Comment from Kathy, 20 year history of pain in forehead, nose and all upper teeth. Very debilitating. Multiple doctors, multiple treatments.....no relief
Dr Shapira response:
Dear Kathy,
The pain you describe follows the innervation of the trigeminal nerve. It sounds like you are an excellent canidate for an evaluation and probably a diagnostic orthotic. It is always necessary to have a complete as possible history that is in chronological order. When did this begin and what was happening in your life. How has this pain affected you, your family and friends and how hs it changed you. I find that chronic pain can ruin patients lives and I want to unerstand these effects. I also want to know what treatment you had and how each worked. what medications you have tried. These are all clues we use alnong with neuromuscular orthotics to understand and treat problems.
You didn't ask but I assume you want to know if Neuromuscular Dentistry can help. I find that most patients have significant relief but not to expect miracles. Shoot for initial improvement of 50-80%. As you begin to feel better we continue to look for additional reuctions in pain as postural changes and nervous system changes take place.
Neuromuscular Dentistry allows the body to heal by removing the underlying pathology. Healing is an internal process and patients are unique which is why your history is so important.
Sunday, May 30, 2010
Friday, May 21, 2010
Prevention of Migraines: Press Release reprint
It is widely accepted that almost all headaches wether classified as vascular, neurogenic , hormonal or muscular in orgins are caused primarily by the Trigeminal Nervous system. While there are many drugs that can be utilized in the treatment of migraines and other headaches one of the best diagnostic proceures may not only clarify why the headaches occur but eliminate, decrease and/or prevent them entirely without the use of dangerous and/or adicting meication.
Neuromuscular Dentistry May Be The Best Migraine Prevention Available For Many Patients. I HATE HEADACHES website provides extensive information on Neuromuscular Dentistry.
The Trigeminal Nerve is so closely tied to headaches that prevention of noxious input can be a permanent cure for many patients. Patients who are tired of their lives being controlled or ruined by headaches should approach treatment cautiously. Initial treatment of headaches should always be preceded by a consultation appointmet with an experienced Neuromuscular Dentist. Patients should expect to spend at least an hour at this initial visit to determine if they are apprpriate canidates for a diagnostic appointment.
Dr Ira L Shapira in Gurnee, Illinois has 30 years experience in utilizing Neuromuscular Dentistry to elimnate, prevent and treat migraines and othe chronic headaches. He will usually spend 60-90 minutes with patients at the initia consultation and will then prescribe a diagnostic appointment appropriate for the patients specific disorders. Patients with more complex problems and longer history of pain are usually given a more comprehensive assessment.
During the consultation it is frequently possible to turn off a head or neck pain in just a few seconds by deactivating myofascial trigger points. Dr Shapira, a Diplomate of the American Academy of Pain Manage explains that he can sometimes see amazing transformations in patients as they realize that finally some knows how to turn off their pain. "I recently saw a patient who accompanied her husband to my office for treatment of his sleep apnea. I noticed that "M" was holding her right temple and asked if she was having headache which she confirmed. I asked if I could try to "turn it off" and she agreed to let me attempt to relieve it. we spent less than five minutes deactivating trigger points and she was "pain free". She then told me she had had a continuos headache for over 50 years which her husband, a retired physcian, confirmed. A appointment was made to deliver her husbands snoring and sleep apnea appliance and to do a consultation and begine treatment the following week. At the next a diagnostic evaluation was done and a diagnostic neuromuscular orthotic was deliverd to "M". One week later M and her husband returned and she reported being headache free and sleeping much better because we had eliminated her husbands snoring s well. M has now been reconstructed to this Neuromuscular Position and remains headache free. She loves to tell stories about how her children and grandaughter are constantly asking if she still doesn't have a headache. She also feels she has never looked as good as she does now since the dental reconstruction."
The use of a diagnostic orthotic is n essential element of both diagnosis and treatment of headache patients. It allows for the corrction of the jaw joints, jaw muscles and most importantly the correction of the input to the Trigeminal Nervous system. It allows the patient to understand and evaluate treatment prior to making any irreversible change. Neuromuscular Dentistry is extremely conservative in it avoids the risk of making problems worse by making permanent bite changes as an initial treatment. If patients decide to make permanent changes they have multiple treatment choices but most importantly they have "test driven" their new bite and know the effects before embarking on the second phase of treatment. The diagnostic orthotic patient is essential to determine treatment direction and to protect the patient.
Centric Relation dentistry is another approach to treating patients. Dr Shapira was both a patient and practitiner of CR dentistry before becoming a strong advocate for the Neuromuscular Approach. "The problem with centric relation treatment" in Dr Shapira's opinion "is that permanent changes are made early in treatment and if a patient becomes worse instead of better ther treatment is not reversible. Centric Relation is determined by the dentist manipulating the patients mandible to position utilizing the dentist's muscles but Neuromuscular Dentistry on the other hand utilizes the patients own muscles to guide treatment. Removal of underlying pathology lets the body heal" according to Dr Shapira, "and then we just have to adjust the diagnostic orthotic to match the healthier position that naturally occurs."
Dr Shapira has created two excellent website to help patients find answers to difficult medical problems:
http://www.ihateheadaches.org for headache and migraine disorders
http://www.ihatecpap.com for patients with sleep apnea and snoring and who want a comfortable alternative to CPAP
There are two excellent articles that should be read by anyone suffering from chronic headaches, Migraines or TMJ disorders published in Sleep and Health Journal:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
http://www.sleepandhealth.com/neuromuscular-dentistry
The first article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses patients symptoms and stories and the second discusses Dr Shapira's explanation of the science of Neuromuscular Dentistry.
Dr Shapira can be contacted for treatment of headaches, sleep apnea, and TMJ disorders at his Delany Dental Care practice where he also practices general dentistry with his partner Dr Mark Amidei.http://www.delanydentalcare.com
Neuromuscular Dentistry May Be The Best Migraine Prevention Available For Many Patients. I HATE HEADACHES website provides extensive information on Neuromuscular Dentistry.
The Trigeminal Nerve is so closely tied to headaches that prevention of noxious input can be a permanent cure for many patients. Patients who are tired of their lives being controlled or ruined by headaches should approach treatment cautiously. Initial treatment of headaches should always be preceded by a consultation appointmet with an experienced Neuromuscular Dentist. Patients should expect to spend at least an hour at this initial visit to determine if they are apprpriate canidates for a diagnostic appointment.
Dr Ira L Shapira in Gurnee, Illinois has 30 years experience in utilizing Neuromuscular Dentistry to elimnate, prevent and treat migraines and othe chronic headaches. He will usually spend 60-90 minutes with patients at the initia consultation and will then prescribe a diagnostic appointment appropriate for the patients specific disorders. Patients with more complex problems and longer history of pain are usually given a more comprehensive assessment.
During the consultation it is frequently possible to turn off a head or neck pain in just a few seconds by deactivating myofascial trigger points. Dr Shapira, a Diplomate of the American Academy of Pain Manage explains that he can sometimes see amazing transformations in patients as they realize that finally some knows how to turn off their pain. "I recently saw a patient who accompanied her husband to my office for treatment of his sleep apnea. I noticed that "M" was holding her right temple and asked if she was having headache which she confirmed. I asked if I could try to "turn it off" and she agreed to let me attempt to relieve it. we spent less than five minutes deactivating trigger points and she was "pain free". She then told me she had had a continuos headache for over 50 years which her husband, a retired physcian, confirmed. A appointment was made to deliver her husbands snoring and sleep apnea appliance and to do a consultation and begine treatment the following week. At the next a diagnostic evaluation was done and a diagnostic neuromuscular orthotic was deliverd to "M". One week later M and her husband returned and she reported being headache free and sleeping much better because we had eliminated her husbands snoring s well. M has now been reconstructed to this Neuromuscular Position and remains headache free. She loves to tell stories about how her children and grandaughter are constantly asking if she still doesn't have a headache. She also feels she has never looked as good as she does now since the dental reconstruction."
The use of a diagnostic orthotic is n essential element of both diagnosis and treatment of headache patients. It allows for the corrction of the jaw joints, jaw muscles and most importantly the correction of the input to the Trigeminal Nervous system. It allows the patient to understand and evaluate treatment prior to making any irreversible change. Neuromuscular Dentistry is extremely conservative in it avoids the risk of making problems worse by making permanent bite changes as an initial treatment. If patients decide to make permanent changes they have multiple treatment choices but most importantly they have "test driven" their new bite and know the effects before embarking on the second phase of treatment. The diagnostic orthotic patient is essential to determine treatment direction and to protect the patient.
Centric Relation dentistry is another approach to treating patients. Dr Shapira was both a patient and practitiner of CR dentistry before becoming a strong advocate for the Neuromuscular Approach. "The problem with centric relation treatment" in Dr Shapira's opinion "is that permanent changes are made early in treatment and if a patient becomes worse instead of better ther treatment is not reversible. Centric Relation is determined by the dentist manipulating the patients mandible to position utilizing the dentist's muscles but Neuromuscular Dentistry on the other hand utilizes the patients own muscles to guide treatment. Removal of underlying pathology lets the body heal" according to Dr Shapira, "and then we just have to adjust the diagnostic orthotic to match the healthier position that naturally occurs."
Dr Shapira has created two excellent website to help patients find answers to difficult medical problems:
http://www.ihateheadaches.org for headache and migraine disorders
http://www.ihatecpap.com for patients with sleep apnea and snoring and who want a comfortable alternative to CPAP
There are two excellent articles that should be read by anyone suffering from chronic headaches, Migraines or TMJ disorders published in Sleep and Health Journal:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
http://www.sleepandhealth.com/neuromuscular-dentistry
The first article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses patients symptoms and stories and the second discusses Dr Shapira's explanation of the science of Neuromuscular Dentistry.
Dr Shapira can be contacted for treatment of headaches, sleep apnea, and TMJ disorders at his Delany Dental Care practice where he also practices general dentistry with his partner Dr Mark Amidei.http://www.delanydentalcare.com
Tuesday, May 11, 2010
CLUSTER HEADACHES AND SLEEP APNEA: CAUSE AND EFFECT AND/OR CURE?
Cluster Headache patients please pay close attention. Sleep apnea has a major statistical connection to your pain. Sleep apnea is a TMJ disorder according to the NIH report (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS. Oral appliances can treat sleep apnea (http://www.ihatecpap.com) and migraines, chronic daily headaches, and tension-type headaches. Cluster headaches are much more frequent with sleep apnea; diagnosis and treatment is advised.
THIS IS A SLIGHTLY OLDER STUDY (pubmed abstract below) looking at the prevelance of sleep apnea in cluster headache. 80% (25 of 31patients) of patients with cluster headache did have sleep apnea with an average index (RDI) of 19.
The authors concluded that: "The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined."
While they did not say there was a cause and effect this was because this was not a prospective study where patients are watched to see if they develop cluster headaches. ( see below)
"There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.
Headache. 2004 Jun;44(6):607-10.
Obstructive sleep apnea and cluster headache.
Graff-Radford SB, Newman A.
The Pain Center, Cedars Sinai Medical Center and UCLA School of Dentistry, Los Angeles, CA 90048, USA.
Abstract
A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea. METHODS: Thirty-nine consecutive patients diagnosed with episodic cluster headache according to the International Headache Society (IHS) criteria were sent for polysomnographic studies. All patients were in an active phase when they were in the study. Patients were told of the proposed relationship and were allowed to choose a sleep laboratory close to their home. RESULTS: Thirty-one patients with episodic cluster headache completed an overnight polysomnographic study. Twenty-three were male and eight female. The average age was 51 years (range 33 to 78 years). The average weight was 173 pounds (range 117 to 260 pounds). A total of 80.64% had sleep apnea (25/31). Average respiratory depression index (RDI) was 19.0 (SD 14.6) with 6 patients having no apnea, 10 having mild, 11 having moderate, and 4 having severe apnea (RDI < 5 = none; RDI 5 to 20 mild; RDI 20 to 40 moderate; RDI > 40 severe). Oxygen saturation decreased on average to 88.4% SD 4.5. Sleep efficiency was 76.2% (SD 13.4). CONCLUSIONS: The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined. There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.
THIS IS A SLIGHTLY OLDER STUDY (pubmed abstract below) looking at the prevelance of sleep apnea in cluster headache. 80% (25 of 31patients) of patients with cluster headache did have sleep apnea with an average index (RDI) of 19.
The authors concluded that: "The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined."
While they did not say there was a cause and effect this was because this was not a prospective study where patients are watched to see if they develop cluster headaches. ( see below)
"There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.
Headache. 2004 Jun;44(6):607-10.
Obstructive sleep apnea and cluster headache.
Graff-Radford SB, Newman A.
The Pain Center, Cedars Sinai Medical Center and UCLA School of Dentistry, Los Angeles, CA 90048, USA.
Abstract
A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea. METHODS: Thirty-nine consecutive patients diagnosed with episodic cluster headache according to the International Headache Society (IHS) criteria were sent for polysomnographic studies. All patients were in an active phase when they were in the study. Patients were told of the proposed relationship and were allowed to choose a sleep laboratory close to their home. RESULTS: Thirty-one patients with episodic cluster headache completed an overnight polysomnographic study. Twenty-three were male and eight female. The average age was 51 years (range 33 to 78 years). The average weight was 173 pounds (range 117 to 260 pounds). A total of 80.64% had sleep apnea (25/31). Average respiratory depression index (RDI) was 19.0 (SD 14.6) with 6 patients having no apnea, 10 having mild, 11 having moderate, and 4 having severe apnea (RDI < 5 = none; RDI 5 to 20 mild; RDI 20 to 40 moderate; RDI > 40 severe). Oxygen saturation decreased on average to 88.4% SD 4.5. Sleep efficiency was 76.2% (SD 13.4). CONCLUSIONS: The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined. There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.
Migraine perspectives from Neurologists who suffer from Migraines
This is an interesting abstract on how Neurologists in France view Migraine.
I was surprised that the views of neurologists who suffered from migraine were similar to those who di not. The most common rugs used were anti-inflamatories (1) and Triptans (2). The article stated that migraine patients are usually undertreated. What would have been most interesting would be the differences in treatments of neurologists with migraine versus those without. While their attitudes were similar the article did not seperate treatment methods. There may also be a reporting bias by neurologists who do not admit (illegal) self treatments.
Headache. 2010 Apr 16. [Epub ahead of print]
Migraine and Migraines of Specialists: Perceptions and Management.
Donnet A, Becker H, Allaf B, Lantéri-Minet M.
From the Neurology Department, Hôpital la Timone, Marseille, France (A. Donnet); Les Anémones Medical Centre, Cannes, France (H. Becker); Almirall SAS, Paris, France (B. Allaf); INSERM U929, Department of Evaluation and Treatment of Pain, Clinical Neurosciences Pole, Hôpital Pasteur, Nice, France (M. Lantéri-Minet).
Abstract
(Headache 2010;**:**-**) Objectives.- To describe the perception of migraine by neurologists in France, to compare perceptions between neurologists who did and did not suffer from migraines and to describe treatments used for their own migraines. Background.- Patients with migraine are usually undertreated, as treatment guidelines are frequently not followed and, therefore, resulting treatment satisfaction is low. One reason for this may be inappropriate perceptions of physicians concerning the seriousness of the pathology and the need to treat. However, available information on physician perceptions of migraine is limited. Methods.- This was an observational, epidemiological survey conducted both in hospital- and community-based neurologists in France. Participating neurologists completed an anonymous questionnaire which collected data on demographics, migraine status, and perceptions of migraine. Neurologists who considered themselves migraineurs also provided data on migraine impact, treatment and on treatment satisfaction. Distributions of responses to questions on migraine perceptions were compared between migraineur and nonmigraineur neurologists. Results.- The study included 368 neurologists, of whom 179 (48.6%) were migraineurs themselves. Some 92.3% of participants claimed to be very or quite interested in migraine. Migraine was considered a real illness by 96.5% of neurologists and to be very or quite disabling by 96.6%. Around half perceived migraine as a challenging condition to manage with respect to unrealistic patient expectations (46.2%), time-consuming treatment (48.9%), and complications because of anxious or depressive comorbidity (59.9%) or medical nomadism (consulting multiple physicians for the same condition; 47.0%). No significant differences in any perception items were observed between migraineur and nonmigraineur neurologists. In total, 83.1% of neurologists were satisfied with acute headache treatments and 60.4% with prophylactic headache treatments. The most frequently reported treatments for neurologist's own migraines were nonsteroidal anti-inflammatory drugs (used by 57.0%) and triptans (50.3%). Conclusions.- French neurologists are interested and concerned about migraine but find it challenging to treat. Migraine perceptions do not differ between neurologists who do and do not suffer from migraines themselves. Neurology training needs to prepare medical students adequately for the challenges of migraine treatment in terms of patient communication and psychiatric issues.
PMID: 20408886 [PubMed - as supplied by publisher]
I was surprised that the views of neurologists who suffered from migraine were similar to those who di not. The most common rugs used were anti-inflamatories (1) and Triptans (2). The article stated that migraine patients are usually undertreated. What would have been most interesting would be the differences in treatments of neurologists with migraine versus those without. While their attitudes were similar the article did not seperate treatment methods. There may also be a reporting bias by neurologists who do not admit (illegal) self treatments.
Headache. 2010 Apr 16. [Epub ahead of print]
Migraine and Migraines of Specialists: Perceptions and Management.
Donnet A, Becker H, Allaf B, Lantéri-Minet M.
From the Neurology Department, Hôpital la Timone, Marseille, France (A. Donnet); Les Anémones Medical Centre, Cannes, France (H. Becker); Almirall SAS, Paris, France (B. Allaf); INSERM U929, Department of Evaluation and Treatment of Pain, Clinical Neurosciences Pole, Hôpital Pasteur, Nice, France (M. Lantéri-Minet).
Abstract
(Headache 2010;**:**-**) Objectives.- To describe the perception of migraine by neurologists in France, to compare perceptions between neurologists who did and did not suffer from migraines and to describe treatments used for their own migraines. Background.- Patients with migraine are usually undertreated, as treatment guidelines are frequently not followed and, therefore, resulting treatment satisfaction is low. One reason for this may be inappropriate perceptions of physicians concerning the seriousness of the pathology and the need to treat. However, available information on physician perceptions of migraine is limited. Methods.- This was an observational, epidemiological survey conducted both in hospital- and community-based neurologists in France. Participating neurologists completed an anonymous questionnaire which collected data on demographics, migraine status, and perceptions of migraine. Neurologists who considered themselves migraineurs also provided data on migraine impact, treatment and on treatment satisfaction. Distributions of responses to questions on migraine perceptions were compared between migraineur and nonmigraineur neurologists. Results.- The study included 368 neurologists, of whom 179 (48.6%) were migraineurs themselves. Some 92.3% of participants claimed to be very or quite interested in migraine. Migraine was considered a real illness by 96.5% of neurologists and to be very or quite disabling by 96.6%. Around half perceived migraine as a challenging condition to manage with respect to unrealistic patient expectations (46.2%), time-consuming treatment (48.9%), and complications because of anxious or depressive comorbidity (59.9%) or medical nomadism (consulting multiple physicians for the same condition; 47.0%). No significant differences in any perception items were observed between migraineur and nonmigraineur neurologists. In total, 83.1% of neurologists were satisfied with acute headache treatments and 60.4% with prophylactic headache treatments. The most frequently reported treatments for neurologist's own migraines were nonsteroidal anti-inflammatory drugs (used by 57.0%) and triptans (50.3%). Conclusions.- French neurologists are interested and concerned about migraine but find it challenging to treat. Migraine perceptions do not differ between neurologists who do and do not suffer from migraines themselves. Neurology training needs to prepare medical students adequately for the challenges of migraine treatment in terms of patient communication and psychiatric issues.
PMID: 20408886 [PubMed - as supplied by publisher]
New Developments in Migraine Treatment and how they relate to Neuromuscular Dentistry and Posturology
A recent article in Current Opinions in Neurology reviewed Migraine treatments. While it mentioned the use of medications such as Botox (onabotulinum toxin type A), triptans , Topiramate, gabapentin, petasites and tizanidine and a new nasal form of dihydroergotamine it also discussed risk factors associated with Temporo-mandibular (TMJ, TMD) disorders, sleep apnea and treatments like occipital nerve stimulators.
These are important aspects of Neuromuscular Dentistry which utilizes ultra-low frequency TENS to stimulate the Cranial Nerves V, VII and XI. This would create effects on occipital nerves as well. The use of Botox on cranial muscles shows that they are responsible for many migraines. Reducing pathological muscle activity is relatively easy utilizing a neuromuscular diagnostic orthotic. The occipital muscles respond to postural changes in the head position that have been well described by the Quadrant Theorem of Guzay. NUCCA and A/O (atlas Orthogonal) chiropractic are both extremely effective with chronic daily headaches and migraines however the adjustments do not hold without neuromuscular correction of the jaw position.
The use of medications to treat migraines is essential for some patients but the same therapeutic changes in brain chemistry can be accomplished for many patients by changing neural input to the brain via the Trigeminal nerve which (dentist's nerve) which also controls vascular headaches thru control of blood flow to the anterior two thirds of the meninges. The primary control of vascular flow to the brain is always affected by the health of the stomatognathic system. The blood flow to the brain from the internal carotid is also indirectly affected by jaw position and its effects on head posture and carotid blood flow.
The blood flow to the brain is provided by "The circle of Willis (also called the cerebral arterial circle, arterial circle of Willis or Willis Polygon) is a circle of arteries that supply blood to the brain. It is named after Thomas Willis (1621–1673), an English physician" (from Wikipedia) The arteries are "The circle of Willis comprises the following arteries:[2]
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)" and also the basilar artery and middle cerebral arteries, though they supply the brain, are not considered part of the circle of Willis. All of these are directly controlled by the Trigeminal Nerves or indirectly affected by head posture.
Neurologists agree that nearly all chronic daily headaches and migraines are controlled to a large extent by the Trigeminal Nerve. Correction of pathology in the oral systems changes the input to the brain and corrects autonomic functioning.
This study (below) qualifies TMD as risk factors but does not delve into how EMG spectral analysis of masticatory muscles could be used to define in a quantitative manner risks of migraines and chronic daily headaches.
Posturology may be considered a new field that combines and correlates many different specialties.
As defined by Wikipedia:
"Posturology is the scientific study of posture.
Posturology science involves comprehensive knowledge within every scientific specialization dealing with motor system as:
- biomechanics
- neurology
- antropology
- empbriology
And a good theoric and clinic knowledge of every function and aspect of anatomy that may directly or indirectly interface with motor system:
- otorhinolaringology
- dentistry
- angiology
- endocrinology
Posturology may take advantage of all instrumental resources that are already in use among those specialties but requires new protocols of measurement to be prototyped for either research and clinical use.
Posturology is aimed at setting up new evaluation methods to provide multi dimensional model of posture and it's variables, not neglecting resoureces such as patient's collaboration which, with adeguate rigour, may take advantage of the most accurate afference processing system: the patient's brain.
Posture is nowadays a challenge for scientific society as the discipline-oriented-approach of medicine organization does not comply with the functional-model of posture: a motor function implementation requires interdisciplinary perspective to be thoroughly evaluated and, so far, medicine does not provide a single figure with multi discipline skill.
Given the absence of scientific society interest in posture and the presence of obscure posturologist professionals, posturology is way far from from yielding scientific results, moreover, the current lack of scientific knowledge of posture and the growing ascertainment of relationship between diffused social deseases and the postural disorder, makes posturology research demand much more urgent than posturology clinic demand.
Posturology specialization, at present, is not scientifically aknowledged, but, if appropriately conceived, not only might overcome the lack of overview of the current scientific discipline-model approach but is the only way to provide the required functional-model approach to scientific research." (end wikipedia quote)
The following is taken from the posturology (http://www.posturology.eu/pages/acc2.htm) website:
"" What is responsible for these pathologies : the system thrown out-of-tune by the abnormal information signals it receives from the peripheral sensors : feet, eyes, teeth, skin etc.
The aim of posturology is to provide a treatment no longer based on the symptoms (pains) but on the causes, and one of reprogramming those out-of-tune sensors in the system.
The latest neurological research has shown that the control of the body’s spatial equilibrium does not depend exclusively on the internal ear, as was believed for a long time, but also on other sensors of the system, of which the feet and the eyes are the most important.
GOOD FEET, GOOD EYES
...These two elements constitute the primary inputs of the system, any disturbance due to ground-contact or of optical origin will have repercussions on the postural ensemble. These sensors being out-of-tune is extremely frequent, and most of the time is present without being noticed.
While feet and eyes provide the principal and most frequently encountered causes, there are others too that give rise to postural imbalance : certain types of scars, the manducatory system (teeth, muscles and articulations), the muscles etc.
GOOD TEETH ARE IMPORTANT
...Another neglected component of the sensorial system is the teeth, muscles and jaw articulation. Bad dental occlusion gives rise to neck-aches, head pains, dizziness, buzzing and evening and morning aches and pains."
The Sleep and Health Journal article on Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) explains many of the postural connections between the teeth, jaws, perioontal ligaments and how they ultimately effect and change total body function.
Curr Opin Neurol. 2010 Jun;23(3):254-8.
New therapeutic developments in chronic migraine.
Lovell BV, Marmura MJ.
Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. loveb9@gmail.com
Abstract
PURPOSE OF REVIEW: Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology. RECENT FINDINGS: Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. SUMMARY: This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.
PMID: 20442572 [PubMed - in process]
These are important aspects of Neuromuscular Dentistry which utilizes ultra-low frequency TENS to stimulate the Cranial Nerves V, VII and XI. This would create effects on occipital nerves as well. The use of Botox on cranial muscles shows that they are responsible for many migraines. Reducing pathological muscle activity is relatively easy utilizing a neuromuscular diagnostic orthotic. The occipital muscles respond to postural changes in the head position that have been well described by the Quadrant Theorem of Guzay. NUCCA and A/O (atlas Orthogonal) chiropractic are both extremely effective with chronic daily headaches and migraines however the adjustments do not hold without neuromuscular correction of the jaw position.
The use of medications to treat migraines is essential for some patients but the same therapeutic changes in brain chemistry can be accomplished for many patients by changing neural input to the brain via the Trigeminal nerve which (dentist's nerve) which also controls vascular headaches thru control of blood flow to the anterior two thirds of the meninges. The primary control of vascular flow to the brain is always affected by the health of the stomatognathic system. The blood flow to the brain from the internal carotid is also indirectly affected by jaw position and its effects on head posture and carotid blood flow.
The blood flow to the brain is provided by "The circle of Willis (also called the cerebral arterial circle, arterial circle of Willis or Willis Polygon) is a circle of arteries that supply blood to the brain. It is named after Thomas Willis (1621–1673), an English physician" (from Wikipedia) The arteries are "The circle of Willis comprises the following arteries:[2]
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)" and also the basilar artery and middle cerebral arteries, though they supply the brain, are not considered part of the circle of Willis. All of these are directly controlled by the Trigeminal Nerves or indirectly affected by head posture.
Neurologists agree that nearly all chronic daily headaches and migraines are controlled to a large extent by the Trigeminal Nerve. Correction of pathology in the oral systems changes the input to the brain and corrects autonomic functioning.
This study (below) qualifies TMD as risk factors but does not delve into how EMG spectral analysis of masticatory muscles could be used to define in a quantitative manner risks of migraines and chronic daily headaches.
Posturology may be considered a new field that combines and correlates many different specialties.
As defined by Wikipedia:
"Posturology is the scientific study of posture.
Posturology science involves comprehensive knowledge within every scientific specialization dealing with motor system as:
- biomechanics
- neurology
- antropology
- empbriology
And a good theoric and clinic knowledge of every function and aspect of anatomy that may directly or indirectly interface with motor system:
- otorhinolaringology
- dentistry
- angiology
- endocrinology
Posturology may take advantage of all instrumental resources that are already in use among those specialties but requires new protocols of measurement to be prototyped for either research and clinical use.
Posturology is aimed at setting up new evaluation methods to provide multi dimensional model of posture and it's variables, not neglecting resoureces such as patient's collaboration which, with adeguate rigour, may take advantage of the most accurate afference processing system: the patient's brain.
Posture is nowadays a challenge for scientific society as the discipline-oriented-approach of medicine organization does not comply with the functional-model of posture: a motor function implementation requires interdisciplinary perspective to be thoroughly evaluated and, so far, medicine does not provide a single figure with multi discipline skill.
Given the absence of scientific society interest in posture and the presence of obscure posturologist professionals, posturology is way far from from yielding scientific results, moreover, the current lack of scientific knowledge of posture and the growing ascertainment of relationship between diffused social deseases and the postural disorder, makes posturology research demand much more urgent than posturology clinic demand.
Posturology specialization, at present, is not scientifically aknowledged, but, if appropriately conceived, not only might overcome the lack of overview of the current scientific discipline-model approach but is the only way to provide the required functional-model approach to scientific research." (end wikipedia quote)
The following is taken from the posturology (http://www.posturology.eu/pages/acc2.htm) website:
"" What is responsible for these pathologies : the system thrown out-of-tune by the abnormal information signals it receives from the peripheral sensors : feet, eyes, teeth, skin etc.
The aim of posturology is to provide a treatment no longer based on the symptoms (pains) but on the causes, and one of reprogramming those out-of-tune sensors in the system.
The latest neurological research has shown that the control of the body’s spatial equilibrium does not depend exclusively on the internal ear, as was believed for a long time, but also on other sensors of the system, of which the feet and the eyes are the most important.
GOOD FEET, GOOD EYES
...These two elements constitute the primary inputs of the system, any disturbance due to ground-contact or of optical origin will have repercussions on the postural ensemble. These sensors being out-of-tune is extremely frequent, and most of the time is present without being noticed.
While feet and eyes provide the principal and most frequently encountered causes, there are others too that give rise to postural imbalance : certain types of scars, the manducatory system (teeth, muscles and articulations), the muscles etc.
GOOD TEETH ARE IMPORTANT
...Another neglected component of the sensorial system is the teeth, muscles and jaw articulation. Bad dental occlusion gives rise to neck-aches, head pains, dizziness, buzzing and evening and morning aches and pains."
The Sleep and Health Journal article on Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) explains many of the postural connections between the teeth, jaws, perioontal ligaments and how they ultimately effect and change total body function.
Curr Opin Neurol. 2010 Jun;23(3):254-8.
New therapeutic developments in chronic migraine.
Lovell BV, Marmura MJ.
Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. loveb9@gmail.com
Abstract
PURPOSE OF REVIEW: Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology. RECENT FINDINGS: Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. SUMMARY: This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.
PMID: 20442572 [PubMed - in process]
MIGRAINE PATIENTS UTILIZING TRIPTANS HAVE HIGHER CO2 LEVELS IN SLEEP. IS THIS A DANGEROUS FINDING OR A THERAPEUTIC EFFECT?
An abstract in Sleep abstract supplement "THE EFFECTS OF TRIPTANS ON RESPIRATORY DYNAMICS AND SLEEP ARCHITECTURE IN PATIENTS WHO SUFFER FROM MIGRAINE HEADACHES" found no changes in Polysomnography but did find there was a significant
finding of increased end-tidal CO2. These higher levels of CO2 may fit with the vascular theory of migraines.
On the other hand the high end-tidal CO2 values may be a significant risk factor when considering long term triptan use.
"We noted significant difference in sleep time spent with End-Tidal Co2 (ETCO2) higher than 45mmhg PLMD" ( 35.56/36.8 vs. 13.84/17.34)
Should we be concerned that there is an increasein CO2 and could it lea to long term difficulties? Maybe the higher CO@ is the therapeutic effect of triptans changing the autonomic breathing drive.
This will probably be the start of interesting research on migraine patients.
finding of increased end-tidal CO2. These higher levels of CO2 may fit with the vascular theory of migraines.
On the other hand the high end-tidal CO2 values may be a significant risk factor when considering long term triptan use.
"We noted significant difference in sleep time spent with End-Tidal Co2 (ETCO2) higher than 45mmhg PLMD" ( 35.56/36.8 vs. 13.84/17.34)
Should we be concerned that there is an increasein CO2 and could it lea to long term difficulties? Maybe the higher CO@ is the therapeutic effect of triptans changing the autonomic breathing drive.
This will probably be the start of interesting research on migraine patients.
Saturday, May 1, 2010
TMJ Disorders can adversely affect the entire family.
TMJ disorders rarely only affect the patient but family friends and colleagues a well. Well there are many symptoms that are discussed it is actually the sum of these symptoms that changes patients personalities. A young mother who has dealth with severe pain uring the day has much less patience with her children and will often be short with them for no reason. She will then feel guilty about this which only exacerbates her symptoms.
A major aspect of sleep disorders if frequently excessive tiredness. This may be due to disturbed sleep from grinding but is frequently associated with upper airway resistance syndrome that is common in TMJ disorders and can lead to fibromyalgia symptoms. Disturbed sleep from any cause can lead to a wide variety of chronic pain conditions. Patients are often not aware of how poor their sleep really is. Many times they just never feel rested. This can be a strain on marriages when there is no longer energy for warm relationships and patients become mere autonoms going thru the motions of a normal life.
Headaches and Migraines associated with TMJ disorders can be overwhelming. Most physicians immediately treat the symptoms with powerful medications without considering that a true neuromuscular problem is at the root of these headaches. Correction of the underlying problem can let symptoms melt away like ice on a hot sumer day.
Children with TMJ disorders are more likely to snore and have ADHD which can be an extra stress on a parent already struggling and feeling like she is failing her family. Loss of social networks is common with any chronic pain condition because pateints are just to tired and beg off parties, dinners and other activities that would actually be therapeutic.
A major aspect of sleep disorders if frequently excessive tiredness. This may be due to disturbed sleep from grinding but is frequently associated with upper airway resistance syndrome that is common in TMJ disorders and can lead to fibromyalgia symptoms. Disturbed sleep from any cause can lead to a wide variety of chronic pain conditions. Patients are often not aware of how poor their sleep really is. Many times they just never feel rested. This can be a strain on marriages when there is no longer energy for warm relationships and patients become mere autonoms going thru the motions of a normal life.
Headaches and Migraines associated with TMJ disorders can be overwhelming. Most physicians immediately treat the symptoms with powerful medications without considering that a true neuromuscular problem is at the root of these headaches. Correction of the underlying problem can let symptoms melt away like ice on a hot sumer day.
Children with TMJ disorders are more likely to snore and have ADHD which can be an extra stress on a parent already struggling and feeling like she is failing her family. Loss of social networks is common with any chronic pain condition because pateints are just to tired and beg off parties, dinners and other activities that would actually be therapeutic.
HEADACHES, MIGRAINES, FIBROMYALGIA AND TMJ DISORDERS
There is an intimate cooection between TMD and Fibromyalgia and Tension-type and Muscle contraction headaches. These can also serve as triggers for many types of migraines and chronic daily headaches.
The connection is the Trigeminal Nerve that controls blood flow to the brain and contributes over half of all input to the brain an central nervous system from the body.
It is generally recognized by neuroscientists and neurologists that almost all headaches and migraines are primarily trigeminal in nature or influenced by the trigeminal nerve.
Neuromuscular dentistry may be the best prevention for these problems that frequently relate to sleep disorders as well.
Neuromuscular dentistry my be the ideal method to improve the your quality of lyour life without excessive medication. Both chiropractic and osteopathic medicine depend on the jaw for stability of the spine and holistic and or alternative health care methods like massage have longer lasting results when postural correction and neurofeedback from the trigemnal nerve are use as a stabilizing force rather than a continuing irritation that prevents healing and interferes with quality of life.
The connection is the Trigeminal Nerve that controls blood flow to the brain and contributes over half of all input to the brain an central nervous system from the body.
It is generally recognized by neuroscientists and neurologists that almost all headaches and migraines are primarily trigeminal in nature or influenced by the trigeminal nerve.
Neuromuscular dentistry may be the best prevention for these problems that frequently relate to sleep disorders as well.
Neuromuscular dentistry my be the ideal method to improve the your quality of lyour life without excessive medication. Both chiropractic and osteopathic medicine depend on the jaw for stability of the spine and holistic and or alternative health care methods like massage have longer lasting results when postural correction and neurofeedback from the trigemnal nerve are use as a stabilizing force rather than a continuing irritation that prevents healing and interferes with quality of life.
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