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Sunday, November 20, 2011

Chronic Daily Headache: Neurological Sciences Study Showed 17 of 20 Patients Required Neurmuscular Orthotic

A neuromuscular orthotic is used to correct occlusal discrepancies that can cause chronic daily headaches, migraines and tension-type headaches.The current study (abstract below) showed that 85% of patients with chronic daily headache has significant discrepancies between their occlusion and their ideal neuromuscular position.

The majority of dentists treating TMJ disorders and chronic head and neck pain are lost when it comes to establishing the neuromuscular position. The neuromuscular rest position and occlusion can only be determined after uilizing ultra-low frequency TENS to relax muscles and deprogram the occlusion.

I prefer the term Diagnostin Neuromuscular Orthotic because even though Neuromuscular Dentistry is extremely effective it is imprortant to establish success prior to long term restoration. The diagnostic orthotic is used to find this three dimensional relaxed position.

I see chronic headache and TMJ disorder patients on a long distance basis. The first series of appointments are to establish improved posture and a functionally correted Diagnostic Neuromuscular Orthotic.

I will have my out of town patients arrive on Sunday and then see them Monday AM for diagnostic evaluation, radiographs, impressions and examination. I then deliver the Diagnostic Orthotic Monday afternoon. It is adjusted Tuesday AM and PM and on Wednesday morning. This protocol allows me to send patients home after a short series of appointments with a functionally corrected neuromuscular diagnostic orthotic. I frequently will also do trigger point injections, SPG blocks and other physical therapy modalities.

I insist I receive a complete history and conduct a phone interview prior to giving the patient an appointment. This is essntial to be able to rapidly help patients get relief from chronic daily headaches, migraines and head and neck pain.
Neurol Sci. 2011 May;32 Suppl 1:S161-4.

Chronic daily headache: suggestion for the neuromuscular oral therapy.


Fondazione IRCCS Cà Granda, Dipartimento di Scienze Chirurgiche Ricostruttive e Diagnostiche Sezione di Odontostomatologia, Università degli Studi di Milano, Via della Commenda 10, 10122 Milan, Italy.


Tweny patients (M: 4, F: 16, mean age 37 ± 11 years) with diagnosis of chronic daily headache (CDH), after drug withdrawal, were under electromyography, kinesiography and masticatory muscle deprogramming by TENS to identify the physiological rest position of the mandible. Our purpose was to clarify a possible role of the neuromuscular stomatognathic system. Examinations showed that 17 patients needed a neuromuscular orthosis, an occlusal device, to provisionally correct the detected discrepancies of jaw position. Of those, the 10 patients who showed an occlusal sagittal discrepancy higher than 2 mm and/or a lateral deviation higher than 0.4 mm, associated with more than three parafunctional activities, had a meaningful decrease on frequency/intensity of migraine crisis and/or of days of headache. VAS pain score during crisis decreased from 9.0 ± 0.9 to 4.9 ± 2.7; frequency of crisis were from 20.7 ± 5.2 to 9.5 ± 7.7. Baseline pain were from 5.3 ± 1.2 to 3.0 ± 1.3. Satisfying clinical results can be reached combining behavioural education and neuromuscular orthosis. This can be very helpful in patients who show significant discrepancy of jaw position that only TENS deprogramming can reveal and kinesiography can detect with such accuracy.

[PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 2:53 PM

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