My Headaches Are Destroying My Relationships and My Family

From www. IHATEHeadaches.org e-mail

Susan: I have been having severe chronic daily headaches for over 5 years. I have been diagnosed as sinus headaches, migraines, atypical migraines, TMJ, Trigeminal Neuralgia. I have had numerous CAT Scans and MRI that all appear normal. I have tried multiple medications that seem to slightly ease the pain on a temporay basis but I do not remember the last time I was pain free. My marital life is a mess and my husband doesn't understand how I can have so much pain when all the tests are normal. I am constantly yelling at the kids and the feel horribly guilty. My friends have all but cut off contact but it is probably my fault. I wish the scans could find a tumor so everyone would know the pain was real.
I'm desperate but that just seems to make the pain even worse.

Dr Shapira:
Susan, Please do not give up. I have heard many stories similar to yours. First, because all of the tests have been negative for disease there is excellent hope for significant improvement.. I suggest you seek out a Neuromuscular Dentist who also understands chronic Myofascial Pain and the use of Trigger Point Injections, Sphenopalatine Ganglion Blocks, Spray and stretch techniques.

Susan, it is important to understand that eliminating your pain is not a cure. You have been forever changed by the hell you have been experiencing. The only real cure would be a do-over on the last five years of your life. The goal of treatment is eliminate pain and restore quality to your life and allow you to reconnect with your husband, children, family and friends. The pain you have lived with has changed who you are forever but that may just make you appreciate your life more in the future.

The medical model for Chronic Headaches is diagnostic test and then perscription medicine. I find that patients who have symptoms you describe are easier to treat than expected. I usually spend 1-2 hours on an initial consultation with new patients. Initially we talk so I can understand who you are, how the pain is affecting you, your life and your family. The next part of the consultation is to try to eliminate some or all of the pain you are experiencing at that time.

I usually begin with trigger point deactivation of the cranial and upper body muscles. It is amazing how frequently we can elimnate all or most of the pain just by utilizing techniques described by Dr Janet Travell over 50 years ago. Dt Travell was President John F Kennedy's physician.

The majority of all pain patients experience is muscular in orgin, and turning off the pain allows us to understand the undrlying processes. At this same visit we will make a trial change of proprioception into the central nervous system from the trigeminal nerves.

We can usually eliminate most pain during the first visit the hard work is to make these changes on a long term basis. I tell my patients to set a goal of 50-80% reduction in pain initially. As treatment progresses we continually try to remove 50-80% of remaining pain. This is accomplished by utilizing a diagnostic neuromuscular orthotic to change how the muscles function and to alter trigeminal nerve proprioceptive input to the brain.  Over time there are postural changes and healing.

I often find that I "meet" my patients at the third or fourth appointment.  The patient I meet initially is the person living in pain for months or years but after a few visits I meet the real person who was lost under an avalanche of pain.  There is a great joy in watching people recover and regain their lives.

I practice Neuromuscular Dentistry and Pain Treatment as part of my Chicago area TMJ practice.

i am experiencing extremely severe headaches and also suffer from migraines but these severe headaches are totally different from a migraine

Angie: i was diagnosed with tmj maybe 20 years or so ago. i wear a "dentist fitted" night guard every night since the tmj diagnosis. i am experiencing extremely severe headaches and also suffer from migraines but these severe headaches are totally different from a migraine. i have even used migraine medications but these have yet to come close to helping with these severe headaches. could the tmj issue be the culprit here??? these headaches are hurting in the jaws, temples, across the forehead, terribly behind the eyes and in the back of my head and neck. an mri recently showed nothing abnormal in the head or neck? i have even tried muscle relaxers and prednisone, no relief. i do not have health insurance but am willing to sell my house or at least my car to get some help{jk}. but seriously, what could be causing these headaches? who would be the best doctor to see? i have been to a neurologist, a dentist, natural healers, you name it, i've been there. can you he lp me with this before i go crazy? thank you and i painfully look forward to your reply.


Dr Shapira Response:
Dear Angie

I do not think there is a "Best Doctor" You did not say if your night guard improved your condition. If it does than consider a 24 hour orthotic. A night guard treats a 24/7 problem just at night.

The normal MRI is good news. I know patient's often want to find a problem on an MRI but ruling out serious organic disease is good news.

I normally spend an hour or two reviewing history before initiating treatment treatment and utilize numerous modalities to address specific portions of the problem.

A diagnostic neuromuscular orthotic is an excellent point to start treatment as it can often give miraculous results. I see long distance patients in my office, Ideally 4 days in a row. Come to town Sunday night and I will see you as a first patient Monday for exam and consultation, diagnostic work-up and delivery of an orthotic in the afternoon. I will then see you for adjustments over the next three days. If you are interested in pursuing treatment at my office I would like a lot more information prior to your visit.

MRI for Migraine: Does dye matter? Neuromuscular Dentistry addresses the problem directly.

Cathy Jo:
Can an MRI with intravenous dye show different results than an MRI without dye. I have suffered from migraine headaches since the age of 5 (I am currently 42) and currently on disability because of the severity of my migraines. I did sustain an injury at the age of 5 and may have injuried my neck according to my mother. I do strongly believe this is the origin of my migraines, but an MRI without dye showed normal results. Would an MRI with dye show anything different?

Dr Shapira: Dear Cathy Jo,
n my experience an additional MRI with dye will rarely, if ever be productive. If it makes you feel better you can have one but I would suggest looking for an answer to your problem. I am enclosing contact information for a Neuromuscular Dentist,. I would appreciate your feedback..

If you were my patient I would suggest you try a neuromuscular diagnostic orthotic as a first step in diagnosis and treatment. If it is a neck injury that began your problem you may also require some cervical therapy, NUCCA Chiropractic and/or A/O Atlas -Orthogonal is frequently very effective when combined with a neuromuscular orthotic. It is important that you feel comfortable with your doctor and you should expect a consultation that takes at least 60-90 minutes. Your history is extremely important.

If you eliminate or substantially decrease the frequency an severity of migraines you can continue treatment. You might also want to try having a spenopalatine ganglion block as they often give incredible results. There is an excellent book "MIRACLES ON PARK AVENUE" that discusses SPG blocks in treating pain.

It is quite common for cervical problems an trigeminal problems and/or jaw problems to be related. The majority of patients have multiple muscle trigger points. Many times patients have severe and/or disabling headaches that are not acually migraines but just severe headaches. You did not give much detail in your letter. Details are extremely important in unraveling chronic pain problems.

Dental work percipitates severe pain problem.

I frequently hear stories of patients who have severe circumstances that result from relatively non-invasive treatment. An example below is the letter I just received.

A temporary crown placed in the middle of January 2010 caused horrible face pain, eye pressure stabbing ear pains, refered tooth pains, migraines on opposite side of normal, facial numbness and neck spasms. Extreme pain for about 7 weeks. Pain is still persistant but now at tolerable levels.Two trips to endodontic clinic sent me to Neuralogist who did MRI and MRA and diagnosed me with Neurological disorder triggered by dental work. It is time to put on crown permanently. Neurologist says next event could trigger more intense an longer lasting pain. Is there any dentist in Wichita, Ks. who might cause less trauma with this procedure? Neurologist next wants to do a sleep study to see if improper night oxygen levels could be causing overactive nervous system and delayed healing. Would love to hear your comments! Thank you for your consideration, B.A.

The question is what set off this problem? Usually there were existing problems already present and the new crown was the proverbial "strw that broke the camels back". It is possible that the crown was too big or changed the bite but it is also possible that merely having the mouth open for an extended appointment was enough to create the problem. Regardless, once the problem is in full glory it often takes more than just correcting the crown to fix the problem.

The basic principles of neuromuscular dentistry is to idealize position of the jaw, the jaw muscles, the jaw joint and the bite to a position of minimal adaptation for healing. Neurological problems related to the trigeminal nerve will frequently self correct.