Showing posts with label Chicago. Show all posts
Showing posts with label Chicago. Show all posts

Wednesday, December 26, 2018

Migraines, Cluster Headaches and Tension-Type Headaches: What is Fastest and Most Effective Treatment? What is the Safest Treatment?

The pain, agony and suffering associated with headaches of all types can rapidly destroy your quality of life.   The suffering while waiting for medication to take effect can be maddening.  This is even more true when an individual has chronic severe headaches.

The most common approach of patients is to try over the counter medications that all have similar issues with slow onset and negative side effects.  Effectiveness varies and often only minimal or partial relief is obtained.

Non-steroidal anti-inflamatories  (NSAID) are probably the most common headache medication used.  This includes aspirin (Bayer), ibuprofen (Advil or Motrin), naproxen  (Allieve) and etedolac.  All of these drugs are excellent anti-inflamatories and all of them have serious side effects including GI disturbances including gastric reflux, burning, ulcers, esophageal burns, and increased bleeding times. 

 The biggest issue is not the negative and often dangerous side effects but the  lack of effectiveness and slow onset.

Tylenol or Acetaminophen is even less effective but usually does not cause GI distress but can cause permanent liver damage especially if taken with alcohol.  Again the biggest issue is poor pain relief and  the  considerable time it takes  to reach effective blood levels to treat the pain.

Pain is felt in the Limbic System where we feel emotion.  When patients are suffering severe pain their emotional level plummets. 

The National Headache Foundation recommends a Triple-Combination Medication  of acetylsalicylic acid, (aspirin), acetaminophen, and caffeine for tension-type headaches.  Unfortunately, this still requires absorption in thee GI tract and carries the same risks as the individual drugs.  Excedrin is a combination medication with these ingredients.  Excedrin and Excedrin Migraine are actually the same medication.

Compare these OTC Drugs and response time to Self-Administered Sphenopalatine Ganglion (SPG) Blocks which typically utilize 2% lidocaine, a natural anti-inflammatory that is often given to stabilize a patients heart beat but is best known  as dental anesthetic.  

Patient's can self-administer an SPG lidocaine block in minutes and relief for Migraine and Cluster Headaches can be almost immediate.  SPG Blocks are especially effective for Tension-Type Headaches and other Trigeminal Nerve associated headaches.

Sphenopalatine Ganglion Blocks can be administered in physicians offices and in Emergency Departments utilizing a nasal catheter such as a Sphenocath, Allevio or TX360.  These are all specialized catheters designed to "squirt" lidocaine to the mucosa covering the Sphenopalatine Ganglion where it sits in the pterygopalatine fossa.  The Sphenopalatine is also known as the Pteerygopalatine Ganglion, named for where it is found.

 While these "squirt gun technique" blocks are effective and can also give almost immediate relief they are also expensive and the patients life is disrupted by the headache and the need to travel for the  headache treatment.

The use of cotton-tipped nasal catheters allows the patient to self-administer SPG Blocks.  This  can be used prophylactiically to prevent headache occurrence as well as to alleviate headaches at initial onset before their increasing severity disrupt patient's lives.

Most physicians do not train patients to self-administer these blocks but it is an easily learned procedure utilized for  over 100 years.

The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head and is part of the Autonomic Nervous System.  The Sympathetic nerves are also part of the autonomic nervous system and are involved in the "fight or flight" reflex which is also known as the stress reflex. 

 The Sphenopalatine Ganglion is also known as the SPG, the Pterygopalatine Ganglion, the Nasal Ganglion, Meckel's Ganglion and Sluder's Ganglion after the physician who first described it's role in treating headaches in 1908.

While many medications can be utilized with SPG Blocks there is no study that has shown anything to be more effective than lidocaine.  Lidocaine is a natural anti-inflamatory with positive cardiac effects in the presence of irregular heart rhythm.  It is commonly utilized as dental anesthetic.

Drugs.com list 66 drugs to treat migraines, including triptans but none have been shown to be more effective than SPG Blocks though there is a massive amount of drug side effects associated with these medications.  All of these medications can be helpful and  SPG Blocks are safe to be used in combination with any headache or migraine medication.

Most importantly,  SPG Blocks can give the fastest relief possible with the lowest risk of medication side effects.  Patient may find that if they self-administer SPG Blocks they require far lower doses of medication if they need it at all.

There are side effects to Sphenopalatine Ganglion Blocks but in general they are positive.  About 1/3 of essential hypertension can be cured with SPG Blocks.  SPG Blocks can relieve anxiety, depression and stress.  The blocks can relieve a wide range of eye, ear, nose , sinus and jaw pains.  A 1930 article "Sphenopalatine Phenomena"  by Hiram Byrd in Annals of Internal Medicine (JAMA) showed almost 100% success in 10,000 blocks in 2000 patients with virtually no negative side effects.

This amazing technique almost became lost as part of forgotten medicine when Big Pharma and pharmaceuticals changed medicine starting in the 1940's.  This technique may have been lost forever but returned after the publication of a popular book "Miracles on Park Avenue" which detailed the practice of Dr Milton Reder an octogenerian  New York City Otolaryngologist whose entire practice focused on treating patients utilizing only Sphenopalatine Ganglion Blocks.

Injection of the Sphenopalatine Ganglion may be a way to increase effectiveness of the block in an acute severe headache.  Dentists are the experts at the intraoral injection through the greater palatine canal.  Extra-oral injections may be done via the Suprazygomatic Approach without fluoroscopy, usually by a Neuromuscular dentist trained in treating TMJ /TMD and orofacial pain or ENT's with extensive experience in treating chronic pain patients.

Sphenopalatine Ganglion Blocks are also very effective for treating TMJ disorders and associated Myofascial Pain and Dysfunction.  TMD and MPD are the primary underlying cause of all tension headaches and muscle contraction headaches.  

Neuromuscular Dentistry utilizes the Myomonitor that has a fifty year safety record as a neuromodulation unit for the trigeminal and facial nerves as well as the sympathetic and parasympatheetic fibers of the autonomic system that pass thru the SPG.

The use of a Diagnostic Neuromuscular Orthotic is often the first step in permanently eliminating Tension-Type Headaches.

Learn more at www.SphenopalatineGanglionBlocks.com

Friday, September 14, 2018

Preventing Seizures with Sphenopalatine Ganglion Blocks

The Sphenopalatine Ganglion Block had many uses in the past many of which became forgotten medicine with the onset of new pharmaceuticals.  Seizures were once treated with SPG Blocks as described in "Sparer W. Cessation of convulsive seizures following injection of alcohol into spheno-palatine ganglia. Three Cases."

Sphenopalatine Ganglion Blocks are safe, easy to administer and still have a place in treatment of seizures resistant to medications and in patients where medication may be inappropriate.

Self-Administration allows patients to self administer the blocks at home for prevention of seizures.  This avoids the more invasive alcohol block.

Wednesday, April 18, 2018

HATE YOUR CPAP? Get INSPIRED! New Device Treats Sleep Apnea successfully


INSPIRE is a new therapy for Sleep Apnea.

CPAP  and Oral Appliances have been the first line treatments for mild to moderate sleep apnea and CPAP is the gold standard for severe sleep apnea.

While CPAP is extremely effective only 25% of patients actually utilize t as prescribed and 60% of patients refuse or fail CPAP completely.

Oral Appliances have been the choice of most patients who do not tolerate CPAP but these new studies show that there is a new effective treatment.  Studies have shown that over 90% of patients offered a choice of CPAP or an Oral Appliance chose the Oral Appliance therapy.  Chicago testimonials for Oral Appliance Therapy can be found at:  https://thinkbetterlife.com/category/blogs/

Now that there is a new player and patients have more choices, a very positive development.

Morbidly obese patients are probably still going to need CPAP but just as oral appliances are used with CPAP to lower pressure cotreatment with inspire will probably be possible as well.

Inspire or Hypoglossal nerve stimulation (HNS) therapy is the newest player on the block.

There are three new studies (abstracts below) on the use of Upper Airway Stimulation with the Inspire device.  This is GOD NEWS for patients who HATE CPAP!

North Shore Health System is the first in Chicago to offer Inspire Therapy.
https://www.northshore.org/sleep-center/procedures/inspire-therapy/

While there are risks associated with this therapy, they are low and the risks of untreated sleep apnea are much greater.


Conclusions in Upper Airway Stimulation for Obstructive Sleep Apnea:  5- Year Outcomes. showed Improvements in sleepiness, quality of life, and respiratory outcomes are observed with 5 years of UAS. Serious adverse events are uncommon. UAS is a nonanatomic surgical treatment with long-term benefit for individuals with moderate to severe OSA who have failed nasal continuous positive airway pressure.  The study showed the responder rate was 63% at 5 years and that there was a 6% rate of serious device-related events related to lead/device adjustments.

The study in  2018 Mar 2. pii: S0196-0709(18)30077-2. doi: 10.1016/j.amjoto.2018.03.003. "Uvulopalatopharyngoplasty vs CN XII stimulation for treatment of obstructive sleep apnea: A single institution experience.  tShowed that Inspire was more successful than traditional UP3 surgery with 65%  HNS patients achieving an AHI of under 5  ie HNS is  "curative" in the majority of patients. "For select patients, HNS therapy provides excellent objective improvement in outcome measures."





 2018 Mar 1:194599818762383. doi: 10.1177/0194599818762383. [Epub ahead of print]

Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes.

Abstract

Objective To present 5-year outcomes from a prospective cohort of patients with obstructive sleep apnea (OSA) who were treated with upper airway stimulation (UAS) via a unilateral hypoglossal nerve implant. Study Design A multicenter prospective cohort study. Setting Industry-supported multicenter academic and clinical trial. Methods From a cohort of 126 patients, 97 completed protocol, and 71 consented to a voluntary polysomnogram. Those having continuous positive airway pressure failure with moderate to severe OSA, body mass index <32 kg="" m="" span="" style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">2
, and no unfavorable collapse on drug-induced sleep endoscopy were enrolled in a phase 3 trial. Prospective outcomes included apnea-hypopnea index (AHI), oxygen desaturation index, and adverse events, as well as measures of sleepiness, quality of life, and snoring. Results Patients who did and did not complete the protocol differed in baseline AHI, oxygen desaturation index, and Functional Outcomes of Sleep Questionnaire scores but not in any other demographics or treatment response measures. Improvement in sleepiness (Epworth Sleepiness Scale) and quality of life was observed, with normalization of scores increasing from 33% to 78% and 15% to 67%, respectively. AHI response rate (AHI <20 and="" events="" hour="" per="">50% reduction) was 75% (n = 71). When a last observation carried forward analysis was applied, the responder rate was 63% at 5 years. Serious device-related events all related to lead/device adjustments were reported in 6% of patients. Conclusions Improvements in sleepiness, quality of life, and respiratory outcomes are observed with 5 years of UAS. Serious adverse events are uncommon. UAS is a nonanatomic surgical treatment with long-term benefit for individuals with moderate to severe OSA who have failed nasal continuous positive airway pressure.

KEYWORDS:

cranial nerve; device; device apnea hypopnea index; hypoglossal nerve; implant; long term; obstructive sleep apnea; polysomnogram; quality of life; sleep; sleepiness; surgery; upper airway stimulation
PMID:
 
29582703
 
DOI:
 
10.1177/0194599818762383

Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry.

Boon M, et al. Otolaryngol Head Neck Surg. 2018.

Abstract

Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients' symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.

PMID

 29557280 [ - as supplied by publisher]


 2018 Mar 2. pii: S0196-0709(18)30077-2. doi: 10.1016/j.amjoto.2018.03.003. [Epub ahead of print]

Uvulopalatopharyngoplasty vs CN XII stimulation for treatment of obstructive sleep apnea: A single institution experience.




Abstract

OBJECTIVES:

Hypoglossal nerve stimulation (HNS) therapy is an emerging surgical treatment for select patients with obstructive sleep apnea (OSA). This study aims to compare outcomes in patients with moderate to severe OSA who underwent HNS surgery (Inspire Medical Systems) and those who underwent traditional airway reconstructive surgery, specifically uvulopalatopharyngoplasty (UPPP).

METHODS:

Patients who underwent HNS implantation (n = 20), all with moderate to severe OSA, inability to adhere to positive pressure therapy, and compliant with previously published inclusion criteria, were compared to a historical cohort that were intolerant of CPAP with similar inclusion criteria who all underwent UPPP (n = 20) with some also undergoing additional procedures such as septoplasty/turbinate reduction. Data including body mass index (BMI), pre- and post-implant apnea-hypopnea index (AHI) were assessed.

RESULTS:

For patients who underwent HNS, mean preoperative BMI was 28.0. Mean AHI decreased significantly from 38.9 ± 12.5 to 4.5 ± 4.8. All patients achieved an AHI < 20 post implant with 65% (13/20) with an AHI ≤ 5. For patients who underwent traditional airway surgery, mean preoperative BMI was 27.5; mean AHI decreased from 40.3 ± 12.4 to 28.8 ± 25.4.

CONCLUSION:

While both traditional surgery and HNS are effective treatments for patients with moderate to severe OSA with CPAP intolerance, our study demonstrates that HNS is "curative" in normalizing the AHI to <5 excellent="" for="" hns="" improvement="" in="" majority="" measures.="" objective="" of="" outcome="" p="" patients.="" patients="" provides="" select="" the="" therapy="">

KEYWORDS:

Apnea hypopnea index; Hypoglossal nerve stimulation; Obstructive sleep apnea; Upper airway surgery; Uvulopalatopharyngoplasty
PMID:
 
29540289
 
DOI:
 
10.1016/j.amjoto.2018.03.003

Tuesday, March 20, 2018

Learn to Self Administer SPG Blocks in Chicago

WHERE CAN I LEARN TO SELF ADMINISTER SPHENOPALATINE GANGLION BLOCKS?

Dr ira L Shapira teaches patients to Self-Administer SphenoPalatine Ganglion Blocks in his Highland Park, Il office.

CONTACT DR SHAPIRA THRU HIS WEBSITE:  WWW.THINKBETTERLIFE.COM

LEARN MORE ABOUT SPG BLOCKS:  WWW.SPHENOPALATINEGANGLIONBLOCKS.COM

Sphenopalatine Ganglion Blocks were first decribed by Sluder in 1903.

Hiram Byrd wrote "Sphenopalatine Phenomena" in 1930 which was published in 1930 and reported phenomenal success in 10,000 SPG Blocks in 2000 patients

Forgotten Medicine:  New Medications and procedures become available and marketed but sometimes valuable medical procedures are forgotten in the process..


DR SHAPIRA'S STORY

In 1986 I learned about Sphenopalatine Ganglion Blocks from a patient who brought me the book, "Miracles on Park Avenue" and wanted me to find him a doctor who did the procedure in Chicago. I was amazed when I read the book and was dismayed when I could not find anyone in the Chicago area who did the procedure.

I learned the procedure from Dr Jack Haden in Kansas city that same year and I have used it ever since. Initially I did a lot of intra-oral injections through the greater palatine foramen because it was a "comfortable" injection for me to give in an area I routinely gave anesthetic. Later, I learned techniques for extra-oral injections which were initially outside my comfort zone. I have embraced them over the years for their ease and predictability.

 My Blog at www.SphenoPalatineGanglionBlocks.com has a wide range of information about Sphenopalatine Ganglion Block including indications and history of this "Miracle Block".
I also took a while to be comfortable with doing the trans-nasal block because it was outside my aera of comfort. I have done thousands of these over the years and have adapted my techniques. In the beginning I always brought the patients in to my office for me to do the SPG blocks.

I have always had long-distance patients who traveled to see me for TMJ treatment and neuromuscular treatment and UI would teach my patients how to treat and eliminate their pain between visits with Travell Spray and Stretch techniques. This was life-changing for my patients who could now turn off severe head, neck and facial pain as well as migraine without a trip to my office. This was initially difficult because pharmacies did not understand the prescriptions and vapocoolant spray was often hard for patients to buy.

Over time, it became routine for me to automatically offer this to all patients. I would also teach them the basic principles so they could relieve pain anywhere in their body.

Empowering patients to take control of their pain without prescription medications resulted in better patient care, fewer visits both to my office and to other physicians and emergency rooms in hospitals.
I later began utilizing home ULF-TENS (Myomonitor) units to my patients for home use rather than just in my office and againfound a tremendous improvement in my ability to care for my patients and in their quality of life.  The Myomonitor also acts as an at home on demand Neuromodulation device for the Sphenopalatine Ganglion.  The Myomonito has over a 50 year safety record.

Every time I empowered patients to self-care I was rewarded with great patient appreciation for my efforts. The same level of pain relief with fewer doctor visits improved the quality of thei lives. Truth is, "Quality of Life Sucks when you are in a Doctor's office or waiting in an ER.

Success rates for treatment improved with fewer visits and lower costs.  This link is to videos of patients who have experienced SPG Blocks.
 https://www.youtube.com/playlist?list=PL5ERlVdJLdtlk8PbufsI0l_MzHo4oOb6g

I used the Sphenopalatine Ganglion Block initially only as a measure of last resort, when other treatments were not working well. My patients who received SPG Blocks taught me that they did better when I did the blocks and the number of visits decreased while their quality of life increased. I remember when I first began to teach patients how to self-administer it was with great trepidation and I did blocks twice a day in the office for two days before teaching them to self-administer because I was worried about adverse reaction, even though they never occurred. Twice a day administration drastically improved the positive effects of the blocks as the blocks appeared to have a cumulative action and increased exposure in frequency and duration increased effectiveness.

I no longer reserved these for patients with TMJ and Facial pain but began to use them for Anxiety, depression and for problems like dental phobias and that were either difficult to treat or resistant to treatment. Gradually, I began to teach self administration to all my patients and found they appreciated having control.

Recently several devices have received FDA approval for delivering anesthetic to the area of mucosa overlying the Sphenopalatine Ganglion and physicians began to bring patients in for a series of 10 treatments (every two weeks) for $750.00 per treatment or $7500 for a course of treatment. (Blue Cross / Blue Shield recently stopped paying for these blocks calling them experimental but in reality I think they became too expensive) These devices are the Sphenocath, the Allevio and the TX 360. All devices are expensive and a single use device costs a physician about $75.00.
When I teach patients to self-administer SPG Blocks I no longer use the cotton-tipped applicators but have switched to cotton-tipped catheters that supply continual capillary feed to the mucosa over the Sphenopalatine Ganglion. This has, in my opinion increased the effectiveness far beyond any of the commercial catheters.

The Sphenocath, the Allevio and the TX 360 are all basically "squirt guns" that shoot a small amount of anesthetic over the mucosa covering the Sphenopalatine Ganglion. Ideally patients will remain supine for 10-20 minutes to increase absorption time.

The cotton-tipped catheter in contrast delivers a continual flow of anesthetic to the mucosa and can be kept in place for 20 minutes to several hours and can be refilled as needed. Due to the continual flow there is no reason to stay supine (on back) but with acute severe pain an initial supine position may increse speed of onset. The size of the cotton-tipped nasal catheter is larger than the other devices and there is certainly cases where I use a Sphenocath or TX360 in my practice. If I teach self-administration I have my patients use the Sphenocath because it is reusable at home. The TX360 can esily be utilized for self administration but is a single use device only.

The cost to the patient of doing a bilateral SPG block with cotton-tipped nasal catheters after initial appointments is less than $1.00. This is an enormous cost saving to the patient and to insurance companies and makes it far less expensive than almost any of the prescription medications available for treating migraine and chronic daily headaches.

In addition there are virtually no side effects from medication. I generally use 2% lidocaine that is extremely safe and has anti-inflammatory properties.

The biggest savings is in time and medical expenses as patient no longer have to leave work for medical visits or suffer long ER waits and thousands of dollars of expense. The biggest savings is TIME. It is the one thing that if we spend it we can never get it back.

I usually will start the self-administration protocol as twice daily for multiple reasons. The two main reasons is it offers better immediate control of even severe pain and secondly if a patient is doing it twice daily they rapidly develop a high level of expertise and can do it without problems in the future. In patients with tight nasal passages they tend to become easier to navigate over time with repeated applications.

I have taught patients from across the United States as well as International patients how to Self-Administer Sphenopalatine Ganglion Blocks.

This link is to over 100 videos of patients treated with Neuromuscular Dentistry, Trigger Point Injections, Sleep Apnea Appliances and SPG Blocks: https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

I used to use SPG Blocks only for patients with the most difficult problems, I was wrong.  I now believe it should be part of the diagnostic work-up for all headache patients before they receive medications and injections like BOTOX.

Chicago Metropolitan area has three airports: O'hare Airport, Midway Airport and Mitchell Field just south of Milwaukee.  O'hare and Mitchell are the most convenient to my office.  The office is also located on the North Line of Metra (Union Pacific to Kenosha) at the Fors Sheridan Train Station.

#spgblocks, #spgblockstrigeminalneuralgia, #spgblockmigraine, #spgblockclusterheadache, #selfadministrationspgblock, spgblocksideeffects, spgblockindications

Monday, March 19, 2018

HEADACHES due to Prevertebral Muscles and Retropharyngeal Tendonitis: Headaches often related to turning head upwards.

The prevertebral muscles and tendons are difficult to address and oftey interfere with healing and recovery.  They are frequently injured in whiplash injures and symptoms can linger for years or even decades.

"Headache attributed to retropharyngeal tendonitis" is classified by "The Third Classification of Headache Disorder, 3rd addition" 
Diagnosis Code 11.2.2

Raising of the eyes by tilting of the head can cause both referred pain, aching and headache.  These muscles and tendons extend over the top 3-4 vertebrae to the skull.   There is a frequent involvement of the upper cervicl complex.

While Neuromuscular Dental Orthotics address the majority of head and neck symptoms by  restoring structural and muscular balance NMD does not correct upper cervical vertebrae.

These can be addressed by specially trained osteopaths and chiropractors.  Atlas-Orthoganol chiropractors wok on the first vertebre (the Atlas) and the second vertebrae (the Axis) and their relation to the skull.   They deliver a precice adjustment to the upper cervical region.  NUCCA chiropractors address the same area utilizzing different techniques.  Both work well as does the osteopathic approach.

It is important to have a stable neuromuscular orthotic before doing the adjustment (on combination cases) and it is often necessary for a patient to have both adjustments on the same day.  Typically, the nuromuscular orthotic is corrected after the A/O adjustment.

I work closely with Dr Mark Freund on patients requiring upper cervical corrections.  https://www.northshoreatlas.com/atlas-orthogonal.

Addressing the fascial and muscular disorders of the prevertebral region is usually started by a very gradual passive gentle stretch with the patient laying on the floor with a very small towel roll under the shoulders allowing the head to extend and tip backwards.  If there is pain or discomfort the size of the towel roll is reduced.  Typically 20 minute sessions that also combine very slow diaphragmatic breathing will let these muscle release their taut bands and tension.  Overdoing the stretch impedes progress.

The scalene muscles are usually also involved in  creating problems but they can be addressed with ULF-TENS (Myomonitor), Spray and Stretch techniques, correction of paradoxical breathing issues and other physical modalities.

Sufficient Magnesium and calcium levels are important for muscle relaxation.
Feldenkrais and Alexander techniques work well in patients with these disorders as do Paul St John techniques.

All of these techniques work best with well balanced neuromuscular orthotics.  The Aqualizer appliance is a self balancing hydrostatic appliance that can also be extremely useful.  Italian studies show it relaxes muscles throughout the body.

I frequently have my patients walk and run up and down stairs in these appliances to let the body and spine unwind and the muscles relax prior to adjusting neuromuscular appliance.

Aqualizers are almost a necessity when having A/O adjustments for patients traveling from one office to another.

Cranial Manipulation is another instance where the Aqualizer is incredibly useful as a patient goes from cranial doctor to have his Neuromuscular Orthotic adjusted.

Dr Mark Freund also utilizes Cranial work.   https://www.northshoreatlas.com/cranial-suture-release

His Highland Park office is across the hall from my Highland Park office:
www.ThinkBetterLife.com

Prevertebral muscle and tendon issues can be very difficult and working with multiplle professionals is key to success.



Sunday, March 18, 2018

Headache Attributed to Acute Rhinosinusitis: Sphenopalatine Ganlion (SPG) Block is First Line Treatment

Headache caused by Acute Rhinosinusitis  (ICHD-3: 11.5.1 and Headache attributed to chronic or recurring Rhinosinusits (ICHD-3; 11.5.2) have specific diagnosis codes in the International Classification of Headaches but this does not answer the question of the best treatment for these disorders.

It is generally accepted that narcotics and other pain medications are probably not indicated (contra-indicated) in the majority of patients.

The treatment likely to give the fastest relief in these types of headaches is a Sphenopalatine Ganglion (SPG) Block which can often give almost instantaneous relief and also reduce anxiety and create a sense of general well being.

SPG Blocks are actually indicated as a treatment for Vasomotor Rhinitis.  The problem with this treatment is that it requires a trip to your physician, neurologist, ENT physician or emergency room.   I have taught hundreds of Neuromuscular Dentists (ICCMO.org) to use my technique.

Self-administration of Sphenopalatine Ganglion Blocks  is an easy procedure and ideally it can be done as an attack begins before the patient experiences increasing pain, anxiety or triggering of a more severe migraine headache.

I routinely teach patients to Self-Administer these blocks in my practice.
www.ThinkBetterLife.com.  I have also built a site dedicated to the art and science of Sphenopalatine Ganglion Blocks and to promote their use and the concept of self-administration.

This link is to an article on that site concerning sinus and nasal issues with SPG Blocks.

Vasomotor Rhinitis Treatment with SPG Block 

 https://www.sleepandhealth.com/vasomotor-rhinitis-treatment-spg-block-sphenopalatine-ganglion-blocks/

The following is a video of a man who became a physician after experiencing a Sphenopalatine Ganglion Block during an Acute Sinus Headache which gave him excellent relief.  He specifically became a physician to help patients but never learned the technique and after 10 years left the practice of medicine and became an artist.  I took this video the day he learned for the first time what a Sphenopalatine Ganglion Block was.
 https://www.youtube.com/watch?v=Sn46l_nH9-A

While the reason to do an SPG Block may be to treat the severe pain, long-term these "Miracle Blocks" can actually help the body recover from the original condition.  The book "Miracles on Park Avenue" detailed the practice of Dr Milton Reder an NY city ENT whose entire practice was delivery of SPG Blocks.

According to ICHD-3 these headaches can be mistaken for Migraine and Tension-Type Headache.  If the diagnosis is one of these other types of headaches the same block will still give almost immediate relief in a majority of patients.  This video is a patient who suffered severe migraines for 10 years shortly after she had her first SPG Block:
 https://www.youtube.com/watch?v=DCPLDRJ2twg&t=1s

What is the Sphenopalatine Ganglion?  It is the largest Parasympathetic ganglion of the head and is located in the Pterygopalatine fossa on the maxillary division of the trigeminal nerve.  It carries both somaticsensory nerve fibers and autonomic nerve fibers from both the sympathetic and the parasympathetic divisions.  It was originally described in 1903 bu Sluer and is often called Sluder's Ganglion.  It is also known as the Nasal Ganglion, the Pterygopalatine ganglion and  Meckel's ganglion.

Sluder described instant relief from "Sluder's Neuralgia" after a transnasal block.  This is now thought to be either a Cluster Headache or TMJ disorder.

There are multiple methods to preform Sphenopalatine Ganglion Blocks.  They can be done by intra-oral or extra-oral injections but are more commonly done with nasal catheters or cotton-tipped applicators.

There are three commercial nasal catheters available, the Sphenocath which is the first and the one I utilize in some patients with tight nasal passages.  The Allevio whic is similar to the Sphenocath.  The third type is the TX 360 that has a double barrel approach for delivering anesthetic to right and left nostrils. that I now have available in my office and is the device used specifically for the MiRx protocol.   They are all basically "squirt guns" designed to deposit anesthetic over the nasal mucosa the covers the very thin plate of bone covering the Sphenopalatine Ganglion.

My preferred method of delivery SPG Blocks is a cotton-tipped nasal catheter that delivers continual capillary feed of lidocaine to the same area where the Sphenocath, the Allevio and the TX 360 deliver anesthetic.  The nasal ctheter can be used straight from the package or can be adapted for even better results.

The reasons I utilize the cotton-tipped catheters are:
1.  It is very easy to teach the majority of patients to self-administer SPG Blocks.
2.  It is very cost effective allowing patients to self administer bilateral SPG blocks for less than $1.00.  The other devices are designed for single use and cost approximately $75.00 for the device.
3.  Continual capillary delivery is far more effective based on my observations and is more convenient for the patient.  Ideally using the other catheters that patient should lay supine (on back) for 20 minutes.  The continual feed allows the patients to continue to do their normal daily activities while the block is working.
4.  The block can be kept in for longer periods of time and can be used more frequently.  Repetitive blocks can  decrease frequency of headaches or eliminate them completely.
5.  They are easily modified and patients can self modify as needed.

Sphenopalatine Ganglion Blocks are considered to be an under utilized pain management technique.
 https://www.sphenopalatineganglionblocks.com/sphenopalatine-ganglion-block-underutilized-tool-pain-management/

The location of the Sphenopalatine Ganglion is very important and explains why Neuromuscular Dentistry is so effective in long term corrections of TMJ disorders and associated pain.  The Myomonitor used to relax the muscles is a
ULF-TENS that also acts on the Sphenopalatine Ganglia acting as a neuromodulation technique.  Neuromodulation of the SPG is being researched worldwide as a cure or treatment of migraines and other intractabler headaches.

There is a 50 year safety record of SPG neuromodulation with the Myomonitor.

Intractable/ Refractory Headaches and Migraines: SPG Blocks (Sphenopalatine Ganglion Blocks) May be the Fastest Safest Treatment

https://www.sphenopalatineganglionblocks.com/intractable-headaches-migraines-sphenopalatine-ganglion-spg-blocks-may-fastest-safest-treatment/

Friday, March 16, 2018

Migraine: Somatotosensory and Autonomic Nervous System Underlie Complex Pathophysiology. Treatment should address both systems.


The complex nature of migraines often leads to confusion, misdiagnosis and mistreatment.  There is an excellent article from the Journal of Neuroscience "Migraine: Multiple Processes, Complex Pathophysiology (abstract below).  Treatment of migraine can often be very easy but the traditional approach can make migraines more difficult to treat. 

Treatment and Elimination of headaches and migraines is most effective if it addresses both the Autonomic and Somatosensory nervous systems.

According to this paper " These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache. "  This means that it is a disturbance in Homeostasis of the brain.  It is important to understand this because the primary cause of changes occuring in the brain is from neurological and vascular input from the body.  The single largest source of input is through the Trigeminal Nerve.

Homeostasis is when all systems are in proper balance and actively respond to changes to restore thaty balance, ie Homeostasis.  This can be compared to a computer, when is is in balance all of software and hardware work correctly.  We have all had a computer crash or lock up.  This would be equivilant to losing Homeostasis.  We reset our computer with "Control /Alt /Delete" which turns off the computer and resets it to the correct settings.  The best way to treat migraines is to reset our brain to restore Homeostasis.  The reasons computers crash is usually an I /O or input /Output error or simply "GARBAGE IN / GARBAGE OUT"  This article will discuss resetting the brain or finding our Control/Alt/ Delete button for our brain to decrease or eliminate headaches and migraines.

Noxious input from the Trigeminal Nerve to the brain responsible for almost all headaches and migraines.  Noxious input is essentially  the "Garbage in".  If there is too much garbage in the computer crashes; in terms of our brain this would be symptoms of headache, migraine, dizziness, tinnitus or many other common symptoms. 

There are two types of nerves that travel through the Trigeminal Nervous System, Somatosensory nerves and Autonomic Nerves.  The Somatosensory Nervous  System is the part we are aware of using, how we move, use our muscles, and do most of our daily activities.  When there are issues with pain or dysfunction we adjust using the Somatosensory nerves.

The Autonomic Nervous System is where activities we don't control occur.  This can be heart rate, digestion, love, fear, how are pupils dilate or constrict in  response to light or we get goose bumps or shiver in response to cold or sweat in response to excessive heat.  We cannot voluntarily control these or have only partial control  

The Autonomic Nervous System is divided into two divisions the Sympathetic division and the Parasympathetic division.  The sympathetic division is responsible for preparing our bodies to take action.  The Sympathetic reflex is the "Fight or Flight reflex"  We send blood to our brain and muscles and get ready to defend ourselves or run like crazy.  For a more primitive lifestyle this is perfect but if you are sitting in a classroom or an office this reflex causes chronic stress.  

The Parasympathetic Division gives us the "Feed and Breed" or "Eat and Digest" reflex.  It sends blood to our gut, slows are heart rate, allows sleep, rest, feelings of love and friendship, puts you into the mood for romance, gives us the good feeling we get playing with babies, puppies and kittens.  If the Sympathetic reflex helps the indivdual survive the parasympathetic iprovides for survival of the species.

We require a balance of these two systems to survive and usually one or the other predominates depending on what is happening in our life.  If the sympathetic system gets "stuck on" we suffer from stress diseases.  This was first described by Hans Selye in his book "The Stress of Life"  He was one of the first to explain the adverse health effects of stress on our brain and body.  This includes headaches and migraines.

When we get out Sympathetic system "Stuck on" it creates problems and destroys the state of homeostasis leaving us "out of balance"  This is the equivilant of our computer crashing.  To reset our brain we need to reset our autonomic nervous system.  One reset button is the Sphenopalatine Ganglion (SPG) Block

For headaches, Migraines, Anxiety and Stress diseases the switch to reset our autonomic nervous system is the Sphenopalatine Ganglion located on the maxillary division of the Trigeminal Nerve in the Pterygopalatine fossa.  It is a small part of the brain outside the calvarium where most of the brain is and located behind the nose.  

A Sphenopalatine Ganglion (SPG) Block can reset the brain and turn off many types os sympathetic overloads, often giving instant relief of migraines, chronic headaches, tension-type headaches and cluster headaches.  Due to the position behind the nose it is easily accessible.  I will explain more about SPG Blocks later.

The second method that can easily reset brain and restore Homeostasis is thru Neuromuscular Dentistry.  Neuromuscular Dentistry utilizes an Ultra Low Frequency (ULF) TENS to relax muscles innervated by the fifth cranial nerve (trigeminal nerve) and the seventh cranial nerve (facial nerve).
While pulsing the muscles the myomonitor also acts as a stimulator or neuromodulator of the Sphenopalatine ganglion, resetting the autonomic nervous system and returning us to a state of Homeostasis.

Both methods of affecting the Sphenopalatine Ganglion return us to Homeostasis by different pathways.  The SPG Blocks can be done by injection but the most common method is by nasal catheter.  Three commercial devices utilized are the Sphenocath, the Allevio and the TX 360.  They are all basically squirt guns that squirt anesthetic to the mucosa over the Pterygopalatine Fossa that holds the Ganglion and are usually done in the ER or in a Neurologist's office.

The best method, in my opinion is to teach patients to self -administer SPG Blocks using cotton-tipped catheters that offer continual capillary feed of anesthetic to the area of the ganglion. Regardless of the method used SPG Blocks are a resetting mechanism for the Autonomic nervous system. 

Another part of the Autonomic Nervous System is the Stellate Ganglion and research has shown that  a single shot of anesthetic can "CURE PTSD" which is amazing!  I have found that patients with PTSD respond very well to repetitive self administered SPG Blocks as well.

All of these approaches address headaches, Migraines, Depression, Anxiety and other "Stress" disorders by restting the brain and restoring Homeostasis or Balance.  Neuromuscular Dentistry also restores balance thru the somatosensory system with the aid of the Myomonitor and the Diagnostic Neuromuscular Orthotic.

Compare these treatments to the typical drug approach where first one and then another drug is used to control headache pain, each and every drug has multiple side effects and change brain chemistry and neurotransmitters.  Drug overuse and withdrawal pains are common.  BOTOX uses a neurotoxin to disconnect muscles and brain rather than restoring them to a normal healthy state and healthy Homeostasis.

Are these otheer treatment bad?  No, they should just not be the first approach to healing which is to restore normal physiology and chemistry and allow healing by removing the impediments to healing.

Additional resources:
https://www.sphenopalatineganglionblocks.com/new-daily-persistent-headache-aka-chronic-headache-acute-onset-spg-blocks-ideal-first-line-treatment/

https://www.sphenopalatineganglionblocks.com/transformed-migraine-chronic-migraine-study-spg-blocks-vs-elavil/

https://www.sphenopalatineganglionblocks.com/new-studies-point-common-etiologic-cause-migraines-essential-hypertension-spg-blocks-missing-piece/

https://www.sphenopalatineganglionblocks.com/intractable-headaches-migraines-sphenopalatine-ganglion-spg-blocks-may-fastest-safest-treatment/
Logo of jneurosciThis ArticleAbout the JournalFor AuthorsSign up for AlertsThe Journal of NeuroscienceSociety for Neuroscience
. 2015 Apr 29; 35(17): 6619–6629.
PMCID: PMC4412887

Migraine: Multiple Processes, Complex Pathophysiology


Abstract

Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex. Once the headache develops, it typically throbs, intensifies with an increase in intracranial pressure, and presents itself in association with nausea, vomiting, and abnormal sensitivity to light, noise, and smell. It can also be accompanied by abnormal skin sensitivity (allodynia) and muscle tenderness. Collectively, the symptoms that accompany migraine from the prodromal stage through the headache phase suggest that multiple neuronal systems function abnormally. As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally. These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache. Advances in understanding the genetic predisposition to migraine, and the discovery of multiple susceptible gene variants (many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity) define the most compelling hypothesis for the generalized neuronal hyperexcitability and the anatomical alterations seen in the migraine brain. Regarding the headache pain itself, attempts to understand its unique qualities point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorbital area and the eye, and intensifies when intracranial pressure increases.
The entire article is available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412887/

New Daily Persistent Headaches: Ideally Treatment Should Be To Reset The System

Neuromuscular Dentistry is excellent at treating a wide variety of headaches and migraines and can quickly restore a patient with New Daily Persistent Headaches (NDPH).  This is partially due to addressing the somatosensory trigeminal nervous system.  The Myomonitor also provides Ultra Low Frequency stimulation and neuromodulation to the Sphenopalatine Ganglion.  I believe this effect on the Autonomic nervous system is of key importance to the success of neuromuscular dentistry.

This article addresses the use of SPG Blocks alone in  the treatment of New Daily Persistent Headaches but combining both treatments is ideal.  The use of medications can actually complicate recovery over the long terms by changes that occur in the brain chemistry associated with medication use and overuse.

This following is reprinted form my SphenopalatineGanglionBlocks.com website.

New Daily Persistent Headache: AKA Chronic Headache with Acute Onset.  Are SPG Blocks the Ideal First Line Treatment?

The New Daily Persistent Headache (NDPH) is daily from its onset and usually peaks in about three days. Most patients can pinpoint exactly when it began to a day or an hour. Many patients remember many specifics of the day as well. These NDP Headaches seem to respond exceedingly well to Sphenopalatine Ganglion Blocks.

Unlike most headache patients, patients suffering from New Daily Persistent Headache rarely have any headache history.  It is very important to rule out any serious underlying causes prior to initiating any treatment!

The symptoms described can mimic migraine or tension-type headache or a mixture of both types. Long term NDPH can match descriptions of chronic migraine or chronic tension headaches.

NDPH can be one of two types, those that resolve spontaneously over a period of several months and also a refractory subtype that seems resistant to aggressive treatment regimens.
The refractory subtype can have features of either intractable migraine or intractable tension-type headache. Like almost all headaches NDPH is a Trigeminal Nerve Headache probably involving both somatosensory nerves and autonomic nerves.

The current rationale for the use of Sphenopalatine Ganglion Blocks (SPG) in treating New Daily Persistent Headache is to treat symptoms not to prevent recurrence. The use of SPG Blocks every two weeks may effectively reduce symptoms over time.

The use of Self Administered SPG Blocks on a twice daily basis initially and tapering down to once daily, than twice weekly and then weekly or even once or twice a month is a better approach for most patients.  Self-Administered Treatment with SPG Blocks may be directed toward elimination of the problem and not just treatment of symptoms.

The effectiveness of the SPG Blocks for both Tension-Type Headaches and for Migraines make them a natural choice for New Daily Persistent Headaches.

Initially SPG Blocks offer quick pain relief and the repeated administration before rebound allows the system to reset itself. Ideally starting treatment before the headache has been present for three months may eliminate the headaches before 3 months making NDPH a poor diagnosis.

The goal is to return the patient to their presymptomatic status as quickly as possible. There is no specific cause for onset but it can be considered that the Homeostatic balance has been lost thereby initiating and maintaining the headache without clear underlying pathology.

Sphenopalatine Ganglion Blocks act as a reset mechanism for Homeostasis in the system. When a computer quits working correctly we reset it by hitting Control /Alt /Delete to rest it.  The effect of the SPG Block is similar and resets Homeostasis.  If we utilize aggressive medication protocols we risk permanently upsetting the homeostatic balance and medication may actually be what causes a self-limiting sub-type to become a refractory sub-type NDPH.  Avoiding iatrogenic conversion from sub-type 1 to sub-type 2 is essential and great care should be taken in patients with sudden onset new headaches.




https://www.sphenopalatineganglionblocks.com/tag/spg-block-refractory-headache/