A recent article in HEADACHE (June 2011)"Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine" looks at patients who have an overlap of vestibular symptoms, such as lightheadedness, unsteadiness, vertigo, balance disturbance and headache.
The study showed just under half of the patients had onset of pain and vestibular symptoms together. This is frequently seen in patients withcraniomandibular neuromuscular disorders and usually responds extremely well to a neuromuscular orthotic, use of ULF TENS, Trigger point injections, spray and stretch elimination of TP's and SPG (Sphenopalatine Ganglion) Blocks.
NEUROMUSCULAR DENTISTRY SHOULD PROBABLY BE A FIRST LINE TREATMENT FOR PATIENTS EXPERIENCING VESTIBULAR SYMPTOMS AND HEADACHE OR MIGRAINE AFTER ORGANIC DISEASE IS RULED OUT.
TMJ DISORDERS HAVE LONG BEEN CALLED "THE GREAT IMPOSTER" because they mimic so many other disorders. All patients with vestibular symptoms and head or neck pain shoud read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IN SLEEP AND HEALTH JOURNAL.
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
The article's conclusions are not diagnostic at all. They cover episodic, acute onset and chronic disorders. The authors stated "Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM"
Headache. 2011 Jun 7. doi: 10.1111/j.1526-4610.2011.01934.x. [Epub ahead of print]
Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine"
Cohen JM, Bigal ME, Newman LC.
Source
From Roosevelt Hospital, Headache Institute, New York, NY, USA (J.M. Cohen and L.C. Newman); Merck, Sharp & Dohme Corp., Whitehouse Station, NJ, USA (M.E. Bigal).
Abstract
Background.- Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms-VS) often co-exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.- To determine common clinical features that may be associated with "vestibular migraine" (VM). Methods.- We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.- Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), "light-headedness" (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.- Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.
© 2011 American Headache Society.
PMID:
21649658
[PubMed - as supplied by publisher]
Related citations
Showing posts with label atypical migraine. Show all posts
Showing posts with label atypical migraine. Show all posts
Monday, June 13, 2011
Sunday, May 29, 2011
POSTUROLOGY AND TMD (TMJ) DISORDERS: WHY THIS IS IMPORTANT TO PATIENTS WITH CHRONIC DAILY HEADACHES, MIGRAINES AND TENSION-TYPE HEADACHES.
THE JAW IS ESSENTIAL IN THE REGULATION OF NORMAL BODY POSTURE. THE SWALLOW SERVES AS A NEUROMUSCULAR RESETTING MECHANISM THAT CAN CORRECT OR CAUSE POSTURAL PROBLEMS THROUGHOUT THE ENTIRE BODY.
THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.
THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.
IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.
THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.
ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"
UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.
NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.
THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,
THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.
FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.
THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.
Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.
PMID: 16128357 [PubMed - indexed for MEDLINE]
THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.
THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.
IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.
THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.
ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"
UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.
NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.
THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,
THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.
FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.
THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.
Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.
PMID: 16128357 [PubMed - indexed for MEDLINE]
Friday, May 20, 2011
Post Traumatic Stress Disorder and Migraine. Is this an example of a neuromusclar Trigeminally mediated headache?
A recent article in "Headache" dated May 17, 2011 (see abstract below) discusses migraines and PTSD. It details how these types of problems are much more common in women and suggests a sex hormonal component to the pain. The statistics are very similar to what is found in MPD (Myofascial Pain and Dysfunction) and TMJ / TMD 9Temporomandibular Dysfunction). These are also found more frequently in women and associated with Migraine, Tension-Type Headache, and Chronic Daily Headache.
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
New research on Migriane Medication focuses on Trigeminal Nerve
A recent article in Cephalgia (see abstract below) focuses on the kynurenine family of compounds which are metabolites of tryptophan in treating migraines. The use of Neuromuscular Dentistry uses neural input to correct chemical imbalances in the Trigeminal Nervous System to treat and eliminate migraines and chronic daily headaches.
The use of drugs to alter neurotransmitters has been shown to be effective but correcting the nociceptive input to the nervous system is a more effective and reliable method of treating trigeminally mediated pain.
Reports of 80-95% effectiveness in treating headaches with a neuromuscular diagnostic orthotic are common and side effects are minimum.
Correcting the problem by altering neural input is the closest to a "cure" for migraines.
Effectiveness has never been the major problem in treating Headaches, Migraines and TMJ disorders with Neuromuscular Dentistry. The problem is that while the treatment is extremely effective it is expensive and insurance companies write contracts that limit coverage. The current cost conscious environment virtually insures that patients will continue to suffer needlessly because lack of coverage puts this extremely effective treatment out of financial viability for any patients.
Patients who suffer from migraines and chronic daily headaches and can affrd neuromuscular dentistry will find it extremely effective.
A downside to neuromuscular dental treatment is that it can be time intensive especially at the start of treatment protocols.
Ending needless pain and suffering is always rewarding to both patients, friends , families and the practitioners.
Cephalalgia. 2011 May 18. [Epub ahead of print]
The L-kynurenine signalling pathway in trigeminal pain processing: A potential therapeutic target in migraine?
Guo S, Vecsei L, Ashina M.
Source
University of Copenhagen, Denmark.
Abstract
Introduction: In recent years the kynurenine family of compounds, metabolites of tryptophan, has become an area of intensive research because of its neuroactive properties. Two metabolites of this family have become of interest in relation to migraine and pain processing. Discussion: Experimental studies have shown that kynurenic acid (KYNA) plays an important role in the transmission of sensory impulses in the trigeminovascular system and that increased levels of KYNA decrease the sensitivity of the cerebral cortex to cortical spreading depression. Furthermore, another metabolite of the kynurenine family, L-kynurenine, exerts vasodilating effects similar to nitric oxide by increasing cyclic guanosine monophosphate. Conclusion: This review summarizes current knowledge of the role of kynurenine signalling in trigeminal and central pain processing, including its therapeutic prospects in migraine treatment.
PMID:
21593189
[PubMed - as supplied by publisher]
The use of drugs to alter neurotransmitters has been shown to be effective but correcting the nociceptive input to the nervous system is a more effective and reliable method of treating trigeminally mediated pain.
Reports of 80-95% effectiveness in treating headaches with a neuromuscular diagnostic orthotic are common and side effects are minimum.
Correcting the problem by altering neural input is the closest to a "cure" for migraines.
Effectiveness has never been the major problem in treating Headaches, Migraines and TMJ disorders with Neuromuscular Dentistry. The problem is that while the treatment is extremely effective it is expensive and insurance companies write contracts that limit coverage. The current cost conscious environment virtually insures that patients will continue to suffer needlessly because lack of coverage puts this extremely effective treatment out of financial viability for any patients.
Patients who suffer from migraines and chronic daily headaches and can affrd neuromuscular dentistry will find it extremely effective.
A downside to neuromuscular dental treatment is that it can be time intensive especially at the start of treatment protocols.
Ending needless pain and suffering is always rewarding to both patients, friends , families and the practitioners.
Cephalalgia. 2011 May 18. [Epub ahead of print]
The L-kynurenine signalling pathway in trigeminal pain processing: A potential therapeutic target in migraine?
Guo S, Vecsei L, Ashina M.
Source
University of Copenhagen, Denmark.
Abstract
Introduction: In recent years the kynurenine family of compounds, metabolites of tryptophan, has become an area of intensive research because of its neuroactive properties. Two metabolites of this family have become of interest in relation to migraine and pain processing. Discussion: Experimental studies have shown that kynurenic acid (KYNA) plays an important role in the transmission of sensory impulses in the trigeminovascular system and that increased levels of KYNA decrease the sensitivity of the cerebral cortex to cortical spreading depression. Furthermore, another metabolite of the kynurenine family, L-kynurenine, exerts vasodilating effects similar to nitric oxide by increasing cyclic guanosine monophosphate. Conclusion: This review summarizes current knowledge of the role of kynurenine signalling in trigeminal and central pain processing, including its therapeutic prospects in migraine treatment.
PMID:
21593189
[PubMed - as supplied by publisher]
Monday, April 11, 2011
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.
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.
Saturday, March 5, 2011
Bent Face Syndrome, THJ Disorders and Chronic Tension Headache and Migraines
TMJ disorders and headaches are closely related. There are distinct differences in underlying structural differences in patients who experience Tension-Type Headaches and Migraine.
The pain can be primarily related to cervical and cranial musculature but can also be secondary to postural distortions that effect the central nervous system.
Bent Face Syndrome is caused by orthopedic displacement of cranial bones or Cranial Orthopedic Distortions. Other patients have Dental Distortions but the Cranial bones are correctly positioned. Most frequently patients have simultaneous cranial and dental distortions.
Symptoms can be headaches, ear aches, ear pressure, retro-orbital eye pain or pressure, ear stuffiness or mild, moderate, or severe and immobolizing headaches or migraines.
Correction of bites may not correct the underlying cranial bone distortion. As I write this I am in the middle of a course with Dr Bob Walker (founder of Chirodontics) who has developed simple methods to diagnose and treat both the cranial and dental problems. Inn addition to reductions in pain there is also major improvements in facial esthetics.
These methods can lead to rapid correction of these problems and improve final positioning. I first saw Bob present this information at the ICCMO meeting in October. What he accomplished was "impossible". After spending a full day with him I now know it is not only possible but relatively quick and easy. He also helps point out which patients are most likely to be very difficult to treat.
The pain can be primarily related to cervical and cranial musculature but can also be secondary to postural distortions that effect the central nervous system.
Bent Face Syndrome is caused by orthopedic displacement of cranial bones or Cranial Orthopedic Distortions. Other patients have Dental Distortions but the Cranial bones are correctly positioned. Most frequently patients have simultaneous cranial and dental distortions.
Symptoms can be headaches, ear aches, ear pressure, retro-orbital eye pain or pressure, ear stuffiness or mild, moderate, or severe and immobolizing headaches or migraines.
Correction of bites may not correct the underlying cranial bone distortion. As I write this I am in the middle of a course with Dr Bob Walker (founder of Chirodontics) who has developed simple methods to diagnose and treat both the cranial and dental problems. Inn addition to reductions in pain there is also major improvements in facial esthetics.
These methods can lead to rapid correction of these problems and improve final positioning. I first saw Bob present this information at the ICCMO meeting in October. What he accomplished was "impossible". After spending a full day with him I now know it is not only possible but relatively quick and easy. He also helps point out which patients are most likely to be very difficult to treat.
Tuesday, February 1, 2011
Why you want to find the most experienced Neuromuscular Dentist to Treat TMJ, TMD, Headaches and Migraines.
Neuromuscular Dentistry can give incredible relief of headaches, TMJ symptoms migraines and numerous other chronic pain disorders. It is important to chose your Neuromuscular Dentist wisely.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
Sunday, January 30, 2011
Study Shows That Majority of Patients Discontinue Triptan Use. Neuromuscular Dentistry is an Alternative to the Pharmaceutical Approach to Treatment
A recent study (pubmed abstract below) in the Journal Cephalgia showed that "Less than 15% of subjects received more than one triptan product in the 2 years." Triptans which are very successful for a small percentage of patients are not a panacea. The reasons for discontinuation may be numerous. I suspect that many patients treated for "migraines" of various types actually have headaches (albeit severe) of muscular or myofascial orgin often associated with craniomandibular disorders, TMD, Temporomandibular Joint Dysfunction, or other primary disorders of the Trigeminal Nerve related to masticatory function. The study also showed that 80% of patients only received one or two packages of Triptan medication. These patients obviously did not obtain significant relief or the side effects caused them to discontinue treatment.
Drug therapy of chronic daily headaches, atypical migraine, chronic migraine, tension-type headaches and other disorders may be useful as a interim measure but I content that removing the underlying cause of migraines and headaches is the optimum long term solution for chronic headache pain. The basis of Neuromuscular Dentistry is to eliminate the noxious input to the Trigeminal Nervous System that is responsible for headache propagation.
Sleep and Health Journal has my article on Neuromuscular Dentistry that was originally published by the American Equilibration Society. It is an excellent resource for all patients with headaces, migraines and TMJ disorders that are considering Neuromuscular Dental Treatment. The Neuromuscular Dentistry article is available @ http://www.sleepandhealth.com/neuromuscular-dentistry
The use of BOTOX to treat migraines and Tenion-Type headaches actually proves the validity of Neuromuscular Dentistry. The long term block with botulism toxin of neurojunctions in masticatory muscles clearly demonstrate that the pain and headache/ migraines are coming either directly from the musces, ie referred or myofascial pain or that noxious input from these muscles is causing central sensitization of the Trigeminal Nerve and Central Nervous system.
Neuromuscular Dentistry creates a healthy homeostasis where long term healing can occur. Neuromuscular Dentistry is frequently criticised for being expensive. This is actually a falsehood. Initial therapy with a diagnostic orthotic is usually done over a period of a few months and can run several thousan dolars but pales when compared to the costs of MRI's CAT SCANS, Chronic medication use with associated side effects and rebound headaches and awful effects on family and friends as well as patients quality of life. Chronic pain patients frequenty suffer sever guilt for the effects of their pain on the lives of their loved ones.
The reason Neuromuscular Dentistry has a reputation of being extremely expensive is that many patients elect to do full mouth reconstruction as long term stabilzation after their pain is eliminated or substantially reduced. They prefer not to have a long term stabilization appliance. The second phase of Neuromuscular Dental Treatment of Migraines and/or Tension Headaches and TMJ disorders requires stabilization so improvements in quality of life are maintained.
Cast removable orthotics, orthodontics and semi-permanent oral orthotics are alternatives to expensive reconstruction. The quality of life of the patient is what is key not the method of long term stabilization.
There are some dental groups that are involved in treatment of TMJ disorders that chose to ignore widespread clinical success from occlusal therapy and prefer to ebrace the pscho-social approach to these problems. They prefer the medication approach and believe this is more a mental problem than a physical problem. they strongly embrace the use of psychoactive medications and other drugs that frequently have dangerous side effects. Evidenced based medicine is the new watchword in research and drug therapy naturally lends itself to randomized clinical trials. These doctors frequently site these drug studies.
Drug studies are not bad but they are the most pervasive due to billions spent by Big Pharma looking to score big in the market place. Recent studies have shown that positive studies are published as much as two years earlier than studies that show negative results and problematic side effects. It has become common place to see the FDA recall products completely or place dire warnings about drug safety after they have been available for years. Even "safe" drugs like Acetaminophen often have dangerous side effects. The following is from WebMD:
""July 1, 2009 -- The FDA should put new restrictions on acetaminophen, an advisory committee recommended Tuesday, saying the move would protect people from the potential toxicity that can cause liver failure and even death.
The FDA does not have to follow its advisory committees’ recommendations, but it usually does. It will likely be months before the FDA makes a final decision on the drug.
You might not know "acetaminophen," because that's the drug's generic name. One of the nation’s top drugs for pain relief, acetaminophen is found in many over-the-counter products -- including Tylenol, aspirin-free Anacin, Excedrin, and numerous cold medicines. It's also found in many prescription drugs." (end Web MD info)
Many negative studies are never published because funding is discontinued when the results are negative and nobody is that interested in drugs that don't work. When those drugs are already on the market and the initial studies show promise physicians are not always aware of later studies.
Another study (abstract below) used experimental mechanical stimulation to induce hyperaemia associated with cortical spreading depression (CSD) the underlying mechanism behind the aura is associated with neurological disorders that 30% of migraine patients patients additionally suffering from. The most common of the focal neurological disturbances is the aura.
What I find most interesting about the experiment is that proves that Cortical Spreading Depression associated with Aura can be mechanically induced which is exactly the philosophy of Neuromuscular Dentistry. Obviously if you read the study it is designed to find new drugs to treat migraine. It is certainly not their intention to show that migraines are primarily central effect of peripheral stimulation. But as I stated previously Botox is an excellent example of peripherally caused migraines being controlled by changing neurolical input to the trigeminal system. I maintain that if possible removing noxious stimuli is preferable to injection of dangerous toxins.
Some of the dangers and General Side Effects associated with Botox injections follow:
* Bruising (Common)
* Dizziness
* Skin rash
* Tiredness
* Muscle spasm
* Numbness
* General Weaknes
* Drowsines
* Flu-like syndrome 2%
* Feeling generally unwell
* Dryness of the mouth
* Sickness
* Headache 13.3%
* Stiffness
Injections around the eye often have one or more the following side effects:
*Drooping upper eyelid 3.2%
* Drooping brow
* Mild inflammation of the surface of the eye
* Difficulty in completely closing the eye
* Overflow of tears
* Dry eye
* Sensitivity to light
Less Frequent side effects include:
* Inflammation of the surface of the eye
* Turning out or Eversion of the eyelid
* Turning in or Inversion of the eyelid
* Double vision
* Facial weakness
* Facial droop
* Blurred vision
The following side effects are rare but do occur:
* Swelling of the eyelids
* Ulcers develop on the surface of the eye
* Eye pressure increase (Glaucoma)
I do feel that there is a definite role of Botox in the treatment of migraines for some patients but I would advise that initiating treatment with a diagnostic neuromuscular orthotic may prove vastly more successful and safer for the patient and provide a better long term quality of life.
Cephalalgia. 2010 May;30(5):576-81. Epub 2010 Feb 11.
Triptans: low utilization and high turnover in the general population.
Panconesi A, Pavone E, Franchini M, Mennuti N, Bartolozzi M, Guidi L, Banfi R.
Health Authority 11, Empoli, Florence, Italy. a.panconesi@virgilio.it
Abstract
Studies performed in selected populations have shown a poor utilization of triptans for migraine. Our study was aimed at establishing patterns of triptans utilization in a large community using the pharmaceutical prescriptions database of two consecutive years in a regional Health Authority in Italy. About 0.5% of the population observed received triptans prescriptions in a year, but > 50% of the cases received only one prescription. On the other hand, 46% of triptan users did not receive a triptan prescription in the following year (past users): in 80% of cases, patients received only 1-2 triptan packages. The evaluation of the discontinued triptan type has shown percentages varying between 30 and 70%. The percentage of triptan users who received a triptan prescription for the first time in the successive year of study (new users) was 52%. These findings together highlight a high turnover in triptans utilization. Less than 15% of subjects received more than one triptan product in the 2 years. In conclusion, we observed a low percentage of triptan users and a low rate of utilization, associated with a high percentage of discontinuation and new utilization (high turnover), without any substantial increase in triptans utilization during the years. All these data probably do not support optimal satisfaction with triptan therapy.
PMID: 19732070 [PubMed - indexed for MEDLINE]
Drug therapy of chronic daily headaches, atypical migraine, chronic migraine, tension-type headaches and other disorders may be useful as a interim measure but I content that removing the underlying cause of migraines and headaches is the optimum long term solution for chronic headache pain. The basis of Neuromuscular Dentistry is to eliminate the noxious input to the Trigeminal Nervous System that is responsible for headache propagation.
Sleep and Health Journal has my article on Neuromuscular Dentistry that was originally published by the American Equilibration Society. It is an excellent resource for all patients with headaces, migraines and TMJ disorders that are considering Neuromuscular Dental Treatment. The Neuromuscular Dentistry article is available @ http://www.sleepandhealth.com/neuromuscular-dentistry
The use of BOTOX to treat migraines and Tenion-Type headaches actually proves the validity of Neuromuscular Dentistry. The long term block with botulism toxin of neurojunctions in masticatory muscles clearly demonstrate that the pain and headache/ migraines are coming either directly from the musces, ie referred or myofascial pain or that noxious input from these muscles is causing central sensitization of the Trigeminal Nerve and Central Nervous system.
Neuromuscular Dentistry creates a healthy homeostasis where long term healing can occur. Neuromuscular Dentistry is frequently criticised for being expensive. This is actually a falsehood. Initial therapy with a diagnostic orthotic is usually done over a period of a few months and can run several thousan dolars but pales when compared to the costs of MRI's CAT SCANS, Chronic medication use with associated side effects and rebound headaches and awful effects on family and friends as well as patients quality of life. Chronic pain patients frequenty suffer sever guilt for the effects of their pain on the lives of their loved ones.
The reason Neuromuscular Dentistry has a reputation of being extremely expensive is that many patients elect to do full mouth reconstruction as long term stabilzation after their pain is eliminated or substantially reduced. They prefer not to have a long term stabilization appliance. The second phase of Neuromuscular Dental Treatment of Migraines and/or Tension Headaches and TMJ disorders requires stabilization so improvements in quality of life are maintained.
Cast removable orthotics, orthodontics and semi-permanent oral orthotics are alternatives to expensive reconstruction. The quality of life of the patient is what is key not the method of long term stabilization.
There are some dental groups that are involved in treatment of TMJ disorders that chose to ignore widespread clinical success from occlusal therapy and prefer to ebrace the pscho-social approach to these problems. They prefer the medication approach and believe this is more a mental problem than a physical problem. they strongly embrace the use of psychoactive medications and other drugs that frequently have dangerous side effects. Evidenced based medicine is the new watchword in research and drug therapy naturally lends itself to randomized clinical trials. These doctors frequently site these drug studies.
Drug studies are not bad but they are the most pervasive due to billions spent by Big Pharma looking to score big in the market place. Recent studies have shown that positive studies are published as much as two years earlier than studies that show negative results and problematic side effects. It has become common place to see the FDA recall products completely or place dire warnings about drug safety after they have been available for years. Even "safe" drugs like Acetaminophen often have dangerous side effects. The following is from WebMD:
""July 1, 2009 -- The FDA should put new restrictions on acetaminophen, an advisory committee recommended Tuesday, saying the move would protect people from the potential toxicity that can cause liver failure and even death.
The FDA does not have to follow its advisory committees’ recommendations, but it usually does. It will likely be months before the FDA makes a final decision on the drug.
You might not know "acetaminophen," because that's the drug's generic name. One of the nation’s top drugs for pain relief, acetaminophen is found in many over-the-counter products -- including Tylenol, aspirin-free Anacin, Excedrin, and numerous cold medicines. It's also found in many prescription drugs." (end Web MD info)
Many negative studies are never published because funding is discontinued when the results are negative and nobody is that interested in drugs that don't work. When those drugs are already on the market and the initial studies show promise physicians are not always aware of later studies.
Another study (abstract below) used experimental mechanical stimulation to induce hyperaemia associated with cortical spreading depression (CSD) the underlying mechanism behind the aura is associated with neurological disorders that 30% of migraine patients patients additionally suffering from. The most common of the focal neurological disturbances is the aura.
What I find most interesting about the experiment is that proves that Cortical Spreading Depression associated with Aura can be mechanically induced which is exactly the philosophy of Neuromuscular Dentistry. Obviously if you read the study it is designed to find new drugs to treat migraine. It is certainly not their intention to show that migraines are primarily central effect of peripheral stimulation. But as I stated previously Botox is an excellent example of peripherally caused migraines being controlled by changing neurolical input to the trigeminal system. I maintain that if possible removing noxious stimuli is preferable to injection of dangerous toxins.
Some of the dangers and General Side Effects associated with Botox injections follow:
* Bruising (Common)
* Dizziness
* Skin rash
* Tiredness
* Muscle spasm
* Numbness
* General Weaknes
* Drowsines
* Flu-like syndrome 2%
* Feeling generally unwell
* Dryness of the mouth
* Sickness
* Headache 13.3%
* Stiffness
Injections around the eye often have one or more the following side effects:
*Drooping upper eyelid 3.2%
* Drooping brow
* Mild inflammation of the surface of the eye
* Difficulty in completely closing the eye
* Overflow of tears
* Dry eye
* Sensitivity to light
Less Frequent side effects include:
* Inflammation of the surface of the eye
* Turning out or Eversion of the eyelid
* Turning in or Inversion of the eyelid
* Double vision
* Facial weakness
* Facial droop
* Blurred vision
The following side effects are rare but do occur:
* Swelling of the eyelids
* Ulcers develop on the surface of the eye
* Eye pressure increase (Glaucoma)
I do feel that there is a definite role of Botox in the treatment of migraines for some patients but I would advise that initiating treatment with a diagnostic neuromuscular orthotic may prove vastly more successful and safer for the patient and provide a better long term quality of life.
Cephalalgia. 2010 May;30(5):576-81. Epub 2010 Feb 11.
Triptans: low utilization and high turnover in the general population.
Panconesi A, Pavone E, Franchini M, Mennuti N, Bartolozzi M, Guidi L, Banfi R.
Health Authority 11, Empoli, Florence, Italy. a.panconesi@virgilio.it
Abstract
Studies performed in selected populations have shown a poor utilization of triptans for migraine. Our study was aimed at establishing patterns of triptans utilization in a large community using the pharmaceutical prescriptions database of two consecutive years in a regional Health Authority in Italy. About 0.5% of the population observed received triptans prescriptions in a year, but > 50% of the cases received only one prescription. On the other hand, 46% of triptan users did not receive a triptan prescription in the following year (past users): in 80% of cases, patients received only 1-2 triptan packages. The evaluation of the discontinued triptan type has shown percentages varying between 30 and 70%. The percentage of triptan users who received a triptan prescription for the first time in the successive year of study (new users) was 52%. These findings together highlight a high turnover in triptans utilization. Less than 15% of subjects received more than one triptan product in the 2 years. In conclusion, we observed a low percentage of triptan users and a low rate of utilization, associated with a high percentage of discontinuation and new utilization (high turnover), without any substantial increase in triptans utilization during the years. All these data probably do not support optimal satisfaction with triptan therapy.
PMID: 19732070 [PubMed - indexed for MEDLINE]
Saturday, January 29, 2011
TREAT HEADACHES, MIGRAINES AND FACIAL PAIN WITHOUT DANGEROUS DRUGS AND ASSOCIATED SIDE EFFECTS. NEUROMUSCULAR DENTISTRY IS A SAFE AND EFFECTIVE.
Neuromuscular Dentistry may be one of the most effective treatments for a wide variety of conditions including various types of "migraine", tension-type headaches, facial pain, trigeminal neuralgia, TMJ disorders, myofascial ain and muscular and neurogenic headaches. Drugs do not cure the underlying problems that cause the problems and frequently their mechanism of action is unknown. Many drugs are recalled due to dangerous or deadly side effects and a large number of patients experience rebound headaches. These patients frequently require higher doses of medication over time.
There are many varied and diverse advantages to neuromuscular dentistry over standard medical approaches. The single biggest problem in treating headaches utilizing neuromuscular dental technology is that it can be expensive. Insurance companies are aware that 50% reduction in symptoms almost always occurs with treatment. This is a higher positive respone than almost any drug regimens. Insurance companies frequently chose to deny coverage to increase profits to shareholders. Patients who have undergone numerous CAT Scans, MRI's ,Drug therapies and surgeries without adequate control of their pain frequently find that Neuromuscular Dentistry gives amazing relief and improves the quality of their lives and the lives of their loved ones and are then denied coverage for treatment. Many of these patients have exhausted their resources on unsuccessful therapies prior to learning about and experiencing relief thru neuromuscular dentistry.
The Alliance of TMD Organizations is working to address the unfair practices of insurance companies relative to the treatment of TMJ disorders and Headaches related to the masticatory system. They are also the primary group protecting the rights of TMJ patients. There is a large group of clinicians in dentistry who believe the problems patients experience are psychosocial and not physical and want medication to become the only treatment available to most patients. They would like to take away patients right to chose non-drug alternative treatments. Unfortunately this group has enormous political influence and exert control over most research funds often to the detriment of patients. This remains true even after scandals in FDA hearings led removal of some of their members from FDA panels. There are also numerous instances of unethical conflicts of interest that were not disclosed to the FDA. Additional information on the TMD alliance is available at: http://www.tmdalliance.org/
I would like to disclose that I am a representative of ICCMO to the Alliance and that I am a long term member of The American Equilibration Society, The American Academy of CranioFacial Pain and a member of The International Academy of Comprehensive Aesthetics. I am also a Diplomate of the American Academy of Pain Management. These are member organizations of the TMD Alliance. I am the chair of the insurance reimbursement commitee.
Neuromuscular Dental Treatment of headaches is usually divided into two phases: the initial treatment phase (pain reduction and elimination) and long term stabilization (long term maintenance of improved quality of life).
The initial treatment phase includes the diagnostic protocols established by the particular neuromuscular dentist, comprehensive exam including medical histroy review (extremely important), muslce palpation exam, range of motion evaluation radiographs. The use of EMG (electomyography) and computerized mandibular scans (CMS or MKG), sonography, ultra low frequency TENS and transcranial neurostimulation are frequently useful in understanding the variable in the course of the doctor establishing a working diagnosis. More advanced practitioners frequently wil do diagnostic trigger point injections, nerve blocks or autonomic blocks such as spenopalatine ganglion blocks.
The mainstay in neuromuscular dental treatment of TMJ disorders (TMD), migraines, tension-type headaches, atypical migraine, chronic daily headaches and facial pain is the diagnostic neuromuscular orthotic. THIS ORTHOTIC IS UTILIZED TO ESTABLISH A HEALTHY "LANDING POINT" THAT HAS MINIMAL MUSCULAR AND NEUROMUSCULAR ADAPTATION. This allows the body and all of the neuromuscular components a healthy environment to heal.
Doctors do not cure patients! The best doctors remove the impediments to healing! The body than returns to a healthy homeostatic condition. This is what is accomplished with the neuromuscular orthotic over a series of several appointment. If the patient experiences complete relief and /or total elimination of symptoms for an extended period the stabilization phase can be initiated. When patient have substantial relief but still have remaining symptoms they will determine whether they are ready for stabilization.
Long term stabilization can be a very expensive full mouth reconstruction but this is usually one of many possible treatments. Long term removable orthotics, orthodontics and semi-permanent appiances allow pain control without the expense of a reconstruction. WHAT IS IMPORTANT IS THAT THE PATIENT IS READY FOR LONG TERM STABILIZATION. The diagnostic orthotic is not a long term treatment. Frequently patients have dramatic improvements with their orthotics but do not precede to long term stabilization and see their symptoms return as the appliance wears down or breaks.
Sleep disturbances frequently accompany craniomandibular disorders and headaches. Patients with tiredness, morning headaches, nocturnal headaches, high blood pressur and memory problems usuallly need to be evaluated at a sleep lab utilizing a full polysomnograph array.
There are many varied and diverse advantages to neuromuscular dentistry over standard medical approaches. The single biggest problem in treating headaches utilizing neuromuscular dental technology is that it can be expensive. Insurance companies are aware that 50% reduction in symptoms almost always occurs with treatment. This is a higher positive respone than almost any drug regimens. Insurance companies frequently chose to deny coverage to increase profits to shareholders. Patients who have undergone numerous CAT Scans, MRI's ,Drug therapies and surgeries without adequate control of their pain frequently find that Neuromuscular Dentistry gives amazing relief and improves the quality of their lives and the lives of their loved ones and are then denied coverage for treatment. Many of these patients have exhausted their resources on unsuccessful therapies prior to learning about and experiencing relief thru neuromuscular dentistry.
The Alliance of TMD Organizations is working to address the unfair practices of insurance companies relative to the treatment of TMJ disorders and Headaches related to the masticatory system. They are also the primary group protecting the rights of TMJ patients. There is a large group of clinicians in dentistry who believe the problems patients experience are psychosocial and not physical and want medication to become the only treatment available to most patients. They would like to take away patients right to chose non-drug alternative treatments. Unfortunately this group has enormous political influence and exert control over most research funds often to the detriment of patients. This remains true even after scandals in FDA hearings led removal of some of their members from FDA panels. There are also numerous instances of unethical conflicts of interest that were not disclosed to the FDA. Additional information on the TMD alliance is available at: http://www.tmdalliance.org/
I would like to disclose that I am a representative of ICCMO to the Alliance and that I am a long term member of The American Equilibration Society, The American Academy of CranioFacial Pain and a member of The International Academy of Comprehensive Aesthetics. I am also a Diplomate of the American Academy of Pain Management. These are member organizations of the TMD Alliance. I am the chair of the insurance reimbursement commitee.
Neuromuscular Dental Treatment of headaches is usually divided into two phases: the initial treatment phase (pain reduction and elimination) and long term stabilization (long term maintenance of improved quality of life).
The initial treatment phase includes the diagnostic protocols established by the particular neuromuscular dentist, comprehensive exam including medical histroy review (extremely important), muslce palpation exam, range of motion evaluation radiographs. The use of EMG (electomyography) and computerized mandibular scans (CMS or MKG), sonography, ultra low frequency TENS and transcranial neurostimulation are frequently useful in understanding the variable in the course of the doctor establishing a working diagnosis. More advanced practitioners frequently wil do diagnostic trigger point injections, nerve blocks or autonomic blocks such as spenopalatine ganglion blocks.
The mainstay in neuromuscular dental treatment of TMJ disorders (TMD), migraines, tension-type headaches, atypical migraine, chronic daily headaches and facial pain is the diagnostic neuromuscular orthotic. THIS ORTHOTIC IS UTILIZED TO ESTABLISH A HEALTHY "LANDING POINT" THAT HAS MINIMAL MUSCULAR AND NEUROMUSCULAR ADAPTATION. This allows the body and all of the neuromuscular components a healthy environment to heal.
Doctors do not cure patients! The best doctors remove the impediments to healing! The body than returns to a healthy homeostatic condition. This is what is accomplished with the neuromuscular orthotic over a series of several appointment. If the patient experiences complete relief and /or total elimination of symptoms for an extended period the stabilization phase can be initiated. When patient have substantial relief but still have remaining symptoms they will determine whether they are ready for stabilization.
Long term stabilization can be a very expensive full mouth reconstruction but this is usually one of many possible treatments. Long term removable orthotics, orthodontics and semi-permanent appiances allow pain control without the expense of a reconstruction. WHAT IS IMPORTANT IS THAT THE PATIENT IS READY FOR LONG TERM STABILIZATION. The diagnostic orthotic is not a long term treatment. Frequently patients have dramatic improvements with their orthotics but do not precede to long term stabilization and see their symptoms return as the appliance wears down or breaks.
Sleep disturbances frequently accompany craniomandibular disorders and headaches. Patients with tiredness, morning headaches, nocturnal headaches, high blood pressur and memory problems usuallly need to be evaluated at a sleep lab utilizing a full polysomnograph array.
Monday, January 24, 2011
CONTINUOS HEADACHE FOR MONTHS!
DEBBIE: i have had a headache non stop for 21 months. i need help now!!!!!!
The doctdors can not tell me what is causing thsi, they just keep giving me drugs.
DR SHAPIRA RESPONSE: Debbie, I frequently hear stories like yours. The fact that the physicians cannot find a cause is good news. It means there isn't a brain tumor or similar organic disorder. The majority of headaches are neuromuscular in orgin and you are probably an excellent canidate for diagnostic blocks, trigger pint deactivation and a neuuromuscular orthotic that addresses the trigeminal nerve and the muscles it feeds.
You did not discuss what tests you have had or your history prior to the headache. I advise that you continual to lookfor the underlying causes of your pain.
Long term like you are experiencing can creat permanent brain changes thru central sensitization.
The doctdors can not tell me what is causing thsi, they just keep giving me drugs.
DR SHAPIRA RESPONSE: Debbie, I frequently hear stories like yours. The fact that the physicians cannot find a cause is good news. It means there isn't a brain tumor or similar organic disorder. The majority of headaches are neuromuscular in orgin and you are probably an excellent canidate for diagnostic blocks, trigger pint deactivation and a neuuromuscular orthotic that addresses the trigeminal nerve and the muscles it feeds.
You did not discuss what tests you have had or your history prior to the headache. I advise that you continual to lookfor the underlying causes of your pain.
Long term like you are experiencing can creat permanent brain changes thru central sensitization.
Sunday, November 7, 2010
Facial Pain, Normal Sinus CT scans, Headache, Migraine and TMD
An older study in the Laryngescope is on 104 patients with facial pain who had normal CT scans. Twenty nine of the patients had previous unsuccessful sinus surgery. The patients were approximately 80% women, TMJ disorders are usually (80%) found in female patients.
The study showed " Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis." It is essential that organic neurologic causes are ruled out but the 100 remaining patients had headaches of undetermined causes. Facial pain and sinus pain are a alert for MPD (myofascial pain) and TMD (temporomandibular pain). Treatment of patients with chronic headaches, migraines sinus and/or facial pain is frequently done without a neuromuscular dental evaluation even though NMD has extremely high success rates.
The Trigeminal nerve innervates the sinus cavities. It is often called the Dentist's nerve because the trigeminal nerve primarily goes to the teeth, jaw muscles, jaw joints, periodontal ligaments and is responsible in full or part for most headaches. It also controls blood flow to the anterior 2/3 of the brain thru the meninges.
Correction of underlying neuromuscular problems often allows drug free effective treatment. When CT scans are normal patients with sinus pain and facial pain should always be evaluated by a neuromuscular dentist. Neurologists should evaluate all patients with organic brain disorders but functional treatment is preferred to heavy drug therapy for the majority of patients.
Frequently Chiropracters and dentists can get miraculous results by working together especially NUCCA and A/O (Atlas Orthogonal) chiropracters. The Dentists can correct nociceptive trigeminal nerve input while the chiropracters correct cervical and head posture. Long term correction of those problems usually requires correction of descending conditions associated with improper jaw function.
Laryngoscope. 2004 Nov;114(11):1992-6.
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.
Paulson EP, Graham SM.
Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USA.
Abstract
OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.
STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board.
METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.
RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).
CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.
PMID: 15510029 [PubMed - indexed for MEDLINE]
The study showed " Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis." It is essential that organic neurologic causes are ruled out but the 100 remaining patients had headaches of undetermined causes. Facial pain and sinus pain are a alert for MPD (myofascial pain) and TMD (temporomandibular pain). Treatment of patients with chronic headaches, migraines sinus and/or facial pain is frequently done without a neuromuscular dental evaluation even though NMD has extremely high success rates.
The Trigeminal nerve innervates the sinus cavities. It is often called the Dentist's nerve because the trigeminal nerve primarily goes to the teeth, jaw muscles, jaw joints, periodontal ligaments and is responsible in full or part for most headaches. It also controls blood flow to the anterior 2/3 of the brain thru the meninges.
Correction of underlying neuromuscular problems often allows drug free effective treatment. When CT scans are normal patients with sinus pain and facial pain should always be evaluated by a neuromuscular dentist. Neurologists should evaluate all patients with organic brain disorders but functional treatment is preferred to heavy drug therapy for the majority of patients.
Frequently Chiropracters and dentists can get miraculous results by working together especially NUCCA and A/O (Atlas Orthogonal) chiropracters. The Dentists can correct nociceptive trigeminal nerve input while the chiropracters correct cervical and head posture. Long term correction of those problems usually requires correction of descending conditions associated with improper jaw function.
Laryngoscope. 2004 Nov;114(11):1992-6.
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.
Paulson EP, Graham SM.
Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USA.
Abstract
OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.
STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board.
METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.
RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).
CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.
PMID: 15510029 [PubMed - indexed for MEDLINE]
Wednesday, September 29, 2010
Sphenopalatine block and tinnitus,swallowing problems and other disorders
I just had a patient in the office who we did a spenopaltine block on 1 week ago with major relief of shoulder pain (I was not treating) and reduction of tinnitus and droopy eyelids that we were sleeping. My patients chief complaint is swallowing problems that were better almost immediately after the SPG block
I have seen patients with severe insomnia sleep well without medications, other patients who have had relief from restless leg and other diverse conditions.
I usually do SPG blocks for sinus pain and pressure, migraine prevention or treating cluster headaches. However, when patients have "wierd" symptoms it is nice to have the SPG block as a possible treatment.
The Sphenopalatine ganglion is an autnomic nervous center and if we see only temporary relief frow symptoms it is possible to send patients to a neurologist for a stellate ganglion block for longer lasting relief.
I have seen patients with severe insomnia sleep well without medications, other patients who have had relief from restless leg and other diverse conditions.
I usually do SPG blocks for sinus pain and pressure, migraine prevention or treating cluster headaches. However, when patients have "wierd" symptoms it is nice to have the SPG block as a possible treatment.
The Sphenopalatine ganglion is an autnomic nervous center and if we see only temporary relief frow symptoms it is possible to send patients to a neurologist for a stellate ganglion block for longer lasting relief.
Friday, September 24, 2010
Trigger point injections are an essential part of TMD, Migraine and Headache treatment for many patients
The importance of this study though extremely limited is that it explains why understanding Myofascial Pain and Dysfunction is essential when chronic pain problems including neck pain, headache and TMD disorders. In this study a single injection in the trapezius muscle (shoulder) gave significant reduction in pain in the masseter region along with reduction in EMG values.
There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.
Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.
Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.
Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.
PMID: 8121703 [PubMed - indexed for MEDLINE]
There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.
Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.
Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.
Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.
PMID: 8121703 [PubMed - indexed for MEDLINE]
Thursday, September 23, 2010
Increased Cortical Activity that causes headaches is increased with sleep apnea.
A recent study in Sleep Med on altered Cortical Excitability in sleep apnea concluded that " This TMS-based study suggests that untreated severe OSAS patients have imbalanced cortical excitabilities that enhanced inhibition or decreased brain excitability when awake during the day."
This may be a major cause of chronic headaches or migraines or other biochemical imbalances leading to stress disorders ofr depression. Many patients do not reach the clinical definition of sleep apnea but have UARS (upper respiratory resistance syndrome). This has been implicated in fibromyalgia and central sensitization as well.
I have included a few relevant pubmed articles below.
Sleep apne is the result of a TMJ disorder (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf)
Neuromuscular Dentistry can help reduce incresed corticl activity, Treatment of sleep apnea can do the same.
Patients with sleep apnea have a smaller airway 24/7 that collapses at night. Correction of apnea and daytime jaw position may be ideal for all patients with chronic pain and sleep apnea.
Sleep Med. 2010 Oct;11(9):857-61.
Altered cortical excitability in patients with untreated obstructive sleep apnea syndrome.
Joo EY, Kim HJ, Lim YH, Koo DL, Hong SB.
Sleep Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Comment in:
Sleep Med. 2010 Oct;11(9):820-1.
Abstract
OBJECTIVE: To investigate cortical excitability in patients with obstructive sleep apnea syndrome (OSAS) during wakefulness.
METHODS: The authors recruited 45 untreated severe OSAS (all males, mean age 47.2 years, mean apnea-hypopnea index=44.6h(-1)) patients and 44 age-matched healthy male volunteers (mean apnea-hypopnea index=3.4h(-1)). The TMS parameters measured were resting motor threshold (RMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP), and short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). These parameters were measured in the morning (9-10 am) more than 2h after arising and the parameters of patients and controls were compared. The Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) were also measured before the TMS study.
RESULTS: OSAS patients had a significantly higher RMT and a longer CSP duration (t-test, p<0.001) compared to healthy volunteers. No significant difference was observed between MEP amplitudes at any stimulus intensity or between the SICI (2, 3, 5ms) and ICF (10, 15, 20ms) values of OSAS patients and healthy volunteers (p>0.05).
CONCLUSIONS: This TMS-based study suggests that untreated severe OSAS patients have imbalanced cortical excitabilities that enhanced inhibition or decreased brain excitability when awake during the day.
PMID: 20817550 [PubMed - in process]
Handb Clin Neurol. 2010;97:73-83.
Biological science of headache channels.
Pietrobon D.
Abstract
Several episodic neurological diseases, including familial hemiplegic migraine (FHM) and different types of epilepsy, are caused by mutations in ion channels, and hence classified as channelopathies. The classification of FHM as a channelopathy has introduced a new perspective in headache research and has strengthened the idea of migraine as a disorder of neural excitability. Here we review recent studies of the functional consequences of mutations in the CACNA1A and SCNA1A genes (encoding the pore-forming subunit of Ca(V)2.1 and Na(V)1.1 channels) and the ATPA1A2 gene (encoding the alpha(2) subunit of the Na(+)/K(+) pump), responsible for FHM1, FHM3, and FHM2, respectively. These studies show that: (1) FHM1 mutations produce gain-of-function of the Ca(V)2.1 channel and, as a consequence, increased glutamate release at cortical synapses and facilitation of induction and propagation of cortical spreading depression (CSD); (2) FHM2 mutations produce loss-of-function of the alpha(2) Na(+)/K(+)-ATPase; and (3) the FHM3 mutation accelerates recovery from fast inactivation of Na(V)1.5 channels. These findings are consistent with the hypothesis that FHM mutations share the ability to render the brain more susceptible to CSD, by causing excessive synaptic glutamate release (FHM1) or decreased removal of K(+) and glutamate from the synaptic cleft (FHM2) or excessive extracellular K(+) (FHM3).
PMID: 20816411 [PubMed - in pr
Handb Clin Neurol. 2010;97:47-71.
Pharmacology.
Bolay H, Durham P.
Department of Neurology, Gazi Hospital and Neuropsychiatry Centre, Gazi University, Besevler, Ankara, Turkey.
Abstract
Headache treatment has been based primarily on experiences with non-specific drugs such as analgesics, non-steroidal anti-inflammatory drugs, or drugs that were originally developed to treat other diseases, such as beta-blockers and anticonvulsant medications. A better understanding of the basic pathophysiological mechanisms of migraine and other types of headache has led to the development over the past two decades of more target-specific drugs. Since activation of the trigeminovascular system and neurogenic inflammation are thought to play important roles in migraine pathophysiology, experimental studies modeling those events successfully predicted targets for selective development of pharmacological agents to treat migraine. Basically, there are two fundamental strategies for the treatment of migraine, abortive or preventive, based to a large degree on the frequency of attacks. The triptans, which exhibit potency towards selective serotonin (5-hydroxytryptamine, 5-HT) receptors expressed on trigeminal nerves, remain the most effective drugs for the abortive treatment of migraine. However, numerous preventive medications are currently available that modulate the excitability of the nervous system, particularly the cerebral cortex. In this chapter, the pharmacology of commercially available medications as well as drugs in development that prevent or abort headache attacks will be discussed.
PMID: 20816410 [PubMed - in process]
Cephalalgia. 2010 Sep;30(9):1101-9. Epub 2010 Mar 19.
Cortical hyperexcitability and mechanism of medication-overuse headache.
Supornsilpchai W, le Grand SM, Srikiatkhachorn A.
Department of Physiology, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok, Thailand.
Abstract
The present study was conducted to determine the effect of acute (1 h) and chronic (daily dose for 30 days) paracetamol administration on the development of cortical spreading depression (CSD), CSD-evoked cortical hyperaemia and CSD-induced Fos expression in cerebral cortex and trigeminal nucleus caudalis (TNC). Paracetamol (200 mg/kg body weight, intraperitonealy) was administered to Wistar rats. CSD was elicited by topical application of solid KCl. Electrocorticogram and cortical blood flow were recorded. Results revealed that acute paracetamol administration substantially decreased the number of Fos-immunoreactive cells in the parietal cortex and TNC without causing change in CSD frequency. On the other hand, chronic paracetamol administration led to an increase in CSD frequency as well as CSD-evoked Fos expression in parietal cortex and TNC, indicating an increase in cortical excitability and facilitation of trigeminal nociception. Alteration of cortical excitability which leads to an increased susceptibility of CSD development can be a possible mechanism underlying medication-overuse headache.
PMID: 20713560 [PubMed - in process]
This may be a major cause of chronic headaches or migraines or other biochemical imbalances leading to stress disorders ofr depression. Many patients do not reach the clinical definition of sleep apnea but have UARS (upper respiratory resistance syndrome). This has been implicated in fibromyalgia and central sensitization as well.
I have included a few relevant pubmed articles below.
Sleep apne is the result of a TMJ disorder (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf)
Neuromuscular Dentistry can help reduce incresed corticl activity, Treatment of sleep apnea can do the same.
Patients with sleep apnea have a smaller airway 24/7 that collapses at night. Correction of apnea and daytime jaw position may be ideal for all patients with chronic pain and sleep apnea.
Sleep Med. 2010 Oct;11(9):857-61.
Altered cortical excitability in patients with untreated obstructive sleep apnea syndrome.
Joo EY, Kim HJ, Lim YH, Koo DL, Hong SB.
Sleep Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Comment in:
Sleep Med. 2010 Oct;11(9):820-1.
Abstract
OBJECTIVE: To investigate cortical excitability in patients with obstructive sleep apnea syndrome (OSAS) during wakefulness.
METHODS: The authors recruited 45 untreated severe OSAS (all males, mean age 47.2 years, mean apnea-hypopnea index=44.6h(-1)) patients and 44 age-matched healthy male volunteers (mean apnea-hypopnea index=3.4h(-1)). The TMS parameters measured were resting motor threshold (RMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP), and short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). These parameters were measured in the morning (9-10 am) more than 2h after arising and the parameters of patients and controls were compared. The Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) were also measured before the TMS study.
RESULTS: OSAS patients had a significantly higher RMT and a longer CSP duration (t-test, p<0.001) compared to healthy volunteers. No significant difference was observed between MEP amplitudes at any stimulus intensity or between the SICI (2, 3, 5ms) and ICF (10, 15, 20ms) values of OSAS patients and healthy volunteers (p>0.05).
CONCLUSIONS: This TMS-based study suggests that untreated severe OSAS patients have imbalanced cortical excitabilities that enhanced inhibition or decreased brain excitability when awake during the day.
PMID: 20817550 [PubMed - in process]
Handb Clin Neurol. 2010;97:73-83.
Biological science of headache channels.
Pietrobon D.
Abstract
Several episodic neurological diseases, including familial hemiplegic migraine (FHM) and different types of epilepsy, are caused by mutations in ion channels, and hence classified as channelopathies. The classification of FHM as a channelopathy has introduced a new perspective in headache research and has strengthened the idea of migraine as a disorder of neural excitability. Here we review recent studies of the functional consequences of mutations in the CACNA1A and SCNA1A genes (encoding the pore-forming subunit of Ca(V)2.1 and Na(V)1.1 channels) and the ATPA1A2 gene (encoding the alpha(2) subunit of the Na(+)/K(+) pump), responsible for FHM1, FHM3, and FHM2, respectively. These studies show that: (1) FHM1 mutations produce gain-of-function of the Ca(V)2.1 channel and, as a consequence, increased glutamate release at cortical synapses and facilitation of induction and propagation of cortical spreading depression (CSD); (2) FHM2 mutations produce loss-of-function of the alpha(2) Na(+)/K(+)-ATPase; and (3) the FHM3 mutation accelerates recovery from fast inactivation of Na(V)1.5 channels. These findings are consistent with the hypothesis that FHM mutations share the ability to render the brain more susceptible to CSD, by causing excessive synaptic glutamate release (FHM1) or decreased removal of K(+) and glutamate from the synaptic cleft (FHM2) or excessive extracellular K(+) (FHM3).
PMID: 20816411 [PubMed - in pr
Handb Clin Neurol. 2010;97:47-71.
Pharmacology.
Bolay H, Durham P.
Department of Neurology, Gazi Hospital and Neuropsychiatry Centre, Gazi University, Besevler, Ankara, Turkey.
Abstract
Headache treatment has been based primarily on experiences with non-specific drugs such as analgesics, non-steroidal anti-inflammatory drugs, or drugs that were originally developed to treat other diseases, such as beta-blockers and anticonvulsant medications. A better understanding of the basic pathophysiological mechanisms of migraine and other types of headache has led to the development over the past two decades of more target-specific drugs. Since activation of the trigeminovascular system and neurogenic inflammation are thought to play important roles in migraine pathophysiology, experimental studies modeling those events successfully predicted targets for selective development of pharmacological agents to treat migraine. Basically, there are two fundamental strategies for the treatment of migraine, abortive or preventive, based to a large degree on the frequency of attacks. The triptans, which exhibit potency towards selective serotonin (5-hydroxytryptamine, 5-HT) receptors expressed on trigeminal nerves, remain the most effective drugs for the abortive treatment of migraine. However, numerous preventive medications are currently available that modulate the excitability of the nervous system, particularly the cerebral cortex. In this chapter, the pharmacology of commercially available medications as well as drugs in development that prevent or abort headache attacks will be discussed.
PMID: 20816410 [PubMed - in process]
Cephalalgia. 2010 Sep;30(9):1101-9. Epub 2010 Mar 19.
Cortical hyperexcitability and mechanism of medication-overuse headache.
Supornsilpchai W, le Grand SM, Srikiatkhachorn A.
Department of Physiology, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok, Thailand.
Abstract
The present study was conducted to determine the effect of acute (1 h) and chronic (daily dose for 30 days) paracetamol administration on the development of cortical spreading depression (CSD), CSD-evoked cortical hyperaemia and CSD-induced Fos expression in cerebral cortex and trigeminal nucleus caudalis (TNC). Paracetamol (200 mg/kg body weight, intraperitonealy) was administered to Wistar rats. CSD was elicited by topical application of solid KCl. Electrocorticogram and cortical blood flow were recorded. Results revealed that acute paracetamol administration substantially decreased the number of Fos-immunoreactive cells in the parietal cortex and TNC without causing change in CSD frequency. On the other hand, chronic paracetamol administration led to an increase in CSD frequency as well as CSD-evoked Fos expression in parietal cortex and TNC, indicating an increase in cortical excitability and facilitation of trigeminal nociception. Alteration of cortical excitability which leads to an increased susceptibility of CSD development can be a possible mechanism underlying medication-overuse headache.
PMID: 20713560 [PubMed - in process]
Sunday, May 30, 2010
Twenty Years of Debilitating Pain, Can Neuromuscular Dentistry Help?
Comment from Kathy, 20 year history of pain in forehead, nose and all upper teeth. Very debilitating. Multiple doctors, multiple treatments.....no relief
Dr Shapira response:
Dear Kathy,
The pain you describe follows the innervation of the trigeminal nerve. It sounds like you are an excellent canidate for an evaluation and probably a diagnostic orthotic. It is always necessary to have a complete as possible history that is in chronological order. When did this begin and what was happening in your life. How has this pain affected you, your family and friends and how hs it changed you. I find that chronic pain can ruin patients lives and I want to unerstand these effects. I also want to know what treatment you had and how each worked. what medications you have tried. These are all clues we use alnong with neuromuscular orthotics to understand and treat problems.
You didn't ask but I assume you want to know if Neuromuscular Dentistry can help. I find that most patients have significant relief but not to expect miracles. Shoot for initial improvement of 50-80%. As you begin to feel better we continue to look for additional reuctions in pain as postural changes and nervous system changes take place.
Neuromuscular Dentistry allows the body to heal by removing the underlying pathology. Healing is an internal process and patients are unique which is why your history is so important.
Dr Shapira response:
Dear Kathy,
The pain you describe follows the innervation of the trigeminal nerve. It sounds like you are an excellent canidate for an evaluation and probably a diagnostic orthotic. It is always necessary to have a complete as possible history that is in chronological order. When did this begin and what was happening in your life. How has this pain affected you, your family and friends and how hs it changed you. I find that chronic pain can ruin patients lives and I want to unerstand these effects. I also want to know what treatment you had and how each worked. what medications you have tried. These are all clues we use alnong with neuromuscular orthotics to understand and treat problems.
You didn't ask but I assume you want to know if Neuromuscular Dentistry can help. I find that most patients have significant relief but not to expect miracles. Shoot for initial improvement of 50-80%. As you begin to feel better we continue to look for additional reuctions in pain as postural changes and nervous system changes take place.
Neuromuscular Dentistry allows the body to heal by removing the underlying pathology. Healing is an internal process and patients are unique which is why your history is so important.
Sunday, April 4, 2010
HEADACHE AND SLEEP APNEA TREATMENT IN SCHAUMBURG,MCHENRY, BARRINGTON, ELGIN AND CRYSTAL LAKE
I HAVE BEEN TRETING PATIENTS WITH CHRONIC HEAD AND NECK PAIN, FACIAL PAIN, MIGRAINES TENSION-TYPE HEADACHES FOR 30 YEARS. I SEE PATIENTS PRIMARILY IN MY GURNEE OFFICE AND OVER THE YEARS PATIENTS HAVE FOUND THAT IT WAS WORTH THE DRIVE FOR RELIEF OF PAIN. I HAVE RECENTLY CREATED CICAGOLAND DENTAL SLEEP MEDICINE ASSOCIATES AND I AM ABLE TO SEE PATIENTS IN SCHAUMBURG IN THE OFFICES OF DR ALAN ACIERNO AN EXCELLENT GENERAL DENTIST.
PATIENTS WITH HEADACHES AND SLEEP DISORDERS CAN MAKE APPOINTMENTS TO SEE ME IN SCHAUMBURG BY CONTACTING ME AT DELANY DENTAL CARE LTD IN GURNEE. CALL TOLL FREE AT 1-800-TM-JOINT OR 1-8-NO-PAP-MASK OR VISIT MY WEBSITE @ http://www.delanydentalcare.com/neuromuscular.html
PATIENTS WITH HEADACHES AND SLEEP DISORDERS CAN MAKE APPOINTMENTS TO SEE ME IN SCHAUMBURG BY CONTACTING ME AT DELANY DENTAL CARE LTD IN GURNEE. CALL TOLL FREE AT 1-800-TM-JOINT OR 1-8-NO-PAP-MASK OR VISIT MY WEBSITE @ http://www.delanydentalcare.com/neuromuscular.html
Monday, March 1, 2010
EAR PAIN: What to do when the ENT says there is no infection and does not have a treatment to relieve ear pain.
When chronic or acute ear pain occurs an evaluation by an otolaryngologist or ENT is a good way to begin treatment. The exception to this rule is when movements of the lower jaw cause the ear pain or the motion of the lower jaw is limited. This is a sign of a TMJ disorder. If it happens suddenly it may be the sign of an acute close-lock of the TM Joint and a dentist with experience in treating temporomandibular disorders is a must. Neuromuscular Dentistry is extremely effective in treating chronic haeadaches, migraines, Tension Headaches and TMD but when an acute close lock occurs time is of the essence to prevent permanent damage.
Many neuromuscular dentists know how to manage the chronic pain aspect of TMD but are less sure of handling an acute disk dislocation.
The wrong treatment is to not attempt to reduce the dislocation, taking anti-inflamatories or pain meds without attempting to reduce the dislocation. The longer the disk is out the more likely there will be permanent damage or internal derangement of the TMJ.
A trip to the emergency room is usually non-productive or may even create additional damage if they try to force the jaw open.
A simple method to reduce a close-lock it to stimulate a strong gag reflex which will sometimes reduce the dislocation. It is then necessary to stabilize the joint with an orthotic.
Many neuromuscular dentists know how to manage the chronic pain aspect of TMD but are less sure of handling an acute disk dislocation.
The wrong treatment is to not attempt to reduce the dislocation, taking anti-inflamatories or pain meds without attempting to reduce the dislocation. The longer the disk is out the more likely there will be permanent damage or internal derangement of the TMJ.
A trip to the emergency room is usually non-productive or may even create additional damage if they try to force the jaw open.
A simple method to reduce a close-lock it to stimulate a strong gag reflex which will sometimes reduce the dislocation. It is then necessary to stabilize the joint with an orthotic.
Wednesday, February 17, 2010
Sleep and Headaches linked in article in Current Treatment Options in Neurology
An article by Jeanetta C. Rains1 and J. Steven Poceta gives an opinion paper on the relation of sleep to headache. They feel that headache is linked to a wide variety of sleep disorders that may impact treatment results and headache management.
They believe that after standard diagnosis of headache a sleep history should be collected according to headache problems. Initally they state that you should rule out sleep apnea in patients with headaches on awakening. I agree and have frequently said that the two main causes of morning headaches are TMJ disorders, Sleep Apnea and Bruxing. The NHLBI of the NIH published a report "Cardiovascular and Sleep Related Consequences of Temoporomandibular Disorders" Morning headaches can also be caused by jaw clenching but newer evidence relates clenching to awakenings by sleep disordered breathing.
They believe that cluster headaches, chronic migraine and chronic tension-type headache should have sleep apnea ruled out as a cause. I believe that looking at the neuromuscular system to evaluate patients for TMJ disorders, muscle disorders and trigeminal nervous disorders related to the bite is also essential. Neuromuscular Dentistry is a method that has been shown to be "overwhelmingly successful according to Dr Barry Cooper and as published in Cranio Journal.
If there are signs and symptoms of sleep apnea they Rx polysomnography and treatment with CPAP. While CPAP is effective I feel patients with headaches and sleep apnea would be much better served by combining treatments by utilizing an intra-oral apnea appliance that will also help decrease headaches of trigeminal orgin, or almost all types of headaches. Studies with oral appliances for headache treatment show a minimal 50% improvement in the majority of patients. They do not advocate suspending regular headache treatment when treating apnea but many of the patients treated with oral appliances report complete relief of headaches. CPAP can also be effective but 60% of patients reject it and it causes negative side effects in a significant number of patients who use it leading to discontinuation of CPAP and/or poor compliance.
The authors stated that use of oral appliance, surgery and weight loss are untested displaying a suprising amout of ignorance about the current parameters of care for treating sleep apnea that considers oral appliances to be a first line of treatment for mild to moderate sleep apnea and an alternative for severe apnea when CPAP is not tolerated. The percentage of patients that do not tolerate CPAP is the same for mild, moderate and severe sleep apnea patients.
The authors reported "patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients." They did not specify it is was sleep onset insomnia or maintenance of sleep insomnia.
The authors also stated "All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management."
I believe it in incumbent on physicians and dentists treating headaches be acutely aware of the effect of sleep disorders on headache.
They should also be aware that psychiatric disorders and depression frequently occur in chronic pain patients as a direct result of the chronic pain.
Treatment of sleep disorders and headache with a combination of a neuromuscular daytime orthotic and a n intraoral sleep apnea appliance or use of a 24 hour orthotic is "overwhelming successful" as published in Cranio Journal.
They believe that after standard diagnosis of headache a sleep history should be collected according to headache problems. Initally they state that you should rule out sleep apnea in patients with headaches on awakening. I agree and have frequently said that the two main causes of morning headaches are TMJ disorders, Sleep Apnea and Bruxing. The NHLBI of the NIH published a report "Cardiovascular and Sleep Related Consequences of Temoporomandibular Disorders" Morning headaches can also be caused by jaw clenching but newer evidence relates clenching to awakenings by sleep disordered breathing.
They believe that cluster headaches, chronic migraine and chronic tension-type headache should have sleep apnea ruled out as a cause. I believe that looking at the neuromuscular system to evaluate patients for TMJ disorders, muscle disorders and trigeminal nervous disorders related to the bite is also essential. Neuromuscular Dentistry is a method that has been shown to be "overwhelmingly successful according to Dr Barry Cooper and as published in Cranio Journal.
If there are signs and symptoms of sleep apnea they Rx polysomnography and treatment with CPAP. While CPAP is effective I feel patients with headaches and sleep apnea would be much better served by combining treatments by utilizing an intra-oral apnea appliance that will also help decrease headaches of trigeminal orgin, or almost all types of headaches. Studies with oral appliances for headache treatment show a minimal 50% improvement in the majority of patients. They do not advocate suspending regular headache treatment when treating apnea but many of the patients treated with oral appliances report complete relief of headaches. CPAP can also be effective but 60% of patients reject it and it causes negative side effects in a significant number of patients who use it leading to discontinuation of CPAP and/or poor compliance.
The authors stated that use of oral appliance, surgery and weight loss are untested displaying a suprising amout of ignorance about the current parameters of care for treating sleep apnea that considers oral appliances to be a first line of treatment for mild to moderate sleep apnea and an alternative for severe apnea when CPAP is not tolerated. The percentage of patients that do not tolerate CPAP is the same for mild, moderate and severe sleep apnea patients.
The authors reported "patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients." They did not specify it is was sleep onset insomnia or maintenance of sleep insomnia.
The authors also stated "All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management."
I believe it in incumbent on physicians and dentists treating headaches be acutely aware of the effect of sleep disorders on headache.
They should also be aware that psychiatric disorders and depression frequently occur in chronic pain patients as a direct result of the chronic pain.
Treatment of sleep disorders and headache with a combination of a neuromuscular daytime orthotic and a n intraoral sleep apnea appliance or use of a 24 hour orthotic is "overwhelming successful" as published in Cranio Journal.
Monday, February 15, 2010
Temporal Arteritis misdiagnosed as migraine leading to tragic conditions for patient
Drug herapy always carries some risks. The following abstract details how a patient was treated for migraines with ergotamine. The patient was suffering from tiredness and weight loss and fever after a single dose of ergotamine. A second dose led to tongue necrosis (necrosis means death of the tissue) The authors felt that the necrosis of the tongue could have been the result of undiagnosed temporal arteritis a condition that can also cause blindness. A clinical sign of temporal arteritis is an elevated sed rate.
Ergotamine is a well known drug in migraine treatment and this is an unusual case. With neuromuscular dentistry we are always on the look out for red herrings. The patient who has a serious disorder that is causing symptoms or a serious disordersthat is not causing the symptoms but is covered up by the pain disorder.
My favorite patients to treat are patients who have had MRI's, CAT scans, Brain Scans, numerous blood tests ruling out organic diseases. These patients are "safe" because all the severe problems have been eliminated as possible causes of the problem.
Neuromuscular Dentistry cannot treat temporal arteritis which is usually treated with steroid but often dissapears after a biopsy.
PUBMED Abstract
Ugeskr Laeger. 2009 Jan 12;171(3):125-6.
[Necrosis of the tongue triggered by ergotamine in unrecognized temporal arteritis]
[Article in Danish]
Olesen JB.
Regionshospitalet Horsens, Medicinsk Afdeling. Jesper.blegvad@ki.au.dk
Tongue necrosis is a rare complication in arteritis temporalis. Our case is a 74-year-old patient who presented with weight loss, tiredness and fever during a 2-3-month period after ingestion of 2 mg ergotamine to treat her migraine. Tongue necrosis then occurred after ingestion of another 2 mg of ergotamine. Our patient had no preexisting diagnosis of arteritis temporalis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. It is possible that ergotamine can cause necrosis due to vasoconstriction of blood vessels which have an unstable blood flow.
PMID: 19174020 [PubMed - indexed for MEDLINE]
Ergotamine is a well known drug in migraine treatment and this is an unusual case. With neuromuscular dentistry we are always on the look out for red herrings. The patient who has a serious disorder that is causing symptoms or a serious disordersthat is not causing the symptoms but is covered up by the pain disorder.
My favorite patients to treat are patients who have had MRI's, CAT scans, Brain Scans, numerous blood tests ruling out organic diseases. These patients are "safe" because all the severe problems have been eliminated as possible causes of the problem.
Neuromuscular Dentistry cannot treat temporal arteritis which is usually treated with steroid but often dissapears after a biopsy.
PUBMED Abstract
Ugeskr Laeger. 2009 Jan 12;171(3):125-6.
[Necrosis of the tongue triggered by ergotamine in unrecognized temporal arteritis]
[Article in Danish]
Olesen JB.
Regionshospitalet Horsens, Medicinsk Afdeling. Jesper.blegvad@ki.au.dk
Tongue necrosis is a rare complication in arteritis temporalis. Our case is a 74-year-old patient who presented with weight loss, tiredness and fever during a 2-3-month period after ingestion of 2 mg ergotamine to treat her migraine. Tongue necrosis then occurred after ingestion of another 2 mg of ergotamine. Our patient had no preexisting diagnosis of arteritis temporalis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. It is possible that ergotamine can cause necrosis due to vasoconstriction of blood vessels which have an unstable blood flow.
PMID: 19174020 [PubMed - indexed for MEDLINE]
Article in Journal of American Osteopathic Association on role of trigeminal nerve in migraines. Why Osteopathy, Chiropractic, A/O and NUCCA work.
Osteopathic manipulation and Chiropractic manipulation both treat headaches by changing input into the trigeminal nerve much like neuromuscular dentistry does. The article states: " Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache." The pathology in the neck is addressed to reduce pain (nociceptive) input into the trigeminal nucleus caudalis. The easiest and most direct method of reducing nociceptive input into the trigeminal nerve is a diagnostic orthotic followed by definitive long term treatment. The beauty of neuromuscular dentistry is that correcting the stomatognathic/ trigeminal system leads to auto correction of many neck problems.
The reason that NUCCA and A/O (atlas orthogonal) chiropractic is so effective when used in conjunction with a neuromuscular orthotic is that the chiropractic and/or osteopathic adjustments hold when the underlying masticatory pathology is adressed.
J Am Osteopath Assoc. 2007 Nov;107(10 Suppl 6):ES10-6.
Diagnosing and managing migraine headache.
Mueller LL.
University Headache Center, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, 42 E Laurel Rd, University Doctors Pavilion, Ste 1700, Stratford, NJ 08084-1354, USA. SOMPhysicians@umdnj.edu
Comment in:
J Am Osteopath Assoc. 2008 Apr;108(4):191; author reply 191, 214.
Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. Although tension-type headaches are the most common kind of headache, patients with this type of headache rarely seek treatment unless occurrence is daily. Migraine, which affects more than 30 million people in the United States, is the most common headache diagnosis for which patients seek treatment. Migraine is a chronic, often inherited condition involving brain hypersensitivity and a lowered threshold for trigeminal-vascular activation. Intermittent debilitating attacks are characterized by autonomic, gastrointestinal, and neurologic symptoms. Migraine results in a marked decrease in a patient's quality of life, as measured by physical, mental, and social health-related instruments. Accurate assessment of a patient's disability will guide physicians in prescribing appropriate modes of therapy. However, migraine remains underdiagnosed, and patients with migraine remain undertreated. A comprehensive treatment approach to migraine may include nonpharmacologic measures, as well as abortive and prophylactic medications. Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.
PMID: 17986672 [PubMed - indexed for MEDLINE]
The reason that NUCCA and A/O (atlas orthogonal) chiropractic is so effective when used in conjunction with a neuromuscular orthotic is that the chiropractic and/or osteopathic adjustments hold when the underlying masticatory pathology is adressed.
J Am Osteopath Assoc. 2007 Nov;107(10 Suppl 6):ES10-6.
Diagnosing and managing migraine headache.
Mueller LL.
University Headache Center, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, 42 E Laurel Rd, University Doctors Pavilion, Ste 1700, Stratford, NJ 08084-1354, USA. SOMPhysicians@umdnj.edu
Comment in:
J Am Osteopath Assoc. 2008 Apr;108(4):191; author reply 191, 214.
Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. Although tension-type headaches are the most common kind of headache, patients with this type of headache rarely seek treatment unless occurrence is daily. Migraine, which affects more than 30 million people in the United States, is the most common headache diagnosis for which patients seek treatment. Migraine is a chronic, often inherited condition involving brain hypersensitivity and a lowered threshold for trigeminal-vascular activation. Intermittent debilitating attacks are characterized by autonomic, gastrointestinal, and neurologic symptoms. Migraine results in a marked decrease in a patient's quality of life, as measured by physical, mental, and social health-related instruments. Accurate assessment of a patient's disability will guide physicians in prescribing appropriate modes of therapy. However, migraine remains underdiagnosed, and patients with migraine remain undertreated. A comprehensive treatment approach to migraine may include nonpharmacologic measures, as well as abortive and prophylactic medications. Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.
PMID: 17986672 [PubMed - indexed for MEDLINE]
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