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Wednesday, November 25, 2015

Quality of Life Considerations in Migraine and Chronic Daily Headache Treatment

This was originally published as a Blog for www.ThinkBetterLife.com and my Highland Park Illinois office that serves Highland Park, Lake Forest, Dererfield, The entire North Shore, Chicago, Lake County and Cook County. The office is conveniently located on the Metra line North at the Fort Sheridan stop.  The office is dedicated to treatment of Chronic pian, TMJ disorders and sleep disorders including migraines, trigeminal neuralgia, and chronic daily headaches.
Migraines, Chronic Daily Headaches, Tension Headaches and the Trigeminal Autonomic Cephalgias are all extremely invasive and disruptive to overall quality of life.
Medications to treat these disorders are often dangerous and have multiple side effects that range from minor to life threatening.
Medication Overuse Headaches and Rebound Headaches can actually be worse than the original problem the medications are used to treat. Even ubiquitous drugs like Ibuprofen are responsible for thousands of deaths on a yearly basis and a host of GI problems.
The two ways to approach headaches treatment is to prevent the onset or to treat the actual headache when it occurs.
Preventing the onset can be the avoidance of headache triggers and /or drug treatment.
I am not discussing drugs for treating migraines in this paper but rather alternative to stand drug therapies.
An excellent alternative that is more effective than most drugs for most people is the Sphenopalatine Ganglion Block. There are several methods of preforming SPG Blocks some of which require a visit to the doctor and others that can be preformed by the patient in the comfort of their own homes. The Sphenopalatine Ganglion is the largest parasympathetic ganglion in the head. The block turns off sympathetic overload often called the Fight or Flight reflex that can be a major headache/migraine trigger.
The best method is the intranasal approach by the patient to be reviewed later in this article.
There are multiple methods of injection. The injection thru the Greater Palatine foramen is an intraoral injection that is routinely used in dentistry. Oral Surgery procedures often require this block for removing wisdom teeth. Many patients who have maxillary wisdom teeth removed experience a respite from migraines often for an extended time. More often than not the migraine relief is from the block not the removal of the teeth. The block can be done just to turn off a severe headache or as a migraine preventive. It is often accompanied by temporary facial numbness and numbness of the palate.
Injection can also be done extraorally either from above the zygomatic arch or through the masseter muscle. I prefer the approach that avoids the muscle. It is a relatively easy injection and can be done in the office. It is also done by some doctors using video fluoroscopy but that gratly increases the cost. This method of injection is the most effective and fastest onset often relieving the headaches in a minute or two.
This is ideal SPG approach for headaches that would put patients in the ER, migraines or severe headaches of several days duration, and especially headaches related to anxiety, stress and worry.
There are also three devices that can deliver local anaesthetic to the nasal mucosa that overlies the Sphenopalatine Ganglion. The three devices are the TX360 nasal applicator using the MiRX protocol. Its is intended for use for Trigeminal Neuralgia, Migraines, Cluster Headaches and Tension Headaches. It is essentially a high tech double barreled squirt gun that is designed to deliver anesthetic solution over the area covering the Ganglion.
The Sphenocath and the Allevio devices are simpler to use and may deliver the anaesthetic solution in a slightly superior position. The Sphenocath is the original device and the Allevio is a copy made by the Sphenocath ‘s original manufacturer.
My preferrd method when nasal passages are large enough is to utilize hollow cotton tipped applicators that use a capillary action to continually deliver anaesthetic over a longer period of time.
The beauty of this approach is that patients can self apply the block in minutes at an extremely low cost. They can turn off the headache faster than any drugs take effect and Lidocaine or other anesthetic can be used.
Side effects are feeling relaxed, turning off fight or flight response, reduced anxiety, increased parasympathetic actiity such a digestion, feelings of warmth and comfort, increased sexual desire and responsiveness, lower blood pressure and other positive effects.
The most effective method of eliminating triggers is through a diagnostic neuromuscular orthotic that can be created to decrease noxious input to the trigeminal nervous system that causes headache. The diagnostic appliance allows evaluation of the effect in a safe and cost effective approach prior to comencine and dental, orthodontic or orthopedic interventions.
The combination or SPG Blocks and Neuromuscular Dentistry may be the closest we will ever come to curing migraines and other trigeminal type headaches.
Drug treatments are directed at changing neurotransmitter and neuropeptide levels by drug interaction. Neuromuscular Dentistry and SPG Blocks do it by restoring homeostasis and eliminating noxious input to the trigeminal nervous system.
The noxious input causes the ultimate release of neuropeptides by the TrigeminoVascular System like CGRP or Calcitonin gene Related Peptide in the meninges in the anter two thirds of the brain which cause vascular headaches,
It also corrects input to the trigeminal cervical complex that is responsible ofr occipital headaches, while at the same time postural corrections of the head reduce excess cervical muslce activity and makes the spine, especially C1 and C@ or the Atlas and Axis more stable. The mechanics have been well explained in the Quadrant Theorem of Guzay.

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posted by Dr Shapira at 10:46 AM

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