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Tuesday, May 11, 2010

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]

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posted by Dr Shapira at 9:44 AM

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