TMJ Illinois: Caniofacial Pain, Orofacial Pain, Headaches, Migraines and Cluster Headaches

Headaches and cranialfacial pain  are all problems related to the Trigeminal Nerve, also known as the dentist's nerve it is involved in almost 100% of all headaches and migraines.  Trigeminal Neuralgia and trigeminal neuropathies are also part of the same problem.

Though patients are usually unaware of the trigeminal nerve dentists, ENT's, Neurologists all know it to be the key input to brain and is involved in 100% of all headaches.  Neuromuscular Dentistry is the best way to decrease noxious input to the CNS.

Treatment usually includes a Diagnostic Neuromuscular Orthotic often received by the patient on their first visit after their consultation visit.  Long distance patients can receive at the same visit of initial consultation.

Visit www.ThinkBetterLife.com to start a process to eliminate and or alleviate (some, most, or all) of  your pain.

Dr Shapira see's patients from across the Chicago metropolitan area, the midwest and across the country.  Special arrangements can be made for long distance patients.

Listen to actual patients on you tube videos describe treatment with Dr Shapira.

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.

Neuromuscular Dentistry: Effective Relief of Migraine and Chronic Daily Headache

Neuromuscular Dentistry is incredibly successful in helping migraine and chronic daily headache for patients as well as other TMJ disorders.  Why is such an effective treatment so controversial.  The history of Neuromuscular Dentistry is important.

Neuromuscular Dentistry was the brain child of Dr Barney Jankelson a Seattle Prosthodontist Specialist who studied the physiology of normal muscles and how ULF TENS could relax muscles to their physiologic resting position.

I had the privilege of studying with with Barney  "Dr J" and I remember asking a couple of questions during his lecture.  He put his arm on my shoulder and said "great question" and I spent the next two days discussing neuromuscular dentistry, physiology and his philosophy.  He loved the science of Neuromuscular Dentistry.

I have been enthralled with the underlying science of Neuromuscular Dentistry for years.  As new research on migraines, chronic daily headache is published it always fit the paradigm the Dr J imagined.

This was a giant leap in dentistry and it created many adversaries.

The biggest contention was the use of biomedical devices to measure what was actually happening during function.  When these measurements  showed old theories were flawed there was a tendency to attack the measurements.  Those who had based their careers  these theories were critical of neuromuscular dentistry

The idea of Centric Relation was an old mechanical viewpoint of where the jaws functioned.  Measurement showed that these assumptions were wrong.  The definition of Centric Relation went thru at least 26 revisions over time many because new technology showed that the definition was not physiologically functional.

Doctors who believed in Centric Relation attacked the science of measurement because they like the the fact that it did not agree with their theories.

Dr J stated "If it is measured it is a fact otherwise it is an opinion"

In spite of numerous attacks on neuromuscular measurement devices including some that extended into illegal and unscrupulous dealings within the FDA the ability and right to measure accurately survived.  The neuromuscular instrumentation has been shown to be safe and effective by the ADA and FDA.  More importantly, patients have experienced life changing improvements in their quality of lives directly because of Neuromuscular Dentistry.

An entire FDA panel was suspended and several unscrupulous characters are no longer involved with the FDA after an internal investigation showed evidence of malfeasance.

The real winners from neuromuscular dentistry are patients whose lives are vastly improved by elimination of chronic pain, headaches migraines and other problems thru the use of Neuromuscular Dentistry.

Migraine Relief: Neuromuscular Dentistry and Sphenopalatine Ganglion Blocks Combination Treatment

Chronic Migraines are at best depresssing but can actually destroy your chance for a meaningful life. The affect relationships with family and friends, work performance and general attitude and quality of life.

Standard Medical approach is to to a lot of medical testing and then medication trial after medication trial.  When single meds are not effective they are given as combination treatments of multiple medications.

There is an alternative approach to migraine relief that can frequently eliminate migraines by correcting underlying causes of migraines.  This does not mean that utilizing medication makes patients failures .  The problem with medication is side effects of the medication, excessive costs of medication, reduction in the quality of life in spite of medictions due to ongoing pain or due to ineffectiveness of medications.

It is well accepted that the Trigeminal Nerve is a central player in all headaches especially migraines. There is also an autonomic aspect of headaches and migraines of due to imbalace between sympathetic and parasympathetic nervous systems.

Neuromuscular dentistry creates reduction in noxius input from the teeth and jaws to the CNS or central nervous system.  The primary input is from proprioceptive fibers in he periodontal ligament that are fed by tooth contact.  Muscle spindles and golgi tendon organs effect and affect muscle function  The TMJoints (TMJ) have input from joint surfaces, retrodiscal lamina and lateral pterygoid muscles.

All of these tissues and others send storms of neural input to the CNS.  The trigeminal nerve innervates all of these tissues but also controls blood flow to  the meninges of the brain where they control blood flow to the anterior two thirds of the brain.

Finding a Neuromuscular Dentist who understands the entire field can be difficult if not impossible.  I suggest the best places to look are ICCMO, The International College of CraniMandibular Orthopedics at http://occlusiontmjauthority.com and at this site.

In Chicago visit www.ThinkBetterLife.com to learn more about neuromuscular dentistry (NMD).

But just NMD may not be enough for total migraine relief.  It may be necessary to also address the autonomic nervous system.  When eliminating migraines, preventing migraines, curing migraines is the goal the SPG block is often the answer.  It is easy to apply and can give miracle pain relief or miracle migraine cures  as described in the book Miracles on Park Avenue.

Combining neuromuscular Dentisry with Sphenopalatine ganglion blocks is awesome for many migraine sufferers.  But this is still not the whole story, Nucca and /or Atlas Orthoganol Chiropractic, cranial manipulation, massage therapy, trigger point injections, Botox, are just a few of the available techniques that can be used to treat chronic migraines.

The key is that Miracle Migraine Cures do not exist but Migraine cures do exist and when medications have failed neuromuscular dentistry has the potential to cure and eliminate chronic migraines.

Combination of multiple approaches are often necessary.  Every patient is unique and has a unique history.  the care interviewing of patients combined with comprehensive exam are the foundation for building a migraine cure.  You cannot treat without understanding and addressing the underlying causes of migraine.

Treatments must match the diagnostic findings and should be safe and effective.  While medications are often safe many hav serious with regard to safety. The mechanism of action is often unknown for many medications.

Neuromuscular Dentistry utilizes objective measurements to evaluate function and to reset the somatic nervous system every time the patient swallows.  Reset mechanisms allow the body to heal and start fresh after effort.  In the same way a good bite is a reset button for the Trgeminal Nerves the Sphenopalatine Ganglion Blocks are a reset for the autonomic nervous system.

The search for a Miracle Migraine Cure may be a combination of these techniques for many patients but not for all patients.  There are other variables that come into play that are beyond  the scope of this article.

The search for a miracle cure could end with NMD or SPG Blocks, some people may find the cure takes combinations of treatments.

The important take away is that migraine cures do occur and usually the cures like the causes are multifactorial.  

TMJ, TMD, Headaches, Migraines, Snoring and Sleep Apnea: FIND A NEUROMUSCULAR DENTIST

NEUROMUSCULAR DENTISTRY can offer incredibly quick relief for many patients suffering from TMJ disorders, Migraines and other issues.  It is ideal for finding the ideal physiologic position for dentistry and full mouth reconstructions.

In the Chicago area I have two locations for patients;

Highland Park, Il www.ThinkBetterLife.com

 Gurnee   www.DelanyDentalCare.com

I frequently see patients who travel long distances to see me in Chicago from the US and overseas.  I can make special arrangements for patients who want me to treat them personally, whether for TMJ pain, headaches, migraines, sleep disorders of cosmetic and reconstructive dentistry.

There are many areas across the country and from around the world where there are not neuromuscular doctors listed on my site.

I reccommend that patients seek out a Neuromuscular Dentist who belongs to ICCMO, The International College of CranioMandibular Orthopedics.

 FIND A NEUROMUSCULAR DENTIST

http://occlusiontmjauthority.com is the ICCMO site.  Patients can learn more about Neuromuscular Dentistry at that site.  I have just agreed to help write additional content for the site.

The find a dentist section is found at:
 http://occlusiontmjauthority.com/find-a-tmj-dentist-2/

Neuromuscular Dentistry is ideal for patients under Chiropractic care, especially patients who see a NUCCA Chiropracter or and A/O (Atlas/Orthoganol) Chiropracter.

LAKE FOREST: TENSION HEADACHES, CHRONIC DAILY HEADACHE, MIGRAINE, CLUSTER HEADACHE AND CHRONIC MIGRAIN

Diagnosis of a particular type of headache is often the worst event for a headache patient.  All headaches are multifactorial and there are many aspects to prevention and treatment.  Unfortunately once the headaches are labeled many patients experience their doctors wearing Blinders and all diagnosis and treatment decisions are outside of the blinders are never considered.  At my new office in Highland Park I take an open approach to chronic pain.  The labels do not help and often interfere with treatment. Visit www.thinkbetterlife.com the website for my HighlandPark office.

There is one common thread to almost 100% of all chronic headaches, the involvement of the Trigeminal Nerve. There is no universal agreement on the sequence or causes of headaches but there is agreement that there are various triggers to most headaches.

Effective Treatment to Prevent, Treat and Eliminate the spectrum of headaches should include a primary Trigeminal Component.

Our nervous system has a Somatic Division which is divided into Sensory and Motor Nerves and an Autonomic component which has a Smpathetic and Parasympathetic components.

Before discussing more common headaches and migraines lets consider a special group of headaches called the Trigeminal Autonomic Cephalgias that includes Cluster Headaches, Paroxysmal Hemicrania and the SUNCT / SUNA headaches or Short Unilateral Neuralgiaform Headache with Conjuctival Injection. All of these often present with severe sudden onsets and initially should be evaluated with either/or CAT Scans and MRI’s to rule out tumors and/or vascular bleeds. I will discuss these special autonomic headaches in more detail in a future post. These headaches frequently can be prevented and allieved in many cases by Neuromuscular Dentistry and by changing Trigeminal Input with a Diagostic Orthotic. More information can be found at www.ihateheadaches.org and http://www.neurology.org/content/74/11/e40.full

Another special type of headache or cranial pain disorder is Trigeminal Neuralgia or Tic Douloureux known for sudden stabbing pain usually unilaterally in the face. Tic Doulourex is considered one of the most severe types of pain a person can experience earning it the name “The Suicide Pain” because of patients taking their life. Trigeminal Neuralgia will also respond to initial treatment with a Neuromuscular Diagnostic Orthotic though radical (and dangerous) therapy may be required.

Tension headaches, muscle spasm headaches, chronic daily headaches, cervicalgia headaches, sinus headaches, TMJ headaches are some of the names given to pain coming primarily from muscles. I would characterize this group of headaches as MPD or Myofascial Pain and Dysfunction in nature. It is associated with taut muscle band and trigger points. The primary cause of all of these in the head and neck is repetitive strain injuries and are ideally treated with Neuromuscular Diagnostic Orthotics as The First Line of treatment. Correction of underlying orthopedic and functional conditions can lead to a lifetime of better health. This treatment is often called TMJ treatment but that is always an oversimplification.
The postural train goes from the jaws to the feet (or hips when sitting) and changes in one area affect all areas. The terms Cranial Sacral Therapy, Sacral Occipital Therapy, and the fields of Chiropractic Medicine, Osteopathic Medicine Physiatry, Physical Therapy, and Naprapathy are all about treating problems between the reset points. Correction of end points are necessary for long term results.

The three endpoints are the bite including the upper and lower jaws including the TMJoints, the feet when standing and the hips when sitting. It is incredibly important to stabilize end points.

The Jaw is the single most important end-point in regards to headaches. This is because it is home to the majority of Trigeminal Nerve input to the brain. The Trigeminal nerve accounts for over 50% of all input to the brain after amplification by the Reticular Activating System. If Nociceptive (painful) inputs are brought into the brain chronic headaches is a frequent outcome. In computer lingo “Garbage in….Garbage Out” where Garbage is pain. The Trigeminal nerve innervates the teeth, the periodontal ligaments, the jaw joints, the jaw muscles, the tongue, soft palate, uvula, the tensor of the ear drum, the muscle that opens and closes the eustachian tube, the lining of the sinuses and MOST IMPORTANT, the Trigeminal Nerve controls the blood flow to the anterior two thirds of the meninges of the brain. This is the connection to all vascular and neurogenic headaches including previously discussed Autonomic Trigeminal Cephalgias and Trigeminal Neuralgia.

All headaches are basically primary or secondary results of input-output errors of the information the Trigeminal Nerve brings into the brain. This input causes chemical changes in the brain through the synapses. This changes blood flow and muscle function, posture, breathing and more.

The NHLBI of the NIH published a report”The Cardiovascular and Sleep -Related Consequences of TemporoMandibular Disorders"  discussing the wide spread affects of TMJ disorders. www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf
This should be read by all headache patients.

I n the past I have seen patients who have lived with chronic pain for most of their lives only to find out there was treatment that could relieve their pain.  One patient had continuous headaches for over fifty years in spite of being married to a physician.  After two visits she was out of pain but also very angry.  Why did she have to live with constant headache pain when treatment was so simple.  The reason is what I call circle of knowledge.  There are thousands of excellent, well educated physicians and specialists who love helping patients and stay abreast in their knowledge.  Unfortunately, even the best and brightest don't know what they don't know.  Often, they have seen a failure in one patient and assume it applies to all patients.

Each patient is unique as is the source and causes of their pain.  A good physician listens to their patients, hears what they express and believes what their patients tell them.  Many patients feel like their doctors don't believe them about the severity of their pain which is very frustrating. 

Diplomat in Pain Management Treating TMJ, Headaches and Migraines in Highland Park and Lake Forest

TMJ Disorders are often called The Great Imposter.  The painful symptoms can mimic many other disorders.  There are a select group of dentists who treat TMJ Disorders who are also Diplomats of the American Academy of Pain Management. 

The American Academy of Pain Management is the largest organization dedicated to treating chronic pains in all of its forms.

Whether you suffer from headaches, migraines, neck pain, TMD, TMJ disorders, foot pain or back pain there are doctors listed on the website of the American Academy of Pain Management who can help you with your problems.  These doctors have spent time and money learning how to better manage pain in their patients.

The user friendly website http://www.aapainmanage.org/ can help you search for doctors in your area who are members and/or credentialed members of the academy.  You can search for patients specializing in your specific type of pain. 

You can go to the directory page and look for credentialed members or general members in the members class field.  You can then search by state, city or zipcode.  I suggest beginning with a state search of credentialed members.

Dentists who treat TMJ Disorders are often key providers of treatment of migraines, chronic daily headaches, chronic migraines and tension headaches.

I am proud to be one of a handful of dentists in Illinois who is a credentialed Diplomat of the American Academy of Pain Management.  I utilize multiple techniques to treat and eliminate chronic headaches and migraines in addition to TMD or Temporomandibular Disorders commonly referred to as TMJ.

Please visit my websites:    http://www.thinkbetterlife.com  and delanydentalcare.com for more information on life changing treatment of your pain.

 

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.

TMJ Help Sites; Creating a TMJ Support Group in Highland Park for Chicago and North Suburban TMJ sufferers.

I HATE Headaches.org is the ultimate TMJ Help site for patients with Chronic Headaches.  Patients in the Highland Park/ Lake Forest and Deerfield areas of North Suburban Chicago have a new resource www.thinkbetterlife.com

Dr Shapira would like to create a TMJ support group in the Highland Park Lake Forest area for patients with chronic headaches and/or TMJ disorders.

My new office is at 3500 Western Ave in Highland Park Illinois across from the Fort Sheridan Train Station.  It is dedicated to helping patients with acute and chronic pain problems including headaches, migraines, sleep apnea and TMJ disorders associated with the teeth, jaws, jaw joints and posture

Headaches Since I was a teenager worsening and becoming excruciating .

Tell us about your headaches... Stephanie    I've been suffering from headaches since I was an early teen. It was around the age of 17 that they began to worsen. I noticed when I would stand up or sit down quickly, I would get these excruciatingly, sharp pains in one area in my head- generally, the right side. It feels almost like someone is using a crowbar to pry open my skull. Now my headaches have progressed as I have gotten older. Now when I start getting those headaches the excruciating pain comes out of nowhere. I'll be walking across the room and I get the "crowbar" feeling- very intense, very brief. But I'll still have a constant, underlying headache with bursts of pain. I've noticed the last few times I've been getting these headaches, they last for a few days, I feel sick to my stomach, my hearing is distant and it hurts to keep my eyes open. It puts an abrupt stop to everything I am doing. I try to self-medicate with excedrine migraine. I drink water. I try to sleep it off. Nothing seems to help but time. But I don't always have time and i can't afford to take the time off work to let it pass. 

 Dr Shapira's Response:   Stepanie, it sounds like there are several different problems that are overlapping.  I believe you have chronic muscle tension headaches as an underlying symptom.  Those respond excedingly well to Neuromuscular dentistry.  You may have an overlay of a neurogenic or vascular type headache as well.  The trigeminally innervated  muscular headaches are often a trigger for the other types.  They are all mediated by the Trigeminal Nerve, often called the dentists nerve.

The problem is you are always near the "breakthru" pain.  The autonomic nervous system is overloaded giving youthe symptoms you describe ae " I feel sick to my stomach, my hearing is distant and it hurts to keep my eyes open"  The fact that this is chronic and nothing helps would lead me to advise you to see a neuromuscular dentist and get a diagnostic orthotic ASAP.  It may not be a "magic" cure but we usually see a 50-80% improvement in symptoms very quickly.

I see patients from across the US in my Gurnee, Illinois office There are several ICCMO members in Nevada who practice Neuromuscular Dentistry.  Dr Norman Thomas does not see patients but he is associated with LVI, the Las Vegas Institue and is one of the most knowledgable people in the world on Neuromuscular Dentistry.  None of these doctors are participants of I Hate Headaches.org but they are all members of ICCMO the leading group for Neuromuscular Dentistry.  

Dr Sam Kherani would probably be my first choice of practitioners in your area  to improve the quality of your life.  I Hate Headaches is dedicated to helping patient thousands of patients find answers for their problems  thru neuromuscular dentistry.

Name: Norman Thomas

Mastership: MICCMO

City, State: Las Vegas, NV

Country: United States

Phone: 702.363.2774

Email: nthomas@lvilive.com

Name: Sam Kherani

Mastership: MICCMO

City, State: Las Vegas, NV

Country: United States

Phone: 888.584.3237

Email: skherani@gmail.com

Name: Mark Escoto

Mastership: MICCMO

City, State: Las Vegas, NV

Country: United States

Phone: 702.256.5353

Email: dr_escoto@msn.com

Name: Michael Miyasaki

City, State: Las Vegas, NV

Country: United States

Phone: 702.304.8200

Email: mmiyasaki@discusdental.com

Name: Mark Duncan

City, State: Las Vegas, NV

Country: United States

Phone: 702.341.7978

Email: mduncan@lviglobal.com

Name: William Dickerson

City, State: Las Vegas, NV

Country: United States

Phone: 702.341.7978

Email: wgddds@msn.com

I am not sure whether they are all familiar with all the trigger point injections, sphenopalatine ganglion blocks and other helpful alternative therapies but they all understand Neuromuscular Dentistry.

I am always available if you decide to travel to the Chicago area for treatment  I usually see new long distance patients Monday AM and PM, Tuesday AM and PM and Wednesday morning for their first series of visits.  We can usually give significant relief in the first few days.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO

Why Physicians Who Treat Headaches Know So Little About TMJ (TMD) And Neuromuscular Dentistry

Jackuelyn:      I've been informing 3 different neuro doctors of my migraine pain the runs from the top of my head/jaw/neck/shoulder. Only to be told by the last 2 that there was nothing they could do for me and the released me as there patient. 

The doctor im seeing now is ok however, i just diagnosed myself when i noticed that my jaw upper jaw row of teeth were not straight (meaning growing outward) i look up TMJ and my photo was on the website. 

My trust in physicians is GONE DUE TO THE SIMPLE FACT THAT I ASKED IF THIS COULD BE THE CAUSE OF MY PAIN AND I WAS TOLD NO.

Dear Jacquelyn,

I understand your frustration, unfortunately many neurologists know little about Neuromuscular Dentistry, Physical Medicine or TMJ disorders and their treatment.  With the exception of Botox injections they are usually limited to doing tests and writing perscriptions.  Botox can be effective but it treats the symptom of referred pain from muscle without addressing the underlying cause of the pain.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO

Migraines, Chronic Daily Headaches, TMJ, TMD and Neuromuscular Dentistry

Tell us about your headaches...: I have suffered from migraines w/and w/o aura since I was 10. I got a brain tear frontal lobe in the third grade. It's only been about the last several years that I got diagnosed with tmj. In the last 6 months it has got unbearable. I've got a permanent mouth guard for night grinding,but I still have pain and migraines help!
First Name: Lorin
Last Name: M.....

DR Shapira's response:

Lorin in Boston,  Your e-mail was rejected, I hope you find this response helpful

Night Guards work great if you only have pain at night or on awakening.  If you have day and night pain it is usually necessary to utilize a 24/7 appliance. TMJ is not a diagnosis but a Joint, the TemporoMandibular Joint.  TMD is a more correct description because it includes the Myofascial and neurogenic aspects of migraine and chronic daily headaches.  I suggest  a neuromuscular diagnostic orthotic as it allows an ongoing healing process as you adjust it for postural changes.  Spenopalatine ganglion blocks can serve to prevent migraines and you can learn to do them easily at home.  Trigger point injections or spray and stretch techniques are useful for eliminating trigger points.

It is a process to correct a lifetime problem and I like the analogy of ealing an onion, you remove one set of problems to get to the next level.

I would like to tell you that everyone who practices Neuromuscular Dentistry (NMD) can help you but NMD is only one part of a larger puzzle.  It is extremely important component of treatment because it addresses nociceptive input to the Trigeminal Nervous system that is primary in all migraine and non-migraine headaches.  Unlike drug treatment that affect the CNS like a shotgun blast NMD particularly is designed to focus on I/O errors or input/output erros into the Trigemininal nervous system.  In computer lingo the expression GARBAGE IN....GARBAGE OUT describes the effect of unfiltered nociceptive input into the central nervous system.  100% of all physicians, neurologists and pain specialists understand that all headaches and migraines are Trigeminally nerve related.  

Neuromuscular Dentistry addresses this input output error of the human computer...ie the brain.

Physicians often consider TMJ and TMD problems a subset of headaches due to their ignorance of the massive input to the CNS (central nervous system) from the Trigeminal Nervous System)

Te use of Botox to treat headaches and Migraines is directly due to effects on the masticatory system of the trigeminal nervous system...  ie a TMD or TMJ problem addressing not the entire scope of the problem but just the myofascial pain aspects.  Botox is a crutch that can be used while correcting the underlying problems.  Unfortunately there is money to be made in injecting dangerous neurotoxins and where there is money there are always willing participants.  The problem is not the use of Botox but the substitution of Botox for correction of the underlying problems.

Read:  http://www.sleepandhealth.com/neuromuscular-dentistry  for more info on neuromuscular dentistry.

I do see up to two long diatance patients  month in my Gurnee office, the first week I see you twice a day on Monday and Tuesday and half a day wednesday.

Ira L Shapira DDS, D,AAPM, D,ABDSM, FICCMO

cluster headache and SPG (sphenopalatine Ganglion block) Block

I have been a strong advocate of utilizing sphenopalatine ganglion blocks to treat cluster headaches, acute and chronic daily migraines, sinus headaches and chronic daily headaches. The following Pub Med abstract is a case report on utilizing lidocaine (an extremely safe drug) to do SPG blocks for cluster headaches.

The Ptsosis (wikipedia...Ptosis (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid ) as well as the pain responded to the block. It is important to note that SPG blocks are more effective at preventing attacks than stopping them. I have many patients who use the blocks prophylactically to prevent headaches or migraines as well as avert them when there is the first onset of symptoms.

SPG blocks with lidocaine are probably the safest and most effective drug therapy for migraines, cluster headaches and other autonomic cranial facial pain syndromes, unfortunately very few physicians teach their patients this valuable technique .

Sphenopalatine Neuralgia or Sluders Neuralgia respond to topical blockage of the SPG ganglion. The second abstract discusses phenolization of the ganglion. I have always been more comfortable utilizing non-toxic lidocaine for SPG Blocks. In Sever cases I will do a block with Marcaine through the palate but I prefer to let the patient avoid attacks with a cotton applicator and lidocaine.

J Med Case Reports. 2012 Feb 15;6(1):64. [Epub ahead of print]

Cluster headache with ptosis responsive to intranasal lidocaine application : a case report.

Bakbak B, Gedik S, Ekinci Koktekir B, Okka M.

Abstract

ABSTRACT: INTRODUCTION: The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. Cases presentation: A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased. CONCLUSION: Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

PMID:

22335966

[PubMed - as supplied by publisher]

Free full text

Otolaryngol Pol. 2007;61(3):319-21.

[Atypical facial pains--sluder's neuralgia--local treatment of the sphenopalatine ganglion with phenol--case report].

[Article in Polish]

Olszewska-Ziaber A, Ziaber J, Rysz J.

Source

Poradnia Chorób Nosa Uniwersyteckiego Szpitala Klinicznego im. WAM Uniwersytetu Medycznego w Lodzi.

Abstract

AIM:

Chronic reccuring head and facial pain can be very difficult for successful treatment. Such a pain can be in some rare cases Sluder's sphenopalatine ganglion neuralgia. The aim of the study was to obtain the pain relief by local treatment in patients with Sluder's sphenopalatine ganglion neuralgia.

METHODS:

We described three cases of Sluder's neuralgia among all the seventeen patients with reccuring head and face pain that were seen in our department. In all these cases 4% Xylocaine was applied intranasally, into the region of shenopalatine ganglion, behind the posterior tip of the middle turbinate four times for ten minutes. According to Kern, the diagnosis of Sluder's neuralgia was confirmed only in cases where local anesthetic block of the sphenopaltine ganglion was successful. It means the patients were pain-free for at least an hour after application of Xylocaine, so they were qualified for phenolization and 88% phenol was applied on the cotton carriers (number of the applications depended on the patient).

RESULTS:

The total relief of pain of different duration was obtained in all the presented cases.

CONCLUSION:

The relief of pain obtained by intranasal phenolization of sphenopalatine ganglion in three patients shows it could be the effective treatment of Sluder's neuralgia. The patients were totally free from the pain and accompanying symptoms like nasal obstruction, rhinorrhea, epiphora or conjunctivitis. The relief period was different but the patients were satisfied with the effectiveness and simplicity of the treatment. They did not need to take the additional medications for months and were able to continue work.

PMID:

17847789

[PubMed - indexed for MEDLINE]

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