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Saturday, May 28, 2011

Chronic Headaches and facial pain are often incorrectly blamed on chronic sinusitis

TMD (TMJ) is frequntly an undiagnosed cause of Headache and Facial Pain according to an article in the Annals of Allergy, Asthma and Immunology. The article " Temporomandibular dysfunction: an often overlooked cause of chronic headaches. " is found in Ann Allergy Asthma Immunol 2007 Oct;99(4):314-8. states that
"many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy"

I have seen this frequently in patients for years who are constantly taking antibiotics for sinus infections that cause their headaches. I have found that when we place these patients in a neuromuscular diagnostic orthotic that nthe headaches subside, as do the "sinus infections" . There is tremendous danger associated with the unnecessary overuse of antibiotics.

An article in Sleep and Health Journal, "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses in detail how patients frequently have the TMD diagnosis missed leading to years of needless suffering. The article can be found at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

The article states "studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches." I believe this is grossly under-rating the frequency where TMD either causes the headache directly, is a trigger to a secondary cause of headache or is involved in increasing the degree of pain the patient suffers. Nearly all headaches and migraines are trigeminally mediated and these headaches are TMD related.

Many patients do not have joint clicking , noise , locking or pain but have muscular disorders of the stomatognathic system.

Neuromuscular dentists are a small group of highly educated dentists in the field. They are able to deal with more complex issues due to sophisticated tools such as ULF-TENS, EMG, Computerized Mandibular Scans (MKG) and Sonography or JVA.

The article concludes "The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities."

WHAT THIS MEANS IS, IF YOUR HEADACHES ARE NOT CLEARLY IDENTIFIED BY OBJECTIVE STUDIES (MRI, CST SCANS, CULTURE, BLOOD TESTS, ETC ) THAN YOU SHOULD BE EVALUATED FOR TMD.

A Neuromuscular Dentist is probably an excellent starting point for patients with chronic daily headaches, sinus headaches and migraines which do not have objective causes identified by medical testing.

Ann Allergy Asthma Immunol. 2007 Oct;99(4):314-8.
Temporomandibular dysfunction: an often overlooked cause of chronic headaches.
Lupoli TA, Lockey RF.
Source
Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, University of South Florida College of Medicine, James A. Haley Veteran's Hospital, Tampa, Florida 33612, USA. tlupoli@hsc.usf.edu
Abstract
OBJECTIVE:
To review and discuss the role of temporomandibular dysfunction (TMD) as a cause of chronic headaches and facial pain.

DATA SOURCES AND STUDY SELECTION:
A literature review was performed using the PubMed database for English-language articles published between January 1, 1981, and August 31, 2006, using the following keywords: temporomandibular dysfunction, temporomandibular disorder, temporomandibular joint, and chronic headache. Additional information was obtained from a review of current medical texts.

RESULTS:
Allergists and immunologists are frequently called on to evaluate patients with chronic headaches and facial pain. TMD is known to cause recurrent facial discomfort and headaches. Many individuals with the disorder present with headache or facial discomfort as their only chief complaint. They mistakenly think it is a "sinus" headache. Nearly 10 million Americans are affected by the disorder, and early studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches.

CONCLUSIONS:
TMD is a likely underdiagnosed cause of chronic headache and facial discomfort. As such, many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy. TMD can be readily diagnosed by a careful history and physical examination. Patients typically respond well to conservative therapy, which includes behavioral modification and nonsteroidal anti-inflammatory drugs. The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities.

PMID: 17941277 [PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 3:16 PM

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