Dr. Shapira's Chicago Headache Blog

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Tuesday, November 24, 2009

Patient Question: migraine sufferer

PATIENT QUESTION:

I’m 29 years old. I've been a severe migraine sufferer since I was about five.2years ago I broke and dislocated my right jaw. My pain is horrific now. At least 3to4 days out of the week I’m sick with them now, when it only used to be maybe 2 a week. It’s really messed up my life. I can’t raise my children like I need to; I can't even hold down a job now. I’ve been on and off imitrex since my teens.I’ve tried every other migraine med. plus depression med. and most of the time imitrex helps but it doesn’t call them down at all and I’m only allowed 9 100mg a month. They last me maybe 2wks out of a month and sometimes since I broke my jaw it doesn’t even touch the pain. I may be getting prosthesis for my jaw and hopefully that’s going to help a few of my migraines but what about the ones I’ve always had. By now, I know all the foods, smells, brightness, stress level. I know all the tricks of a migraine. And still, most of the time there’s not much I can do when it comes on.jus lay down, sometimes for 2 or three days. My life has never been right. Ive been in constant pain. What to do?

ANSWER:

Dear ______,
I would recommend you get a neuromuscular dental work-up as soon as possible. You may find that when you treat the new headaches from the broken jaw that you will also impact the long standing headaches. Migraines are caused by disturbances in the trigeminal nerve, which controls the jaw muscles but also supplies nerves to the teeth jaw joints sinuses and tongue.. If you can correct the bite with a diagnostic orthotic and restore the neuromuscular system the headaches should become less frequent and less severe at the very least but often can be eliminated. I recently had a patient who had a continuous headache for fifty years that disappeared with her orthotic. The Trigeminal nerve also controls blood flow to the anterior 2/3 of the brain (which is where many migraines begin) and correcting the system can give remarkable results.
I have had patients whose migraines disappeared for most of the month but still showed up if they were exposed to old triggers. Often even those get better with time. Other patients find relief except during menses or ovulation. Frequently initial therapy results in immediate decreasing frequency and severity of the headaches and as the patients continue treatment other problems are found that were not previously apparent. Some of these patients with severe problems need to have other non-dental proceedures done in conjuction with their neuromuscular orthotics. I usually start with the orthotic and then work on remaining symptoms. I describe what I call my onion analogy. Correcting a long term severe problem is like peeling an onion. You remove one layer which expose the next layer. Each layer is different some may belong to the dentist or physical therapist while others can belong to the patient, ie breaking bad habits or unhealthy behavior. Other layers can be treated by Chiropracters, opthamologists, allergists varying with each patient. I find I sometimes meet the real patient only after several visits when the pain is significantly resolved. The patients personalities were buried under layers and layers of pain. It is amazing how different patients are when they are no longer in constant or frequent pain.

posted by Dr Shapira at 2:38 PM

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