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Friday, July 31, 2015

Chicago: Occipital Headaches, Migraines and Occipital Neuralgia. Are Occipital Nerve Blocks the Answer?

Chronic migraines, chronic daily headaches sinus headaches are all issues arriving in the Trigeminal Nervous System and are in many ways the same problem.related.  Occipital headaches and occipital neuralgias have a different origins but there is a tremendous crossover both neurologically and structurally.

At the end of this article are patient testimonial videos but it is important to understand the concepts before watching the videos.

According to Johns Hopkins occipital neuralgia is "Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply these regions.
Irritation of one these nerves anywhere along their course can cause a shooting, zapping, electric, or tingling pain very similar to that of trigeminal neuralgia, only with symptoms located on one side of the scalp rather than in the face. Sometimes the pain can also seem to shoot forward (“radiate”) toward one eye. In some patients the scalp becomes extremely sensitive to even the lightest touch, making washing the hair or lying on a pillow nearly impossible. In other patients there may be numbness in the affected area. The region where the nerves enter the scalp may be extremely tender." 

What Johns Hopkins does tell patients is that the position of the head , jaw and neck are closely related and that neck and jaw problems caused by  overclosure  or malpositioning of the mandible can create excessive pressure on posterior nerves and muscles .

Johns Hopkins says "Occipital Neuralgia may occur spontaneously, or as the result of a pinched nerve root in the neck (from arthritis, for example), or as the result of prior injury or surgery to the scalp or skull. Sometimes “tight” muscles at the back of the head can entrap the nerves." but they ignore the easiest to fix problem, the bite.

The Quadrant Theorem of Guzay clearly shows the relation of the head and jaw position to the first two cervical vertebrae.  These connections are the structural key to understanding how neck problems interact with the Trigeminal Nervous System and the TrigeminoVascular system to cause headaches.
Whenever the answer to a problem requires different professions to work together  patient frequently suffer form incomplete or partial treatment.
I posted this in response to a question about occipital nerve blocks on Reddit.com  

Migraines and Occipital Nerve Blocks

Occipital and greater occipital blocks are very good at relieving a severe headache (migraine or muscle) but not preventing future ones. Trigger point injections should follow the occipital nerve block to decrease future headaches and with the block they are painless. The headaches relieved are marked by the dermatone figure.https://en.wikipedia.org/wiki/Greater_occipital_nerve#/media/File:Gray784.png.
Remember, most migraines and headaches can have cervical input but are primarily trigeminal in nature as seen in above dermatone
SPG blocks are far more effective for turning off an acute migraine and have a longer effect and help reduce future migraines.
Headaches and migraines (almost 100%) are caused (mediated) by the Trigeminal nerves. The Sphenopalatine Ganglion is a parasympathetic ganglion and blocking it has been shown effective in treating and turning off migraines. Parts of trigeminal nerve pass thru SPG. A block can be performed from a facial approach, an intraoral approach or an intranasal approach. Intranasal can be performed at physicians office or prophylactically at home to eliminate most headaches and migraines. For Acute pain facial injection is the best choice, to eliminate future headaches daily or twice daily appllication is best choice. Newer methods such as Sphenocath or TX360 are done periodically at physicians office. Less effective than injections for acute pain.
The dermatone chart shows distribution of Trigeminal vs occipital (cervical) nerves. Occipital or greater occipital block only addresses cervical component not the central trigeminal component of headache or migraine.
The Trigeminal Nerve is where almost 100% of headaches arise. This is usually due to nociceptive input into the trigeminal nerve. This is where Botox has an effect. There are better alternatives that don't involve injecting toxins to decrease nociception to Trigeminal Nerve.
The NTI appliance is FDA approved to prevent migraines and is a small oral appliance. It works for some people but can cause a host of adverse effects (much less than drugs). Neuromuscular Dentistry is the best way to decrease nociception into the Trigeminal Nervous System and can eliminate migraines or severely decrease frequency and severity.www.ICCMO.org represents neuromuscular dentistry at its best. There are qualified neuromuscular dentists (NMD)who are not members of ICCMO but the best NMD are usually members of ICCMO the premiere research and education group founded by Barney Jankelson, the father of Neuromuscular Dentistry.
All neuromuscular dentists are not the same.
All neuromuscular dental treatment should begin with a diagnostic neuromuscular orthotic and it is important to only consider other treatment if very significant improvement in headaches and migraines is seen within 5-7 visits.
A long term stabilization may be necessary but this does not mean you need reconstruction. Long tem removable orthotics are a very viable option as is orthodontics, Epigenetic orthodontics (DNA APPLIANCE)

The long term stabilization is key to controlling occipital neuralgia and headaches .

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posted by Dr Shapira at 10:58 AM

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