Dr. Shapira's Chicago Headache Blog

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Saturday, February 14, 2015

LAKE FOREST: TENSION HEADACHES, CHRONIC DAILY HEADACHE, MIGRAINE, CLUSTER HEADACHE AND CHRONIC MIGRAIN

Diagnosis of a particular type of headache is often the worst event for a headache patient.  All headaches are multifactorial and there are many aspects to prevention and treatment.  Unfortunately once the headaches are labeled many patients experience their doctors wearing Blinders and all diagnosis and treatment decisions are outside of the blinders are never considered.  At my new office in Highland Park I take an open approach to chronic pain.  The labels do not help and often interfere with treatment. Visit www.thinkbetterlife.com the website for my HighlandPark office.
There is one common thread to almost 100% of all chronic headaches, the involvement of the Trigeminal Nerve. There is no universal agreement on the sequence or causes of headaches but there is agreement that there are various triggers to most headaches.
Effective Treatment to Prevent, Treat and Eliminate the spectrum of headaches should include a primary Trigeminal Component.
Our nervous system has a Somatic Division which is divided into Sensory and Motor Nerves and an Autonomic component which has a Smpathetic and Parasympathetic components.
Before discussing more common headaches and migraines lets consider a special group of headaches called the Trigeminal Autonomic Cephalgias that includes Cluster Headaches, Paroxysmal Hemicrania and the SUNCT / SUNA headaches or Short Unilateral Neuralgiaform Headache with Conjuctival Injection. All of these often present with severe sudden onsets and initially should be evaluated with either/or CAT Scans and MRI’s to rule out tumors and/or vascular bleeds. I will discuss these special autonomic headaches in more detail in a future post. These headaches frequently can be prevented and allieved in many cases by Neuromuscular Dentistry and by changing Trigeminal Input with a Diagostic Orthotic. More information can be found at www.ihateheadaches.org and http://www.neurology.org/content/74/11/e40.full
Another special type of headache or cranial pain disorder is Trigeminal Neuralgia or Tic Douloureux known for sudden stabbing pain usually unilaterally in the face. Tic Doulourex is considered one of the most severe types of pain a person can experience earning it the name “The Suicide Pain” because of patients taking their life. Trigeminal Neuralgia will also respond to initial treatment with a Neuromuscular Diagnostic Orthotic though radical (and dangerous) therapy may be required.
Tension headaches, muscle spasm headaches, chronic daily headaches, cervicalgia headaches, sinus headaches, TMJ headaches are some of the names given to pain coming primarily from muscles. I would characterize this group of headaches as MPD or Myofascial Pain and Dysfunction in nature. It is associated with taut muscle band and trigger points. The primary cause of all of these in the head and neck is repetitive strain injuries and are ideally treated with Neuromuscular Diagnostic Orthotics as The First Line of treatment. Correction of underlying orthopedic and functional conditions can lead to a lifetime of better health. This treatment is often called TMJ treatment but that is always an oversimplification.
The postural train goes from the jaws to the feet (or hips when sitting) and changes in one area affect all areas. The terms Cranial Sacral Therapy, Sacral Occipital Therapy, and the fields of Chiropractic Medicine, Osteopathic Medicine Physiatry, Physical Therapy, and Naprapathy are all about treating problems between the reset points. Correction of end points are necessary for long term results.
The three endpoints are the bite including the upper and lower jaws including the TMJoints, the feet when standing and the hips when sitting. It is incredibly important to stabilize end points.
The Jaw is the single most important end-point in regards to headaches. This is because it is home to the majority of Trigeminal Nerve input to the brain. The Trigeminal nerve accounts for over 50% of all input to the brain after amplification by the Reticular Activating System. If Nociceptive (painful) inputs are brought into the brain chronic headaches is a frequent outcome. In computer lingo “Garbage in….Garbage Out” where Garbage is pain. The Trigeminal nerve innervates the teeth, the periodontal ligaments, the jaw joints, the jaw muscles, the tongue, soft palate, uvula, the tensor of the ear drum, the muscle that opens and closes the eustachian tube, the lining of the sinuses and MOST IMPORTANT, the Trigeminal Nerve controls the blood flow to the anterior two thirds of the meninges of the brain. This is the connection to all vascular and neurogenic headaches including previously discussed Autonomic Trigeminal Cephalgias and Trigeminal Neuralgia.
All headaches are basically primary or secondary results of input-output errors of the information the Trigeminal Nerve brings into the brain. This input causes chemical changes in the brain through the synapses. This changes blood flow and muscle function, posture, breathing and more.
The NHLBI of the NIH published a report”The Cardiovascular and Sleep -Related Consequences of TemporoMandibular Disorders"  discussing the wide spread affects of TMJ disorders. www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf
This should be read by all headache patients.
I n the past I have seen patients who have lived with chronic pain for most of their lives only to find out there was treatment that could relieve their pain.  One patient had continuous headaches for over fifty years in spite of being married to a physician.  After two visits she was out of pain but also very angry.  Why did she have to live with constant headache pain when treatment was so simple.  The reason is what I call circle of knowledge.  There are thousands of excellent, well educated physicians and specialists who love helping patients and stay abreast in their knowledge.  Unfortunately, even the best and brightest don't know what they don't know.  Often, they have seen a failure in one patient and assume it applies to all patients.
Each patient is unique as is the source and causes of their pain.  A good physician listens to their patients, hears what they express and believes what their patients tell them.  Many patients feel like their doctors don't believe them about the severity of their pain which is very frustrating. 


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posted by Dr Shapira at 7:19 AM

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