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Friday, March 27, 2015

VASCULAR HEADACHES AND TMJ DISORDERS; VASCULAR CHANGES IN MIGRAINE MEDIATED BY THE TRIGEMINAL NERVE.

This article on Migraine discusses a physiologic basis for migraine.   While it does not mention TMJ, Neuromuscular Dentistry or the trigeminal nerve .  The control of blood flow to the anterior two thirds of the meninges of the brain is controlled by the trigeminal nerve.  This is the nerve that neuromuscular dentistry is primarily concerned with.  By correction of masicatory physiology we effect the vascular vessels involved in migraine.



Evidence for a vascular factor in migraine.
Asghar MS, Hansen AE, Amin FM, van der Geest RJ, Koning PV, Larsson HB, Olesen J, Ashina M.

Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Abstract
OBJECTIVE: It has been suggested that migraine is caused by neural dysfunction without involvement of vasodilatation. Because dismissal of vascular mechanisms seemed premature, we examined diameter of extra- and intracranial vessels in migraine without aura patients.

METHODS: A novel high-resolution direct magnetic resonance angiography imaging technique was used to measure arterial circumference of the extracranial middle meningeal artery (MMA) and the intracranial middle cerebral artery (MCA). Data were obtained at baseline, during migraine attack, and after treatment with the migraine abortive drug sumatriptan (a 5-hydroxytryptamine agonist).

RESULTS: We found dilatation of both MMA and MCA during migraine attack (p = 0.001). Sumatriptan administration caused amelioration of headache (p < 0.001) and contraction of MMA (p < 0.001), but MCA remained unchanged (p = 0.16). Exploratory analysis revealed that in migraine attacks with half-sided headache, there was only dilatation on the headache side of MMA of 12.49% (95% confidence interval [CI], 4.16-20.83%) and of MCA of 12.88% (95% CI, 3.49-22.27%) and no dilatation on the nonheadache side of MMA (95% CI, -4.27 to 11.53%) and MCA (95% CI, -6.7 to 14.28%). In double-sided headache we found bilateral vasodilatation of both MMA and MCA (p < 0.001).

INTERPRETATION: These data show that migraine without aura is associated with dilatation of extra- and intracerebral arteries and that the headache location is associated with the location of the vasodilatation. Furthermore, contraction of extracerebral and not intracerebral arteries is associated with amelioration of headache. Collectively, these data suggest that vasodilatation and perivascular release of vasoactive substances is an integral mechanism of migraine pathophysiology. ANN NEUROL 2011.

Copyright © 2010 American Neurological Association.

posted by Dr Shapira at 8:43 AM

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