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Monday, February 20, 2017

Cluster Headaches and Trigeminal Autonomic Cephalgias, TMJ Disorders and Neurostimulation

Various stimulators can be used for treating migraines and cluster headaches. A 50-70% reduction in Trigeminal Headaches was seen by  stimulation of the Deep Brain, the Sphenopalatine Ganglion and with occipital stimulation.  The Trigeminal-Autonomic reflex is key to understanding these types of headaches.
Neuromuscular Dentistry also utilizes stimulation of the Trigeminal Nervous System to create muscle relaxation as well as central effects.  Neuromuscular Dentistry reestablishes a healthy homeostasis within the Trigeminal Nervous System by the use of a diagnostic neuromuscular orthotic.  This treatment allows patients to maintain a healthy neurological state and healthy condition of trigeminaly innervated muscles.  In addition, postural correction also occur which reduce occipital headaches.

The use of neuromuscular dentistry and SPG Blocks or Sphenopalatine Ganglion Blocks can give remarkable long lasting relief.

Permanent correction will prove to curative for a significant number of patients but should only be considered after suitable trial period.  There are many patient videos on Reddit attesting to the amazing effects of neuromuscular Dentistry and SPG Blocks.  Combination of these techniques gives patients multiple pathways to a better quality of life.

I have practiced neuromuscular dentistry since 1980 and learned from Barney Jankelson , the genius who created the field.  I currently practice Neuromuscular Dentistry in Chicago in my two offices in Highland Park and Gurnee.  Treatment of TMJ disorders will frequently also eliminate Migraines, cluster headaches and many other chronic pain conditions.

The Highland Park office website is www.ThinkBetterlife.com

The Highland Park office is www.DelanyDentalCare.com




PubMed Abstract:
 2017 Feb;57(2):327-335. doi: 10.1111/head.12874. Epub 2016 Aug 4.

Cluster headache and other TACs: Pathophysiology and neurostimulation options.



The trigeminal autonomic cephalalgias (TACs) are highly disabling primary headache disorders. There are several issues that remain unresolved in the understanding of the pathophysiology of the TACs, although activation of the trigeminal-autonomic reflex and ipsilateral hypothalamic activation both play a central role. The discovery of the central role of the hypothalamus led to its use as a therapeutic target. After the good results obtained with hypothalamic stimulation, other peripheral neuromodulation targets were tried in the management of refractory cluster headache (CH) and other TACs.


This review is a summary both of CH pathophysiology and of efficacy of the different neuromodulation techniques.


In chronic cluster headache (CCH) patients, hypothalamic deep brain stimulation (DBS) produced a decrease in attack frequency of more than 50% in 60% of patients. Occipital nerve stimulation (ONS) also elicited favorable outcomes with a reduction of more than 50% of attacks in around 70% of patients with medically intractable CCH. Stimulation of the sphenopalatine ganglion (SPG) with a miniaturized implanted stimulator produced a clinically significant improvement in 68% of patients (acute, preventive, or both). Vagus nerve stimulation (VNS) with a portable device used in conjunction with standard of care in CH patients resulted in a reduction in the number of attacks. DBS and ONS have been used successfully in some cases of other TACs, including hemicrania continua (HC) and short-lasting unilateral headache attacks (SUNHA).


DBS has good results, but it is a more invasive technique and can generate serious adverse events. ONS has good results, but frequent and not serious adverse events. SPG stimulation (SPGS) is also efficacious in the acute and prophylactic treatment of refractory cluster headache. At this moment, ONS and SPG stimulation techniques are recommended as first line therapy in refractory cluster patients. New recent non-invasive approaches such as the non-invasive vagal nerve stimulator (nVNS) have shown efficacy in a few trials and could be an interesting alternative in the management of CH, but require more testing and positive randomized controlled trials.


hypothalamus; migraine pathophysiology; neuromodulation; trigeminal autonomic cephalalgia

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posted by Dr Shapira at 6:34 AM

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