Dental Health Care for Headache Relief

Title *

Your Name *

Email Address *

Phone Number *

City *

By whom were you were referred?

Do you clench or grind your teeth during the day?

Yes No

Have you been made aware of clenching or grinding your teeth during the night?

Yes No

Do you often wake up during the night?

Yes No

Are your jaws or teeth tired when you awaken?

Yes No

Do you feel refreshed when you awaken in the morning?

Yes No

Do you suffer from chronic headaches or neck and shoulder pains?

Yes No

Do you now, or have you ever had pain in your jaw joint or the sides of your face particularly around the ear?

Yes No

Have your jaws ever clicked or popped when you open your mouth?

Yes No

Do you tend to chew on only one side of your mouth?

Yes No

Have you ever had any dental work (crowns, bridges, fillings etc.) that stopped your teeth biting normally together or felt "in the way"?

Yes No

Headache Treatment and Stress Headache Treatment with Dental Health Care