A recent article in the Journal of Orofacial Pain identifies Migraine as the most frequent primary headache in patients with temporomandibular disorders. The majority of migraines are actually trigeminally moderated and it is no surprise that they would be common. Tension type headaches were the second most common headache. Headaches occured in 45.6 % of control group and 85.5 % of TMD group.
Patients with chronic migraines and tension headaches who are looking for relief should consider the utilization of neuromuscular dentistry.
A neuromuscular diagnostic orthotic is the first step in changing the quality of life. It is a well established fact that the trigeminal nerves are an integral part of most chronic migraine and tension headaches. Neuromuscular dentistry is probably the best approach to correcting the physiologic causes of migraine. Aitional information on the treatment of TMJ disorders and chronic headaches utilizing neuromuscular dentistry cn be found in Sleep and Health Journal.
J Orofac Pain. 2010 Summer;24(3):287-92.
Migraine is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders.
Franco AL, Goncalves DA, Castanharo SM, Speciali JG, Bigal ME, Camparis CM.
Abstract
Aims: To assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD. Methods: The sample consisted of 158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls. The Research Diagnostic Criteria for TMD were used to diagnose the TMD patients. HAs were assessed using a structured interview and classified according to the Second Edition of the International Classification for Headache Disorders. Data were analyzed by chi-square tests with a significance level of 5% and odds ratio (OR) tests with a 95% confidence interval (CI). Results: HAs occurred in 45.6% of the control group (30.9% had migraine and 14.7% had tension-type headache [TTH]) and in 85.5% of individuals with TMD. Among individuals with TMD, migraine was the most prevalent primary HA (55.3%), followed by TTH (30.2%); 14.5% had no HA. In contrast to controls, the odds ratio (OR) for HA in those with TMD was 7.05 (95% confidence interval [CI] = 3.65-13.61; P = .000), for migraine, the OR was 2.76 (95% CI = 1.50-5.06; P = .001), and for TTH, the OR was 2.51 (95% CI = 1.18-5.35; P = .014). Myofascial pain/arthralgia was the most common TMD diagnosis (53.2%). The presence of HA or specific HAs was not associated with the time since the onset of TMD (P = .714). However, migraine frequency was positively associated with TMD pain severity (P = .000). Conclusion: TMD was associated with increased primary HA prevalence rates. Migraine was the most common primary HA diagnosis in individuals with TMD. J Orofac Pain 2010;24:287-292.
PMID: 20664830 [PubMed - in process]
Friday, July 30, 2010
Tuesday, July 20, 2010
NERVE BLOCKS AND TRIGGER POINT INJECTIONS IN THE TREATMENT OF CHRONIC HEADACHES
A new study "Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: Results of the American Headache Society Interventional Procedure Survey (AHS-IPS)" in Headache found widespread use of trigger point injections and nerve blocks it headache treatment. Many Neuromuscular dentists have a great deal of expertise in the utilization of these injections as part of coordinated treatment for Migraines, Tension-Type headaches and TMJ disorders.
Neuromuscular Dentists recognize that these injections are effective but do not address the underlying causes of patients problems. Correction of the Neuromuscular relationships and trigeminal nerve innervated muscles function is the key to long term correction of these problems. When diagnostic blocks and trigger points are effective the next step is to utilize a diagnostic orthotic to reduce noxious input to the Trigeminal nervous system and correct underlying postural pathology.
Headache. 2010 Jun;50(6):937-42.
Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: Results of the American Headache Society Interventional Procedure Survey (AHS-IPS).
Blumenfeld A, Ashkenazi A, Grosberg B, Napchan U, Narouze S, Nett B, DePalma T, Rosenthal B, Tepper S, Lipton RB.
The Headache Center of Southern California, Encinitas, CA, USA.
Comment in:
Headache. 2010 Jun;50(6):953-4.
Abstract
BACKGROUND: Many clinicians use peripheral nerve blocks (NBs) and trigger point injections (TPIs) for the treatment of headaches. Little is known, however, about the patterns of use of these procedures among practitioners in the USA. OBJECTIVES: The aim of this study was to obtain information on patterns of office-based use of peripheral NBs and TPIs by headache practitioners in the USA. METHODS: Using an Internet-based questionnaire, the Interventional Procedures Special Interest Section of the American Headache Society (AHS) conducted a survey among practitioners who were members of AHS on patterns of use of NBs and TPIs for headache treatment. RESULTS: Electronic invitations were sent to 1230 AHS members and 161 provided usable data (13.1%). Of the responders, 69% performed NBs and 75% performed TPIs. The most common indications for the use of NBs were occipital neuralgia and chronic migraine (CM), and the most common indications for the use of TPIs were chronic tension-type headache and CM. The most common symptom prompting the clinician to perform these procedures was local tenderness at the intended injection site. The most common local anesthetics used for these procedures were lidocaine and bupivacaine. Dosing regimens, volumes of injection, and injection schedules varied greatly. There was also a wide variation in the use of corticosteroids when performing the injections. Both NBs and TPIs were generally well tolerated. CONCLUSIONS: Nerve blocks and TPIs are commonly used by headache practitioners in the USA for the treatment of various headache disorders, although the patterns of their use vary greatly.
PMID: 20618812 [PubMed - in process]
Neuromuscular Dentists recognize that these injections are effective but do not address the underlying causes of patients problems. Correction of the Neuromuscular relationships and trigeminal nerve innervated muscles function is the key to long term correction of these problems. When diagnostic blocks and trigger points are effective the next step is to utilize a diagnostic orthotic to reduce noxious input to the Trigeminal nervous system and correct underlying postural pathology.
Headache. 2010 Jun;50(6):937-42.
Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: Results of the American Headache Society Interventional Procedure Survey (AHS-IPS).
Blumenfeld A, Ashkenazi A, Grosberg B, Napchan U, Narouze S, Nett B, DePalma T, Rosenthal B, Tepper S, Lipton RB.
The Headache Center of Southern California, Encinitas, CA, USA.
Comment in:
Headache. 2010 Jun;50(6):953-4.
Abstract
BACKGROUND: Many clinicians use peripheral nerve blocks (NBs) and trigger point injections (TPIs) for the treatment of headaches. Little is known, however, about the patterns of use of these procedures among practitioners in the USA. OBJECTIVES: The aim of this study was to obtain information on patterns of office-based use of peripheral NBs and TPIs by headache practitioners in the USA. METHODS: Using an Internet-based questionnaire, the Interventional Procedures Special Interest Section of the American Headache Society (AHS) conducted a survey among practitioners who were members of AHS on patterns of use of NBs and TPIs for headache treatment. RESULTS: Electronic invitations were sent to 1230 AHS members and 161 provided usable data (13.1%). Of the responders, 69% performed NBs and 75% performed TPIs. The most common indications for the use of NBs were occipital neuralgia and chronic migraine (CM), and the most common indications for the use of TPIs were chronic tension-type headache and CM. The most common symptom prompting the clinician to perform these procedures was local tenderness at the intended injection site. The most common local anesthetics used for these procedures were lidocaine and bupivacaine. Dosing regimens, volumes of injection, and injection schedules varied greatly. There was also a wide variation in the use of corticosteroids when performing the injections. Both NBs and TPIs were generally well tolerated. CONCLUSIONS: Nerve blocks and TPIs are commonly used by headache practitioners in the USA for the treatment of various headache disorders, although the patterns of their use vary greatly.
PMID: 20618812 [PubMed - in process]
Saturday, July 17, 2010
ARURICULAR NERVE STIMULATION FOR TREATING MIGRAINE vs NEUROMUSCULAR DENTISTRY AND DIAGNOSTIC ORTHOTIC TREATMENT
An article in Headache "Implanted auriculotemporal nerve stimulator for the treatment of refractory chronic migraine' (see abstract below) reports on a case of refractory headache with phonopobia treated by implanted peripheral nerve stimulators. Treatment reduced but did not eliminate the patients pain. The authors chose to only treat only a single branch of the mandibular nerve and did not address the entire Trigeminal Nervous system. A second article in Headache "Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome." discusses the use of occipital nerve blocks in treating migraines. The correction of forward head position thru neuromuscular dentistry can frequently eliminate the need for these blocks.
The ULF-TENS utilized by Neuromuscular Dentistry stimulates all three divisions of the Trigeminal nerve. The anti-dromic stimulation also causes plsing and relaxation of the masticatory muscles. A diagnostic orthotic is used to continually reduce the noxious input to the Trigeminal system which is implicated in almost all migraines and most headaches. The trigeminal nerve is often referred to as the dentist's nerve. Neuromuscular dentists often utilize occipital nerve blocks during treatment but can also utilize ULF TENS of he XI cranial nerve, the accessory nerve to eliminate or reduce the need for these blocks.
According to Wikipedia ""The auriculotemporal nerve is a branch of the mandibular nerve that runs with the superficial temporal artery and vein, and provides sensory innervation to various regions on the side of the head" The orgin of the nerve "arises as two roots from the posterior division of the mandibular nerve (The mandibular nerve is a branch of the trigeminal nerve). These roots encircle the middle meningeal artery (a branch of the mandibular part of the maxillary artery, which is in turn a terminal branch of the external carotid artery). The roots then converge to form a single nerve."
The clinical significance according to Wikipedia is "This nerve as it courses posteriorly to the condylar head, is frequently injured in temporomandibular joint surgery, causing an ipsilateral parasthesia of the auricle and skin surrounding the ear. Actually, it is the main nerve that supplies the TMJ, along with branches of the masseteric nerve and the deep temporal."
This does seem to explain one more reason why Neuromuscular Dentistry is so successful at long term prevention, elimination and treatment of of migraines and other headaches. TMJ disorders are frequently called "The Great Imposter" .
An article in Sleep and Health Journal "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" can be found at http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor as well as another article originally published by the American Equilibration Society that discusses the scientific basis for Neuromuscular Dentistry http://www.sleepandhealth.com/neuromuscular-dentistry
The treatment of migraines with peripheral nerve stimulators is an excellent idea but only after a trial of a Neuromuscular Orthotic has not proven successful. Neuromuscular Dentistry leads to healing of the entire trigeminal nervous system as well as correcting cervical and orthopedic problems that interfere with complete relief.
An excellent dermatone distribution of the Trigeminal and occipital nerves can be found at http://en.wikipedia.org/wiki/File:Gray784.png
te connections of the trigeminal nerves and occipital nerves are furher explored in "Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes" (see link below)
http://www.clusterattack.com/blog/wp-content/uploads/2009/11/busch-2006-functional-connectivity-between-trigeminal-and-occipital-nerves-revealed-by-occipital-nerve-blockade-and-nociceptive-blink-reflexes.pdf
The summary of this article notes the occipital nerve and trigeminal nerve connections. These explain why occipital migraines and cervical pain are relieved thru neuromuscular dental treatment when it is not explained by cervical orthopedic corrections.
Headache. 2010 Jun;50(6):1064-9.
Implanted auriculotemporal nerve stimulator for the treatment of refractory chronic migraine.
Simopoulos T, Bajwa Z, Lantz G, Lee S, Burstein R.
Beth Israel Deaconess Medical Center - Anesthesia, Boston, MA, USA.
Abstract
OBJECTIVE: To report a case of improved pain control and function in a patient with chronic migraine after treatment with auriculotemporal nerve stimulation. METHODS: The patient is a 52-year-old woman with refractory pain in the bilateral temporal distribution and marked phonophobia as a result of chronic migraine. RESULTS: After a successful trial period, the patient underwent implantation of bilateral peripheral nerve stimulators targeting the auriculotemporal nerves. At 16 months of follow up, her average pain intensity declined from 8-9/10 on the numeric rating scale to 5/10. Her function improved as assessed by the Migraine Disability Assessment, from total disability (grade IV) to mild disability (grade II). Her phonophobia became far less debilitating. CONCLUSION: Auriculotemporal nerve stimulation may be useful tool in the treatment of refractory pain in the temporal distribution due to chronic migraine.
FROM WIKIPEDIA AURICULARTEMPORAL NERVE
"The auriculotemporal nerve is a branch of the mandibular nerve that runs with the superficial temporal artery and vein, and provides sensory innervation to various regions on the side of the head"
"Origin
The auriculotemporal nerve arises as two roots from the posterior division of the mandibular nerve (The mandibular nerve is a branch of the trigeminal nerve). These roots encircle the middle meningeal artery (a branch of the mandibular part of the maxillary artery, which is in turn a terminal branch of the external carotid artery). The roots then converge to form a single nerve.
Course
The auriculotemporal nerve passes laterally to the neck of the mandible, gives off parotid branches and then turns superiorly, posterior to its head and moving anteriorly, gives off anterior branches to the auricle. It then crosses over the root of the zygomatic process of the temporal bone, deep to the superficial temporal artery
Innervation
The somatosensory root (superior) originates from branches of the mandibular nerve, which pass through the otic ganglion without synapsing. Then they form the somatosensory (superior) root of the auriculotemporal nerve. The two roots re-unite and shortly after the branching of secretomotor fibers to the parotid gland (parotid branches) the auriculotemporal nerve comprises exclusively somatosensory fibers, which ascend to the superficial temporal region. Supplies the auricle, external acoustic meatus, outer side of the tympanic membrane and the skin in the temporal region (superficial temporal branches). It also carries a few articular branches which go on to supply the temporomandibular joint.
The parasympathetic root (inferior) carries postganglionic fibers to the parotid gland. These parasympathetic, preganglionic secretomotor fibers originate from the glossopharyngeal nerve (CN IX) as one of its branches, the lesser petrosal nerve. This nerve synapses in the otic ganglion and its postganglionic fibers form the inferior, parasympathetic root of the auriculotemporal nerve. The two roots re-unite and shortly after the "united" auriculotemporal branch gives off parotid branches, which serve as secretomotor fibers for the parotid gland.
Clinical significance
This nerve as it courses posteriorly to the condylar head, is frequently injured in temporomandibular joint surgery, causing an ipsilateral parasthesia of the auricle and skin surrounding the ear. Actually, it is the main nerve that supplies the TMJ, along with branches of the masseteric nerve and the deep temporal.
After a parotidectomy, the nerves from the Auriculotemporal Nerve that previously innervated the parotid gland can reattach to the sweat glands in the same region. The result is sweating along the cheek with the consumption of foods (Frey's syndrome). Treatment involves the application of an antiperspirant or glycopyrrolate to the cheek, Jacobsen's neurectomy along the middle ear promontory, and lifting of the skin flap with the placement of a tissue barrier (harvested or cadaveric) to interrupt the misguided innervation of the sweat glands.
Pain related to a condition call parotiditis, or commonly referred to as " the mumps" will be carried by the auriculotemporal nerve."
Headache. 2010 Jun;50(6):1041-4.
Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome.
Weibelt S, Andress-Rothrock D, King W, Rothrock J.
University of Alabama Headache, Treatment and Research Program, University of Alabama School of Medicine, Birmingham, AL, USA.
Abstract
BACKGROUND: Approximately 1 in 50 Americans is afflicted by chronic migraine (CM). Many patients with CM describe cervicogenic headache. Options for treating CM effectively are at present quite limited. OBJECTIVE: To determine the safety and efficacy of occipital nerve blocks (ONBs) used to treat cervicogenic chronic migraine (CCM) and to identify variables predictive of a positive treatment response. METHODS: Using a uniform dose and injection paradigm, we performed ONBs consecutively on a series of patients presenting with CCM. Patients were stratified according to specific findings found to be present or absent on physical examination. A positive treatment outcome was defined as a 50% or greater reduction in headache days per month over the 30 days following treatment relative to the 30-day pre-treatment baseline. We used a 5-point Likert scale as one of the secondary outcome variables. RESULTS: We treated 150 consecutive patients with unilateral (37) or bilateral (113) ONBs. At the 1-month follow-up visit 78 (52%) exhibited evidence of a positive treatment response according to the primary outcome variable, and 90 (60%) reported their headache disorder to be "better" (44; 29%) or "much better" (46; 30%). A total of 8 (5%) patients reported adverse events within the ensuing 72 hours, and 3 (2%) experienced adverse events that reversed spontaneously but required emergent evaluation and management. CONCLUSION: For suppression of CCM, ONBs may offer an attractive alternative to orally administered prophylactic therapy.
PMID: 20618817 [PubMed - in process]
The ULF-TENS utilized by Neuromuscular Dentistry stimulates all three divisions of the Trigeminal nerve. The anti-dromic stimulation also causes plsing and relaxation of the masticatory muscles. A diagnostic orthotic is used to continually reduce the noxious input to the Trigeminal system which is implicated in almost all migraines and most headaches. The trigeminal nerve is often referred to as the dentist's nerve. Neuromuscular dentists often utilize occipital nerve blocks during treatment but can also utilize ULF TENS of he XI cranial nerve, the accessory nerve to eliminate or reduce the need for these blocks.
According to Wikipedia ""The auriculotemporal nerve is a branch of the mandibular nerve that runs with the superficial temporal artery and vein, and provides sensory innervation to various regions on the side of the head" The orgin of the nerve "arises as two roots from the posterior division of the mandibular nerve (The mandibular nerve is a branch of the trigeminal nerve). These roots encircle the middle meningeal artery (a branch of the mandibular part of the maxillary artery, which is in turn a terminal branch of the external carotid artery). The roots then converge to form a single nerve."
The clinical significance according to Wikipedia is "This nerve as it courses posteriorly to the condylar head, is frequently injured in temporomandibular joint surgery, causing an ipsilateral parasthesia of the auricle and skin surrounding the ear. Actually, it is the main nerve that supplies the TMJ, along with branches of the masseteric nerve and the deep temporal."
This does seem to explain one more reason why Neuromuscular Dentistry is so successful at long term prevention, elimination and treatment of of migraines and other headaches. TMJ disorders are frequently called "The Great Imposter" .
An article in Sleep and Health Journal "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" can be found at http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor as well as another article originally published by the American Equilibration Society that discusses the scientific basis for Neuromuscular Dentistry http://www.sleepandhealth.com/neuromuscular-dentistry
The treatment of migraines with peripheral nerve stimulators is an excellent idea but only after a trial of a Neuromuscular Orthotic has not proven successful. Neuromuscular Dentistry leads to healing of the entire trigeminal nervous system as well as correcting cervical and orthopedic problems that interfere with complete relief.
An excellent dermatone distribution of the Trigeminal and occipital nerves can be found at http://en.wikipedia.org/wiki/File:Gray784.png
te connections of the trigeminal nerves and occipital nerves are furher explored in "Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes" (see link below)
http://www.clusterattack.com/blog/wp-content/uploads/2009/11/busch-2006-functional-connectivity-between-trigeminal-and-occipital-nerves-revealed-by-occipital-nerve-blockade-and-nociceptive-blink-reflexes.pdf
The summary of this article notes the occipital nerve and trigeminal nerve connections. These explain why occipital migraines and cervical pain are relieved thru neuromuscular dental treatment when it is not explained by cervical orthopedic corrections.
Headache. 2010 Jun;50(6):1064-9.
Implanted auriculotemporal nerve stimulator for the treatment of refractory chronic migraine.
Simopoulos T, Bajwa Z, Lantz G, Lee S, Burstein R.
Beth Israel Deaconess Medical Center - Anesthesia, Boston, MA, USA.
Abstract
OBJECTIVE: To report a case of improved pain control and function in a patient with chronic migraine after treatment with auriculotemporal nerve stimulation. METHODS: The patient is a 52-year-old woman with refractory pain in the bilateral temporal distribution and marked phonophobia as a result of chronic migraine. RESULTS: After a successful trial period, the patient underwent implantation of bilateral peripheral nerve stimulators targeting the auriculotemporal nerves. At 16 months of follow up, her average pain intensity declined from 8-9/10 on the numeric rating scale to 5/10. Her function improved as assessed by the Migraine Disability Assessment, from total disability (grade IV) to mild disability (grade II). Her phonophobia became far less debilitating. CONCLUSION: Auriculotemporal nerve stimulation may be useful tool in the treatment of refractory pain in the temporal distribution due to chronic migraine.
FROM WIKIPEDIA AURICULARTEMPORAL NERVE
"The auriculotemporal nerve is a branch of the mandibular nerve that runs with the superficial temporal artery and vein, and provides sensory innervation to various regions on the side of the head"
"Origin
The auriculotemporal nerve arises as two roots from the posterior division of the mandibular nerve (The mandibular nerve is a branch of the trigeminal nerve). These roots encircle the middle meningeal artery (a branch of the mandibular part of the maxillary artery, which is in turn a terminal branch of the external carotid artery). The roots then converge to form a single nerve.
Course
The auriculotemporal nerve passes laterally to the neck of the mandible, gives off parotid branches and then turns superiorly, posterior to its head and moving anteriorly, gives off anterior branches to the auricle. It then crosses over the root of the zygomatic process of the temporal bone, deep to the superficial temporal artery
Innervation
The somatosensory root (superior) originates from branches of the mandibular nerve, which pass through the otic ganglion without synapsing. Then they form the somatosensory (superior) root of the auriculotemporal nerve. The two roots re-unite and shortly after the branching of secretomotor fibers to the parotid gland (parotid branches) the auriculotemporal nerve comprises exclusively somatosensory fibers, which ascend to the superficial temporal region. Supplies the auricle, external acoustic meatus, outer side of the tympanic membrane and the skin in the temporal region (superficial temporal branches). It also carries a few articular branches which go on to supply the temporomandibular joint.
The parasympathetic root (inferior) carries postganglionic fibers to the parotid gland. These parasympathetic, preganglionic secretomotor fibers originate from the glossopharyngeal nerve (CN IX) as one of its branches, the lesser petrosal nerve. This nerve synapses in the otic ganglion and its postganglionic fibers form the inferior, parasympathetic root of the auriculotemporal nerve. The two roots re-unite and shortly after the "united" auriculotemporal branch gives off parotid branches, which serve as secretomotor fibers for the parotid gland.
Clinical significance
This nerve as it courses posteriorly to the condylar head, is frequently injured in temporomandibular joint surgery, causing an ipsilateral parasthesia of the auricle and skin surrounding the ear. Actually, it is the main nerve that supplies the TMJ, along with branches of the masseteric nerve and the deep temporal.
After a parotidectomy, the nerves from the Auriculotemporal Nerve that previously innervated the parotid gland can reattach to the sweat glands in the same region. The result is sweating along the cheek with the consumption of foods (Frey's syndrome). Treatment involves the application of an antiperspirant or glycopyrrolate to the cheek, Jacobsen's neurectomy along the middle ear promontory, and lifting of the skin flap with the placement of a tissue barrier (harvested or cadaveric) to interrupt the misguided innervation of the sweat glands.
Pain related to a condition call parotiditis, or commonly referred to as " the mumps" will be carried by the auriculotemporal nerve."
Headache. 2010 Jun;50(6):1041-4.
Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome.
Weibelt S, Andress-Rothrock D, King W, Rothrock J.
University of Alabama Headache, Treatment and Research Program, University of Alabama School of Medicine, Birmingham, AL, USA.
Abstract
BACKGROUND: Approximately 1 in 50 Americans is afflicted by chronic migraine (CM). Many patients with CM describe cervicogenic headache. Options for treating CM effectively are at present quite limited. OBJECTIVE: To determine the safety and efficacy of occipital nerve blocks (ONBs) used to treat cervicogenic chronic migraine (CCM) and to identify variables predictive of a positive treatment response. METHODS: Using a uniform dose and injection paradigm, we performed ONBs consecutively on a series of patients presenting with CCM. Patients were stratified according to specific findings found to be present or absent on physical examination. A positive treatment outcome was defined as a 50% or greater reduction in headache days per month over the 30 days following treatment relative to the 30-day pre-treatment baseline. We used a 5-point Likert scale as one of the secondary outcome variables. RESULTS: We treated 150 consecutive patients with unilateral (37) or bilateral (113) ONBs. At the 1-month follow-up visit 78 (52%) exhibited evidence of a positive treatment response according to the primary outcome variable, and 90 (60%) reported their headache disorder to be "better" (44; 29%) or "much better" (46; 30%). A total of 8 (5%) patients reported adverse events within the ensuing 72 hours, and 3 (2%) experienced adverse events that reversed spontaneously but required emergent evaluation and management. CONCLUSION: For suppression of CCM, ONBs may offer an attractive alternative to orally administered prophylactic therapy.
PMID: 20618817 [PubMed - in process]
Thursday, July 15, 2010
Frontal and Occipital Headaches with Facial Numbness
From Vicki:
I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.
Dr Shapira response:
I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.
The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.
The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.
One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.
The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.
The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.
Following complete (or close) pain relief a long term solution can be evaluated.
I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.
Dr Shapira response:
I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.
The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.
The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.
One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.
The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.
The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.
Following complete (or close) pain relief a long term solution can be evaluated.
Monday, July 5, 2010
ARE CHRONIC HEADACHES AND SLEEP DISORDERS INTER-RELATED?
A new article "Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study" in the June 2010 issue of Headache addresses this issue. The article (pubmed abstract below) concludes that "Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification."
This recognition of the relation of sleep disorders and chronic headache and migraine is similar to information reported by the NHLBI, National Heart Lung and Blood Institue. The article "Cardiovascular and sleep related consequences of temporomandibular disorders" details the relation of TMJ disorders and sleep apnea. Patients with sleep disorders are prone to chronic headache and headache and TMJ patients are prone to sleep disorders. Are these merely different symptom patterns of the same disorder.
Patients with sleep apnea have a small airwy when awahe that is protected by the neuromuscular system. As sleep moves o deeper phases this neuromuscular compensation fails. Sleep apnea and/or snoring then results. Clenching and Brusism occur when arousal occurs from apnea. Is bruxism and clenching a isease or pathology or is it how the body protects us from airway collapse during sleep?
It appears that sleep apnea is a TMJ disorder that is related to functional development of the oral structures and the airway.
Breastfeeding of infants and early orthodontic expansion may be the best hope of raising a generation of children with healthy cpmpetent airways. This may also be he est method of preventing developmental ADD, ADHD, and other behavioral disordes. A generation of healthier children will increase inteligence and reduce medical expenses on a yearly basis for a lifetime.
Can early treatment of sleep disorders prevent or eliminate lifetime of headaches, migraines. TMJ disorders and other medical disorders. An article in Cranio by Shimshak et al showed a 300% increase in medical expenses in every field of medicinein patients diagnosed with TMJ disorders.
Additional information on sleep apnea can be found at www.ihatecpap.com.
Headache. 2010 Jun 21. [Epub ahead of print]
Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study.
Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, Grimaldi D, Cortelli P, Montagna P.
From the Department of Neurological Sciences, University of Bologna, Bologna, Italy.
Abstract
Objectives.- The aim of our study was to investigate the prevalence of sleep disorders in chronic headache patients and to evaluate the role of psychiatric comorbidity in the association between chronic headache and sleep complaints. Background.- The prevalence of sleep disorders in chronic headache has been seldom investigated, although from the earliest description chronic headache has been associated with sleep disturbances. On the contrary, mood disorders are commonly associated with both sleep disturbances and chronic headache - each of which are, in turn, core features of mood disorders. Therefore, it may be important to discriminate between sleep problems that can be attributed to a comorbid psychiatric disorder, and those specifically associated with headache. Only a few studies investigating the association of chronic headache with sleep difficulties have also taken into account to consider the possible role of anxiety and depression. Patients and Methods.- A total of 105 consecutive patients with daily or nearly daily headache and 102 patients with episodic headache, matched by age, sex, and type of headache at onset, underwent a structured direct interview about their sleep habits and psychiatric diseases. Results.- In total, 80 out of 105 patients with chronic headache received a diagnosis of medication overuse headache, 21 patients were classified as chronic migraine and 4 as chronic tension-type headache without drug overuse. Patients.- Patients with chronic headache showed a high prevalence of insomnia, daytime sleepiness, and snoring with respect to controls (67.7% vs 39.2%, 36.2% vs 23.5%, and 48.6% vs 37.2%, respectively). Forty-five patients with chronic headache (42.9%) had psychiatric comorbidity (anxiety and/or depressive disorders), vs 27 episodic headache patients (26.5%). Multivariate analysis disclosed that low educational level, lower mean age at headache onset, and insomnia are independently associated with chronic headache. Conclusions.- Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification.
PMID: 20572880 [PubMed - as supplied by publisher]
This recognition of the relation of sleep disorders and chronic headache and migraine is similar to information reported by the NHLBI, National Heart Lung and Blood Institue. The article "Cardiovascular and sleep related consequences of temporomandibular disorders" details the relation of TMJ disorders and sleep apnea. Patients with sleep disorders are prone to chronic headache and headache and TMJ patients are prone to sleep disorders. Are these merely different symptom patterns of the same disorder.
Patients with sleep apnea have a small airwy when awahe that is protected by the neuromuscular system. As sleep moves o deeper phases this neuromuscular compensation fails. Sleep apnea and/or snoring then results. Clenching and Brusism occur when arousal occurs from apnea. Is bruxism and clenching a isease or pathology or is it how the body protects us from airway collapse during sleep?
It appears that sleep apnea is a TMJ disorder that is related to functional development of the oral structures and the airway.
Breastfeeding of infants and early orthodontic expansion may be the best hope of raising a generation of children with healthy cpmpetent airways. This may also be he est method of preventing developmental ADD, ADHD, and other behavioral disordes. A generation of healthier children will increase inteligence and reduce medical expenses on a yearly basis for a lifetime.
Can early treatment of sleep disorders prevent or eliminate lifetime of headaches, migraines. TMJ disorders and other medical disorders. An article in Cranio by Shimshak et al showed a 300% increase in medical expenses in every field of medicinein patients diagnosed with TMJ disorders.
Additional information on sleep apnea can be found at www.ihatecpap.com.
Headache. 2010 Jun 21. [Epub ahead of print]
Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study.
Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, Grimaldi D, Cortelli P, Montagna P.
From the Department of Neurological Sciences, University of Bologna, Bologna, Italy.
Abstract
Objectives.- The aim of our study was to investigate the prevalence of sleep disorders in chronic headache patients and to evaluate the role of psychiatric comorbidity in the association between chronic headache and sleep complaints. Background.- The prevalence of sleep disorders in chronic headache has been seldom investigated, although from the earliest description chronic headache has been associated with sleep disturbances. On the contrary, mood disorders are commonly associated with both sleep disturbances and chronic headache - each of which are, in turn, core features of mood disorders. Therefore, it may be important to discriminate between sleep problems that can be attributed to a comorbid psychiatric disorder, and those specifically associated with headache. Only a few studies investigating the association of chronic headache with sleep difficulties have also taken into account to consider the possible role of anxiety and depression. Patients and Methods.- A total of 105 consecutive patients with daily or nearly daily headache and 102 patients with episodic headache, matched by age, sex, and type of headache at onset, underwent a structured direct interview about their sleep habits and psychiatric diseases. Results.- In total, 80 out of 105 patients with chronic headache received a diagnosis of medication overuse headache, 21 patients were classified as chronic migraine and 4 as chronic tension-type headache without drug overuse. Patients.- Patients with chronic headache showed a high prevalence of insomnia, daytime sleepiness, and snoring with respect to controls (67.7% vs 39.2%, 36.2% vs 23.5%, and 48.6% vs 37.2%, respectively). Forty-five patients with chronic headache (42.9%) had psychiatric comorbidity (anxiety and/or depressive disorders), vs 27 episodic headache patients (26.5%). Multivariate analysis disclosed that low educational level, lower mean age at headache onset, and insomnia are independently associated with chronic headache. Conclusions.- Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification.
PMID: 20572880 [PubMed - as supplied by publisher]
Friday, July 2, 2010
Waking with sinus pain or pressure.
Patient: I Wake up with sinus type headache and pressure around eyes.
This is a frequent area for patients to have referred pain from both jaw muscles and neck muscles. It is frequently secondary to clenching or grinding of the teeth. Another common cause for morning headaches is sleep apnea.
This is a frequent area for patients to have referred pain from both jaw muscles and neck muscles. It is frequently secondary to clenching or grinding of the teeth. Another common cause for morning headaches is sleep apnea.
CLUSTER HEADACHE AND TMJ DISORDER
QUESTION: My fiance has been having these headaches (her doctor thinks they are cluster headaches) for months now. The headaches are intense and always have the same focal point in the front left part of her head. She also has chronic neck pain and has been diagnosed with TMJD.
DR SHAPIRA: I WOULD STRONGLY RECOMMEND HAVING AN EVALUATION WITH A TRAINED NEUROMUSCULAR DENTIST. THAT IS A COMMON AREA FOR MANY TYPES OF PAIN RELATED TO NECK AND JAW PROBLEMS. REFERRED MUSCLE PAIN FROM THE TEMPORALIS MUSCLE, MASSTER MUSCLE ,STERNOCLEIDOMASTOID OR TRAPEZIUS MUSCLES COULD EASILY BE A CAUSE OF THE PAIN. MOST PAINS ASSOCIATED WITH TMJ DISORDERS ARE MUSCULAR IN ORGIN.
CLUSTER HEADACHES ARE MEDIATED BY THE TRIGEMINAL NERVE AND CAN BE A SECONDARY EFFECT OF TMD OR NEUROMUSCULAR PROBLEMS.
TMJ DISORDERS ARE OFTEN CALLED "THE GREAT IMPOSTER" BECAUSE THEY ARE SO OFTEN MISDIAGNOSED OR APPEAR TO BE A DIFFERENT PROBLEM SUCH AS CLUSTER HEADACHES.
CLUSTER HEADACHES FREQUENTLY RESPOND WELL TO OXYGEN TREATMENTS AND/OR SPG OR SPENOPALATINE GANGLION BLOCKS.
DR SHAPIRA: I WOULD STRONGLY RECOMMEND HAVING AN EVALUATION WITH A TRAINED NEUROMUSCULAR DENTIST. THAT IS A COMMON AREA FOR MANY TYPES OF PAIN RELATED TO NECK AND JAW PROBLEMS. REFERRED MUSCLE PAIN FROM THE TEMPORALIS MUSCLE, MASSTER MUSCLE ,STERNOCLEIDOMASTOID OR TRAPEZIUS MUSCLES COULD EASILY BE A CAUSE OF THE PAIN. MOST PAINS ASSOCIATED WITH TMJ DISORDERS ARE MUSCULAR IN ORGIN.
CLUSTER HEADACHES ARE MEDIATED BY THE TRIGEMINAL NERVE AND CAN BE A SECONDARY EFFECT OF TMD OR NEUROMUSCULAR PROBLEMS.
TMJ DISORDERS ARE OFTEN CALLED "THE GREAT IMPOSTER" BECAUSE THEY ARE SO OFTEN MISDIAGNOSED OR APPEAR TO BE A DIFFERENT PROBLEM SUCH AS CLUSTER HEADACHES.
CLUSTER HEADACHES FREQUENTLY RESPOND WELL TO OXYGEN TREATMENTS AND/OR SPG OR SPENOPALATINE GANGLION BLOCKS.
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