Dental implant oral surgery

[Alyssaaaa]

Hey all! I've been an episodic CH sufferer since I was 14 Y.O. and I'm 33 now (almost 20 years). I've had lots of dental work over the years, braces, Invisalign, wisdom teeth pulled, lots of fillings, root canals, cleanings, etc. and never really found that any of these procedures ever triggered a CH attack or an episode. Obviously if I'm in an active episode I avoid the dentist like the plague and barely leave my house....

My last CH episode ended in Feb 2024 so it's been almost 1.5 years with no attacks, thank God. It varies, but typically I go 6 months to 2 years between attacks so I know I'm sadly nearing the end of this amazing "remission" and they're bound to come back sometime by the end of the year.

1 week ago I got a dental implant (bone grafting and screw installed) where my tooth #14 would be (upper tooth near the back). Leaving the appointment I was totally fine. The next day following the procedure, I walked my dog and midway through my walk I felt the prodrome, then progressive CH symptoms on the same side as the implant. I got home as quickly as I could popped a few Advil, hit the oxygen and chugged a coffee and within about 30 mins I went from a level 6 pain to 0. Next day, no headaches so it seemed like a false alarm and figured it was just my trigeminal nerve acting up from the surgery the day before. 

Over the last few days, I got a handful more of these same headaches, mimicking the symptoms of my CH pretty much to a tee, but was able to kick them in about 30 mins with Advil or Tylenol and some coffee. Annoying but not a big deal. Normally my abortive routine requires imitrex 100mg and/or 15 mL/min of oxygen for 20-25 mins, etc. So again, at this point still just thinking my nerve is acting up.

BUT last night, I woke up at 2am and had a ripper. My headache lasted 4 hours and wasn't responding to Advil, Tylenol, or the oxygen. Usually I respond to oxygen very well so I was a bit surprised I was at level 8 pain almost the whole time. Finally I gave in and popped an imitrex 100mg and within 20 mins I felt the amazing relief I needed so much and it quickly went away and was able to go back to sleep. Then today I got another headache after the imitrex wore off, I took 4 Advil a coffee and oxygen and it went away without having to take another imitrex.

My oral surgeon is amazing and the X-ray of the implant is perfect. Everything went very well with the procedure. When I brought this up he said I'm the first one that's had this experience post implant surgery and he's been doing it for over 20 years. Of course *sigh*

Has anyone else who is diagnosed with episodic CH ever had a dental implant? If so, what was your experience afterwards? 

I can't find any data showing they trigger CH episodes. I only found a medical case study actually showing the opposite, a guy got an implant and had 5x longer remission from his episodic CH than he normally gets.

[CHfather]

Given all the circumstances, it seems very unlikely that this is the issue, but I think it's almost universally true that the anesthetic that dentists typically use, Xylocaine + epinephrine, triggers CH attacks.  (It's the epinephrine that does it.)  But, among other things, the attacks usually come on more quickly than what you're describing, and of course you've had many previous dental procedures so it seems very likely you would have had the X+e during one of them. I think your next procedure with this oral surgeon won't be for quite a while, but I suppose you could request a different anesthetic just in case. 

Edited Monday at 02:48 PM by CHfather

[Bejeeber]

That's some weird, suspect timing following the implant, but even though epinephrine at the dentist is a notorious trigger for some, the fact that the repercussions would typically be expected more instantly makes it sound like coincidence can't be entirely ruled out(?).

Also, as you may be well aware, even following decades of consistent behavior, we can still expect CH to pull a change up on us, and start a cycle in a never-before-experienced fashion, such as a slow ramp up with advil etc. abort-able attacks at first. Hate to think it, but I would be bracing for some possible continued ramping up.