A recent article in HEADACHE (June 2011)"Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine" looks at patients who have an overlap of vestibular symptoms, such as lightheadedness, unsteadiness, vertigo, balance disturbance and headache.
The study showed just under half of the patients had onset of pain and vestibular symptoms together. This is frequently seen in patients withcraniomandibular neuromuscular disorders and usually responds extremely well to a neuromuscular orthotic, use of ULF TENS, Trigger point injections, spray and stretch elimination of TP's and SPG (Sphenopalatine Ganglion) Blocks.
NEUROMUSCULAR DENTISTRY SHOULD PROBABLY BE A FIRST LINE TREATMENT FOR PATIENTS EXPERIENCING VESTIBULAR SYMPTOMS AND HEADACHE OR MIGRAINE AFTER ORGANIC DISEASE IS RULED OUT.
TMJ DISORDERS HAVE LONG BEEN CALLED "THE GREAT IMPOSTER" because they mimic so many other disorders. All patients with vestibular symptoms and head or neck pain shoud read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IN SLEEP AND HEALTH JOURNAL.
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
The article's conclusions are not diagnostic at all. They cover episodic, acute onset and chronic disorders. The authors stated "Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM"
Headache. 2011 Jun 7. doi: 10.1111/j.1526-4610.2011.01934.x. [Epub ahead of print]
Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine"
Cohen JM, Bigal ME, Newman LC.
Source
From Roosevelt Hospital, Headache Institute, New York, NY, USA (J.M. Cohen and L.C. Newman); Merck, Sharp & Dohme Corp., Whitehouse Station, NJ, USA (M.E. Bigal).
Abstract
Background.- Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms-VS) often co-exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.- To determine common clinical features that may be associated with "vestibular migraine" (VM). Methods.- We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.- Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), "light-headedness" (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.- Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.
© 2011 American Headache Society.
PMID:
21649658
[PubMed - as supplied by publisher]
Related citations
Monday, June 13, 2011
Tuesday, June 7, 2011
Tinnitus: The TMJ (TMD) and Headache Connection. Can we predict and prevent tinnitus?
A new article "Signs and symptoms of temporomandibular disorders and the incidence of tinnitus." in the April 2011 Journal of Oral Rehabilitation showed that TMD and Headache were the two primary predictors of tinnitus. Tinnitus is a frequent symptom of TMJ disorders and is routinely considered to be related to TMD. There are many causes of tinnitus that are related to dentistry and posture.
The medial pterygoid muscle and the tensor of the ear drum (tensor veli tympani) have a common trigeminal nerve root. They are embryologically the same muscle that splits in two as the embryo develops into a fetus. Tinnitus is frequently triggered by palpating the medial pterygoid muscle which is also implicated in sleep apnea, a common finding in TMJ disorders.
The Sterncleidomastoid muscle can also have trigger points that cause both tinnitus, vertigo and feelings of loss of equilibrium.
The study analysed 3134 subjects Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ),24 or 12.6% over a five year period later developed tinnitus. Only 124 of the entire group developed tinnitus or 5.8% so there was a 7.7% increased risk in the group with palpation pain.
This study certainly shows that not treating TMD problems can lead to future problems. What is remarkable is that they only looked at one possible TMD symptom, if they had expanded this study to other TMD symptoms they probably would have found a much larger increased risk of developing tinnitus.
When a neuromuscular Dental orthotic is used to begin treatment of a TMD problem it is not unusual to see rapid elimination of tinnitus when there are other symptoms of TMD such as headache, sinus pain, muscle soreness or trigger points etc. Patients who present with tinnitus as a single symptom do not always respond as well as patients with multiple symptoms.
I strongly Rx starting treatment for all tinnitus patients with a neuromuscular orthotic after ruling out organic disease.
J Oral Rehabil. 2011 Apr 23. doi: 10.1111/j.1365-2842.2011.02224.x. [Epub ahead of print]
Signs and symptoms of temporomandibular disorders and the incidence of tinnitus.
Bernhardt O, Mundt T, Welk A, Köppl N, Kocher T, Meyer G, Schwahn C.
SourceDepartment of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Department of Prosthodontics, Gerodontology and Biomaterials, Center of Oral Health, University of Greifswald Unit of Periodontology, Department of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Statistical Department, Center of Oral Health, University of Greifswald, Greifswald, Germany.
Abstract
Summary In a cross-sectional analysis of data from the Study of Health in Pomerania (SHIP 0), temporomandibular disorders (TMD) were the strongest predictors for tinnitus beside headache. The aim of this study was to investigate whether signs and symptoms of TMD can be identified as risk factors for developing tinnitus. The SHIP 1 is a population-based 5-year longitudinal study intended to systematically describe the prevalence of and risk factors for diseases common in the population of Pomerania in northern Germany. A total of 3300 subjects (76% response) were reevaluated after 5 years for tinnitus and signs and symptoms of TMD using the same questionnaires and examination tools as baseline. To estimate the relative risk (RR) appropriately, a modified Poisson regression was used. After exclusion of prevalent cases with diagnosed tinnitus, 3134 subjects were analysed. Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ), 24 subjects (12·6%) received diagnosed tinnitus after 5 years, whereas among the 2643 unexposed subjects 142 subjects (5·8%) received tinnitus yielding a risk difference of 7·7% (95% confidence interval [CI]: 3·0%-12·5%) and a risk ratio of 2·60 (95% CI: 1·7-3·9). The risk ratio was 2·4 (95% CI: 1·6-3·7) after adjustment for gender, age, school education and frequent headache. Pain on palpation of the TMJ, however, did not worsen the prognosis for tinnitus in prevalent tinnitus cases (RR = 0·8, P = 0·288). Signs of TMD are a risk factor for the development of tinnitus.
© 2011 Blackwell Publishing Ltd.
PMID: 21517934 [PubMed - as supplied by publisher]
The medial pterygoid muscle and the tensor of the ear drum (tensor veli tympani) have a common trigeminal nerve root. They are embryologically the same muscle that splits in two as the embryo develops into a fetus. Tinnitus is frequently triggered by palpating the medial pterygoid muscle which is also implicated in sleep apnea, a common finding in TMJ disorders.
The Sterncleidomastoid muscle can also have trigger points that cause both tinnitus, vertigo and feelings of loss of equilibrium.
The study analysed 3134 subjects Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ),24 or 12.6% over a five year period later developed tinnitus. Only 124 of the entire group developed tinnitus or 5.8% so there was a 7.7% increased risk in the group with palpation pain.
This study certainly shows that not treating TMD problems can lead to future problems. What is remarkable is that they only looked at one possible TMD symptom, if they had expanded this study to other TMD symptoms they probably would have found a much larger increased risk of developing tinnitus.
When a neuromuscular Dental orthotic is used to begin treatment of a TMD problem it is not unusual to see rapid elimination of tinnitus when there are other symptoms of TMD such as headache, sinus pain, muscle soreness or trigger points etc. Patients who present with tinnitus as a single symptom do not always respond as well as patients with multiple symptoms.
I strongly Rx starting treatment for all tinnitus patients with a neuromuscular orthotic after ruling out organic disease.
J Oral Rehabil. 2011 Apr 23. doi: 10.1111/j.1365-2842.2011.02224.x. [Epub ahead of print]
Signs and symptoms of temporomandibular disorders and the incidence of tinnitus.
Bernhardt O, Mundt T, Welk A, Köppl N, Kocher T, Meyer G, Schwahn C.
SourceDepartment of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Department of Prosthodontics, Gerodontology and Biomaterials, Center of Oral Health, University of Greifswald Unit of Periodontology, Department of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Statistical Department, Center of Oral Health, University of Greifswald, Greifswald, Germany.
Abstract
Summary In a cross-sectional analysis of data from the Study of Health in Pomerania (SHIP 0), temporomandibular disorders (TMD) were the strongest predictors for tinnitus beside headache. The aim of this study was to investigate whether signs and symptoms of TMD can be identified as risk factors for developing tinnitus. The SHIP 1 is a population-based 5-year longitudinal study intended to systematically describe the prevalence of and risk factors for diseases common in the population of Pomerania in northern Germany. A total of 3300 subjects (76% response) were reevaluated after 5 years for tinnitus and signs and symptoms of TMD using the same questionnaires and examination tools as baseline. To estimate the relative risk (RR) appropriately, a modified Poisson regression was used. After exclusion of prevalent cases with diagnosed tinnitus, 3134 subjects were analysed. Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ), 24 subjects (12·6%) received diagnosed tinnitus after 5 years, whereas among the 2643 unexposed subjects 142 subjects (5·8%) received tinnitus yielding a risk difference of 7·7% (95% confidence interval [CI]: 3·0%-12·5%) and a risk ratio of 2·60 (95% CI: 1·7-3·9). The risk ratio was 2·4 (95% CI: 1·6-3·7) after adjustment for gender, age, school education and frequent headache. Pain on palpation of the TMJ, however, did not worsen the prognosis for tinnitus in prevalent tinnitus cases (RR = 0·8, P = 0·288). Signs of TMD are a risk factor for the development of tinnitus.
© 2011 Blackwell Publishing Ltd.
PMID: 21517934 [PubMed - as supplied by publisher]
BITE PROBLEMS ASSOCIATED WITH HEADACHES ACCORDING TO NEW ARTICLE IN THE JOURNAL OF PROSTHETIC DENTISTRY, JUNE 2011
THE PRIMARY INDICATION THAT THE TEETH, BITE AND TEMPOROMANDIBULAR APPARATUS are involved in headaches and migraines is the involvement ot the Trigeminal nerve in all of these disorders. The input to the trigeminal nerve can cause nociceptive nervous input which results in headaches, migraines and other autonomic and somatic symptoms.
Neuromuscular Dentistry reduces the nociceptive input into the central nervous system and can often eliminate or prevent many types of headaches and migraines, especially those involving trigeminally innervated tissues including teeth, jaw muscles, jaw (TMJ)joints, eustacian tubes, muscles that tighten the eardrum. This can correct blood flow to the anterior 2/3 of the meninges to the brain.
J Prosthet Dent. 2011 Jun;105(6):410-7.
Prevalence and association of headaches, temporomandibular joint disorders, and occlusal interferences.
Troeltzsch M, Troeltzsch M, Cronin RJ, Brodine AH, Frankenberger R, Messlinger K.
SourcePrivate Practice, Ansbach, Germany; Department of Physiology and Pathophysiology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Abstract
STATEMENT OF PROBLEM: Although an interaction of malocclusion, parafunction, and temporomandibular joint disorders (TMD) can be inferred from the experience of daily practice, scientific evidence to corroborate this hypothesis does not exist. However, there are indications that TMD and headaches may be intertwined.
PURPOSE: The purpose of this study was to identify the presence or absence of an association of occlusal interferences, parafunction, TMD, or physiologic, muscular, or prosthodontic factors with the occurrence of headache.
MATERIAL AND METHODS: In a private practice population of 1031 subjects (436 men and 595 women, mean age 49.6 years) the demographic parameters, headache and general pain history, habits and general personal information were recorded. Clinical examination for dental, muscular, and temporomandibular joint pathology was accomplished. Data were statistically analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-Square tests (α = .05). A multinomial logistic regression analysis was performed with respect to confounding variables.
RESULTS: Headache affliction was found to affect women more frequently than men (1.7:1). Students and non academics were more prone to suffer from headache. Parafunction (P=.001), TMD (P=.001) and gross differences between centric occlusion and maximum intercuspation of more than a 3 mm visible track marked with 8 μm articulation foil (P=.001) significantly influenced the presence of headache. Headache intensity and frequency decreased with age. While tension-type headache was most frequently diagnosed, the parameters studied were not significantly associated with one certain headache diagnosis more frequently than others.
CONCLUSIONS: Stomatognathic factors of TMD, parafunction, and gross differences between centric occlusion and maximum intercuspation of more than 3 mm are associated with headache. These findings should be interpreted with caution due to the cross-sectional nature of this study.
Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.
PMID: 21640243 [PubMed - in process]
Neuromuscular Dentistry reduces the nociceptive input into the central nervous system and can often eliminate or prevent many types of headaches and migraines, especially those involving trigeminally innervated tissues including teeth, jaw muscles, jaw (TMJ)joints, eustacian tubes, muscles that tighten the eardrum. This can correct blood flow to the anterior 2/3 of the meninges to the brain.
J Prosthet Dent. 2011 Jun;105(6):410-7.
Prevalence and association of headaches, temporomandibular joint disorders, and occlusal interferences.
Troeltzsch M, Troeltzsch M, Cronin RJ, Brodine AH, Frankenberger R, Messlinger K.
SourcePrivate Practice, Ansbach, Germany; Department of Physiology and Pathophysiology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Abstract
STATEMENT OF PROBLEM: Although an interaction of malocclusion, parafunction, and temporomandibular joint disorders (TMD) can be inferred from the experience of daily practice, scientific evidence to corroborate this hypothesis does not exist. However, there are indications that TMD and headaches may be intertwined.
PURPOSE: The purpose of this study was to identify the presence or absence of an association of occlusal interferences, parafunction, TMD, or physiologic, muscular, or prosthodontic factors with the occurrence of headache.
MATERIAL AND METHODS: In a private practice population of 1031 subjects (436 men and 595 women, mean age 49.6 years) the demographic parameters, headache and general pain history, habits and general personal information were recorded. Clinical examination for dental, muscular, and temporomandibular joint pathology was accomplished. Data were statistically analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-Square tests (α = .05). A multinomial logistic regression analysis was performed with respect to confounding variables.
RESULTS: Headache affliction was found to affect women more frequently than men (1.7:1). Students and non academics were more prone to suffer from headache. Parafunction (P=.001), TMD (P=.001) and gross differences between centric occlusion and maximum intercuspation of more than a 3 mm visible track marked with 8 μm articulation foil (P=.001) significantly influenced the presence of headache. Headache intensity and frequency decreased with age. While tension-type headache was most frequently diagnosed, the parameters studied were not significantly associated with one certain headache diagnosis more frequently than others.
CONCLUSIONS: Stomatognathic factors of TMD, parafunction, and gross differences between centric occlusion and maximum intercuspation of more than 3 mm are associated with headache. These findings should be interpreted with caution due to the cross-sectional nature of this study.
Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.
PMID: 21640243 [PubMed - in process]
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