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Monday, November 21, 2011

Cervicogenic Headaches, TMJ, TMD, and the Trigeminocervical System. Treatment should include trigger point injections and greater occipital blocks.

Headaches and TMJ disorders usually have multiple symptoms. According to an article in Nov 2011 Neurologist these include the following symptoms: complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain.

I firmly believe that the autonomic symptoms ot temporomandibular disorders must be addressed. A neuromuscular orthotic can alleviate many of the symptoms but SPG blocks, greater occipital blocks and trigger point injections are frequently required for more effective treatment. All of these treatments are minimally ivasive and safer and more effective than use of tiptans or topomax.

The abstract reported the following results:
Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).

Neurologist. 2011 Nov;17(6):312-7.

Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache.

Source

Department of Neurology, Cleveland Clinic Neurological Institute, Center for Headache and Pain, Cleveland, OH.

Abstract

BACKGROUND:

: The trigeminocervical system is integral in cervicogenic headache. Cervicogenic headache frequently coexists with complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain. Controversy exists as to whether this constellation of symptoms may be cervically mediated.

OBJECTIVES:

: To determine whether a wider spectrum of cervically mediated symptoms exist, and to investigate a potential role of greater occipital nerve blocks (GON) and trigger point injections (TPI) in these patients.

METHODS:

: Retrospective review of GON/TPI performed in a tertiary otoneurology/headache clinic from May 2006 to March 2007 for suspected cervically mediated symptoms. Data included chief complaint, secondary symptoms, response to injection, pre-GON/TPI posterior vertex sensation changes to pinprick, cervical spine examination, and response to vibration of cervical and suboccipital musculature.

RESULTS:

: Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).

CONCLUSIONS:

: A wider spectrum of cervically mediated symptoms may exist by influence of trigeminocervical and vestibular circuitry through cervical afferent neuromodulation. Certain examination findings may help to predict benefit from GON/TPI.

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posted by Dr Shapira at 7:21 PM

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