enquiring about the gum chewing habits of adolescents reporting daily or recurrent headaches. "If the neurological examination is normal and the habit is present, they should first of all discontinue it to see if headaches improve, before embarking on expensive diagnostic procedures, or prescribing medications for the headache," Dr. Watemberg notes.
Their findings are published in the January issue of Pediatric Neurology.
Kicking the Chewing Habit
Dr. Watemberg said he has long observed a relationship between gum chewing and headaches in his practice. For several years, he has had very good results with headache relief after patients stop chewing gum.
For this study, he and his colleagues included 30 youngsters (25 girls), ranging in age from 6 to 19 years, who had recurrent episodes or chronic headache and were daily gum chewers. Their headaches were classified as migrainous (60%) or tension-type (40%).
Patients filled out a questionnaire that included information on medical and neurologic history, headache characteristics, family history of headaches, and known headache triggers. Researchers divided the participants into 4 groups according to gum chewing duration: up to 1 hour a day, 1 to 3 hours a day, 3 to 6 hours a day, and more than 6 hours a day.
Study participants were asked to stop gum chewing for a month. After this discontinuation, 26 patients responded (19 had complete resolution of headaches and 7 had some improvement in headache frequency and intensity). No improvement occurred in 4 patients.
The duration of symptoms before stopping gum chewing did not play a role in the clinical response. Some children who reported full or significant improvement had experienced chronic headaches for up to 6 years.
Patients were then asked to renew their gum chewing habit to the same extent as before discontinuation. All 20 of the 26 patients who first reported complete or partial headache relief and who reintroduced gum chewing reported relapse, within a week, of headaches of similar intensity as before they discontinued the chewing habit.
Research shows common headache triggers include weather, stress, menstruation, frequent travel, sleep disturbances, perfume, and lights. Triggers in children appear similar to those in adults, although they may also be vulnerable to video games, environmental noise, exposure to smoke, and school book reading, said Dr. Watemberg. Specific foods, such as chocolate, alcoholic drinks, and cheese, are also associated with headaches.
Headache has been shown to be associated with and be provoked by TMJ dysfunction. Chewing gum, as well as other oral habits (such as excessive nail biting and teeth grinding), imposes a mechanical burden on the joint.
In this study, the duration of gum chewing did not appear to be as important as the habit itself because all 4 groups included a fair number of cases. The "impressive" response to gum chewing discontinuation "strongly suggest in our opinion that the habit (and the burden on the temporomandibular joint) played a major role in our patients," the authors conclude.
Dr. Watemberg said he doesn't have any clear opinion about the maximal amount of chewing, or maximal time that could be spent chewing gum without developing headaches, since in this study some children who chewed gum as little as 1 hour a day reported headaches.
"I would think that the time/amount of chewing is related to other predisposing factors affecting the individual patient, such as anatomical facial features; maybe even a genetic predisposition to migraines," he said. "Therefore, my advice is that any person who chews gum on a daily basis and starts experiencing daily or recurrent headaches, is to discontinue the habit for several weeks irrespective of the time spent chewing. If the headaches improve or subside, then the chewing habit is the reason behind the headaches."
The authors have disclosed no relevant financial relationships.
Pediatr Neurol. 2013;50:69-72. Abstract
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Cite this: Gum Chewing in Kids Under-Recognized Cause of Headaches - Medscape - Jan 17, 2014.