Cluster Headaches and Trigeminal Autonomic Cephalgias, TMJ Disorders and Neurostimulation

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

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

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

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

The Highland Park office website is www.ThinkBetterlife.com

The Highland Park office is www.DelanyDentalCare.com

THE FOLLOWING REDDITS HAVE PATIENT TESTIMONIALS

https://www.reddit.com/r/NeuroMuscularDent/

https://www.reddit.com/r/SPGBlocks/

PubMed Abstract:

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

Cluster headache and other TACs: Pathophysiology and neurostimulation options.

Láinez MJ1,2, Guillamón E1.

Author information

Abstract

BACKGROUND:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

© 2016 American Headache Society.

KEYWORDS:

hypothalamus; migraine pathophysiology; neuromodulation; trigeminal autonomic cephalalgia

CGRP Antagonists: Treatment of Migraine Can we prevent release of CGRP rather than treat with Antagonists

There is big money in the treatment of migraines.

 According to the Tevapharm.com website Teva and Hepartes entered in an agreement to discover and develop novel, small-molecule CGRP Antagonists for treatment of migraine.  Hepartes may receive potential payments of $400 million.  This is excellent news because much of the current drug regimens have safety and effectiveness issues.

Is there a better alternative to CGRP Antagonists for migrane.

Calcitonin gene-related peptide is a vaso-active neuropeptide released by branches of the Trigemino-vascular system of the Trigeminal Nerve.  CGRP and other neurotransmitters released at nerve synapses have been implicated in migraine headaches. 

Drug therapy for migraines are big business worldwide.  The question is there a better method of preventing and eliminating migraines available.

It is unlikely that funding to evaluate neuromuscular dentistry as migraine prevention will ever materialize.  This is in spite of the fact that it is well established that almost 100% of all headaches and migraines (including Trigeminal Autonomic cephalgias) are Trigeminally controlled.

The Trigeminal Nerve is often called the Dentist's nerve because it innervates the teeth (ie. dental pulp), the Periodontal Ligaments, the Jaw Muscles, the Jaw Joints, the anterior two thirds of the tongue, the tensor of the ear drum, the tensor of soft palate (opens and closes eustacian tubes).

The Trigemino-Cervical Complex descends cervically and connects to the sympathetic chain and is responsible for neck and occipital headaches.

The TrigeminoVascular System controls blood flow to the anterior two thirds of the meninges of the brai.  It is in this location that CGRP are released causing vaso dilation asociated with migraines.

The question is not can these drugs work but rather is it possible to prevent the release of the vasoactive neuropeptides by changing input to the trigeminal nervous system?

After accounting for amplification in the Reticular Activating System the Trigeminal Nervous System accounts for more that half of all input to the brain.

If we think of the brain as our central computer we can discuss the computer concept

GARBAGE IN- GARBAGE OUT  as a cause of all migraines and headaches.

Noxious input to the Trigeminal Nervous System causes release of neurotransmitters and vaso-active neuropeptides to the meninges of the brain  that are trigeminally innervated.

Can changing input correct migraine physiology.  The Sphenopalatine Ganglion (SPG) is the Largest Parasympathetic Ganglion of the head.  The SPG Block is extremely effective is stopping and preventing migraines and since it is generally done with lidocaine it is very safe.

Trigeminal fibers pass thru the Ganglion but do not have cell bodies there.  There are currently numerous implantable devices being studied that can change neural input to the Sphenopalatine Ganglion and treat Migraines, Cluster Headaches, Anxiety, Depression and many other disorders.  The block turns of the sympathetic overload of the fight or flight response.  In the parasympathetic mode we feel relaxation, safety, satiety, sexual,  loving, etc

This is proof of fact that changing neural input can treat, prevent and eliminate migraines and other headaches.

Neuromuscular Dentistry also has been shown to be very effective in treating patients with chronic headaches and migraines.  Unfortunately thousands of individual case studies do not carry the same evidence based medicine weight of double blind drug studies.  By its nature it is not possible to do double blind studies with neuromuscular Dentistry.......

There is a situation that clearly showed  the effectiveness of a Neuromuscular TMJ treatment program at Chicago HMO in the 1980's until 1993.

In the 1980's until 1993 I worked closely with Dr Mitchell Trubitt the Medical Director of Chicago HMO.  What started as a fight for insurance coverage for a single patient moved on to a test with six patients to see if Neuromuscular Dentistry could lead to cost savings for insurance compaines.  The initial test was six patients who were treated with neuromuscular orthotics for their TMJ and Headache problems.   All six patients had two surgical opinions stating TMJoint surgery was needed.  All six patients were treated without surgery.  The patients all reported being very happy with results that included relief of headaches and migraines.

The results were that we demonstrated estimated massive savings $250,000 on  just those six patients.  Because of the positive results of that test Chicago HMO began to cove 100% of the cost of Phase one Neuromuscular TMJ treatment .  These savings reflected hospitalization and surgery costs, surgical fees, anaesthesia and physical therapy.  Chicago HMO did not cover phase two treatment so all patients were fitted with appliances made on vitallium frameworks to prevent breakage.  Patients desiring orthodontics or crowns were not reimbursed by medical insurance.

Chicago HMO did not decide to cover  TMJ, disorders, in fact contract language specifically stated non-surgical treatment of TMJ problems were not covered.  In spite of that language Dr Trubitt authorized coverage due to cost savings.  Chicago HMO doctors who referred patients for non-surgical treatment actually were charged less for out of network referrals.  TMJ was given the same cost for referring physicians as Cancer and Heart Disease.

Patients not only experienced improvements in TMJ disorders but also reduction and elimination of headaches and migraines.  TMJ has been called "The Great Imposter" because so many diverse ymptoms are associated with it.  At the time Chicago HMO had no means of tracking drug savings nor did they consider costs of other related disorders.

When insurance coverage and out of pocket costs were taken out of the picture with a guarantee payment we were no longer in a pay per procedure mode but a global fee.  Trigger point injections, SPG Blocks and other procedures were used without additional costs leading to rapid patient improvement.

While there were no patient complaints during the program there were several complaints from oral surgeons objecting to a general dentist seeing patients for non-surgical treatment on patients they deemed surgery necessary.

In 1993 United Health Care bought out Chicago HMO (parent HMO America) and the program ended abruptly even though it had demonstrated significant savings over several years.

I met with the new medical director along with Dr Trubitt in an attempt to keep this very successful treatment and cost containment program going but was told that since United Health Care didn't pay for surgery they would save money treating TMJ non-surgically.

Four years after this experience The Shimshak article was  published that showed that patients carrying a TMJD diagnosis had a 200% increase in total medical expenses.  Shimshak stated "The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories."  (Pubmed abstract below)

One year later a follow-up study showed that the increased costs were actually 300% over patients not carrying TMJ diagnosis.  Shimshak stated "For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects." (pubmed abstract below)

Learn more at www.IHateHeadaches.org   www.ThinkBetterLife.com

Cranio. 1997 Apr;15(2):150-8.

Medical claims profiles of subjects with temporomandibular joint disorders.

Shimshak DG1, Kent RL, DeFuria M.

Author information

Abstract

The primary goal of this study was to evaluate the claims profiles of subjects with TMJ disorders relative to a control group without the disorders and to provide a characterization of the type of healthcare services received and the associated costs of healthcare for patients with TMJ disorders. The administrative data base of a major medical insurer was used to compare the claims history of 1,819 patients diagnosed with TMJ disorders to matched controls. The analysis was based only on medical claims. The study found that total medical claim payments for the patients with TMJ disorders were double that of the subjects without TMJ disorders, and similarly, the utilization of institutional and professional care services was found to be approximately twice as high, though not uniformly distributed across all Major Diagnostic Categories, physician specialties or types of service. The level and nature of the differences in the quantity and costs of healthcare between subjects with and without TMJ disorders were unexpectedly large. The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories.

Cranio. 1998 Jul;16(3):185-93.

Health care utilization by patients with temporomandibular joint disorders.

Shimshak DG1, DeFuria MC.

Author information

Abstract

The claims data base of a large New England managed care organization was used to compare the health care utilization patterns of patients with TMJ disorders to non-TMJ subjects. Inpatient, outpatient and psychiatric claims data were examined over a wide range of diagnostic categories. Age and sex adjusted results showed that, overall, patients with TMJ disorders were greater utilizers of health care services and had higher associated costs than non-TMJ subjects. For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects.

Find A TMJ Dentist: Who is The Academy of Applied Myofunctional Sciences and where do they fit in TMJ treatment?

There are several excellent ways to locate a TMJ Dentist.

There are several schools of thought in TMJ Dysfunction.  The Alliance of TMD Organizations represents all of the major groups who treat TMJ Disorders.

I am current the Chair, Alliance of TMD Organizations.  It represents groups with several schools of thought.

Personally, I would recommend starting with a Neuromuscular Dentist who is a member of ICCMO.  These doctors are dedicated to the neuromuscular concepts discussed throughout the I Hate Headaches website.

I also belong to the American Equilibration Society and the American Academy of Craniofacial pain, both groups have wonderful courses and I love seeing problems from all angles.  I find I learn more from people outside the primary focus in my practice.  The AES is primarily centered on Centric Relation as a starting point for treatment.  While I don't agree with Centric Relation as the best starting points there are excellent doctors who are well trained in treating TMJ disorders.   The AES puts on a fantastic yearly meeting but the underlying focus is CR as taught by Peter Dawson.  That will change gradually when Dr Dawson retires and leaves the field.  He is much less visible than in the past due to increasing age.  Centric Relation is losing popularity in the age of precise measurement.  The concept of CR has had at least 26 different definitions over the years.

The American Academy of Pain Management is no longer a member of the Alliance but dentists who are also Diplomats of the AAPM tend to be very knowledgable on medical aspects of pain.  The problem in recent years is the AAPM has moved further in the direction of medication as a primary treatment rather than correcting underlying pathology.

The Academy of Orofacial Pain takes this type of treatment to the extreme.  There is a tendency to ignore the physiology of the muscles, TMJoints and Occlusal factors.

The International Association of Physiologic Aesthetics also holds excellent meetings.  It tend toward being a user group of LVI, The Las Vegas Institute that teaches neuromuscular dentistry primarily for use in esthetic dentistry.  LVI teaches excellent cookbook neuromuscular dentistry but does not delve into the science like ICCMO  does.  My preference is find a neuromuscular dentist who belongs to IAPA and ICCMO.

All of the basic principles and top educators at LVI are ICCMO members.  LVI recruited from ICCMO specifically due to their excellence in Neuromuscular Dentistry.  Many ICCMO doctors, myself included went to LVI to increase efficiency in reconstructive dentistry.

The Kois Center and Dr John Kois are similar to LVI in teaching his version of Centric Relation as a way to reconstruct patients.  Interesting, is that while he calls it CR it is actually very very similar to the neuromuscular position.   Dr Kois give excellent courses on technical aspects of dentistry.  

There are other groups teaching Neuromuscular Dentistry.  OcclusionConnections is one such group, its founder learned neuromuscular dentistry at ICCMO and later taught at LVI before going on his own.  Clayton teaches his form of neuromuscular dentistry and I again suggest seeing doctors who also belong to ICCMO.

Ther are other groups who belong to the TMD Alliance including Sacro Occipital Technique Organization or SOTO an excellent Chiropractic group very interested in TMJ treatment as part of whole body biomechanics, Tennessee Cranio and The International Association for Orthodontics who teach functional orthodontics to create healthy physiology and TMJoints.

The newest member is the Academy of Applied Myofunctional Sciences. Their first meeting is September 9-13.  I have been very impressed with their organization and I am enjoying the meeting.  I really belong to too many organizations but feel this is one more I must join not because of the work with adult TMJ patients but because of their commitment to grow healthy children into healthy adults without TMJ, sleep or breathing problems.  I expect great good to come from their efforts and I am proud to be at their first meeting.

Myofuntional Therapists work with patients oral habits and oral function and treat patients by correcting pathological patters.  regardless of which doctors are treating you Myofunctional Therapy can help the process.

TMJ Association and the TMD Alliance: An Open Letter to the TMD Association

Review of  the TMJ Association         
TMJ Association Ltd
13625 Bishop's Woods Ct # 101, Brookfield, WI

  I am currently Chair of the Alliance of TMD Organizations which represents multiple groups involved in treatment of TMD.  When we contacted the TMJ Association they had no interest in working with us to better the health of all TMD patients.  The following is directly from the website of the TMD Alliance.

Alliance of TMD Organizations Fundamental Principles

Founded in 1995 on behalf of patients’ well-being, the Alliance of TMD Organizations’ mission is to support and protect the right and freedom of clinicians to practice in the field of TMD within the scope of their care, skill, judgment, and scientific information.

The Alliance of TMD Organizations has been created to represent the broad interests of professional organizations and their member practitioners who understand the importance of effective diagnosis and treatment of cranio-oro-facial disorders.
1. The Alliance of TMD Organizations supports ethical and professional patient centered care.

2. Treatment should be based upon individual patient needs.

3. TMD and associated facial pain disorders/diseases may encompass physical, functional, cognitive, and psycho-social factors all of which may contribute to patient’s symptoms and complaints. Dental occlusion may have a significant role in TMD; as a cause, precipitating, and/or perpetuating factor. Any or all aspects may be taken into consideration when developing diagnoses and treatments accepting that TMD and associated co-morbidities including other pain disorders may be multi-factorial in nature.

4. Diagnoses and treatments should be based upon scientific information in conjunction with the skill, knowledge, and judgment of the providing clinician within the scope of their care.

5. Patient care should progress from initially minimally invasive treatment with gradations of increased intervention weighing risk versus benefit within reasonable standards of care.

6. The diagnosis and treatment of TMD should be considered an emerging science accepting that approaches for diagnoses and treatments may change based upon scientific evidence, clinical evidence. Reasonable standards of care should always be considered in the differential diagnosis of all head, neck and facial pain.

7. Efforts should be made to allow for continuity of care between multi-disciplinary health care providers.

8. Although not gender specific, TMD symptoms and associated pain disorders are gender biased and found to be reported predominately in females.

9. Since TMD and associated pain disorders are by nature gender biased affecting a significant portion of the female population, they should also be considered a women’s health issue.

10. Third party payers should not discriminate based upon gender, body part, location of symptoms, specific dysfunction, or professional degree of the licensed health care provider.

These 10 basic principles were developed by the majority of the representatives of TMD Alliance members.

I understand that Ms Cowley the founder of the organization was the victim of a surgical disaster but her organization actually disuades patients from care that could improve their quality of life.

I believe that if the TMJ Association is really vested in the best interest of all patients then  the TMJA should accept the offer to work with the TMD Alliance and its member organizations.

This is an open invitation to the TMJ Association it to work with the dentists who treat TMJ disorders, the individual groups that further the scientific aims of those groups and with the TMD Alliance that represents the intrests of patients with TMJ Dysfunction.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations

Severe Exacerbation of Lifetime Headache Problem: Migraines, TMJ, TMD, MPD or other problem. All tests are negative but quality oof life is being destroyed and medications are no help.

Paul's Question for Dr Shapira
Tell us about your headaches...:    I remember my mother taking me to the doctors when I was a child for random tension headaches. I've always been an over-thinker, which can cause anxiety and stress, potentially leading to headaches. Throughout my childhood and adult life, I had headaches hear and there (more frequent than the average person, I'd say), but nothing that a an OTC and a little time couldn't handle. It was never chronic or debilitating. All that changed on October 25th, 2014...

On that day, after a stressful year and a half, I was knocked down by the worst headache/migraine I'd ever had. I didn't know what it was, but I feared for my life. It was as though something was going to explode in my head at any moment.

In the months that followed, it never went away, and I was plagued with off neurological symptoms (felt like someone was pouring cold water on my head at times, odd sensations in random parts of my body, my eyes would hurt at night) but the most difficult thing was the pressure. Every day it felt like my head was going to pop. I was living as though any second I could die.

Though the some of the strange symptoms have subsided, the pressure and fatigue remain. The emanate from the base of my skull where my spine meets my skull. That seems to be the centerpiece, but it moves to the sides of my head just above the ears, and sometimes the top. Different positions rarely help.

I've seen two neurologists. One said it was atypical migraines. She's wrong, though they can rarely turn into migraines, that's not what they are. She started me on magnesium, melatonin and riboflavin as well as topamax to no avail. I moved on to another neurologist who's DX was Chronic Daily Headaches, and does nothing but through pills at me. I'll admit that the only thing that relieves the pressure and makes me feel somewhat normal is Soma, but it's short-lived, tolerance builds fast, and I feel we are not getting to the root of the problem. Klonopin also seems to help, which makes me think it's a muscle tension, possible TMJ issue.

I had a decaying tooth, so I even saw the dentist, who wound up doing 2 root canals and I went through a round of amoxicillin just in case there was an infection. I can say my teeth are now the best is town (after a whole summer of treatments), but dental stuff doesn't seem to be the issue. She just gave me a referral to be evaluated for TMJ.

I also saw my optometrist, he said everything looked fine; however, my vision had improved, and I had been wearing contact lenses that were too strong for awhile. He said this isn't the cause of my headaches, but it certainly isn't helping.

I am now seeing a Chiropractor 3x/week who says I have an Atlas Sublaxation, and a bone in my neck/base of skull is out of place and could be pinching nerves. Over time, he plans to put that bone back in place. I'm skeptical.

I have had a CT and MRI of the brain, all unremarkable. Last week I went for a Lumbar Puncture to rule out other things. I go over the results with my neurologist on Tuesday.

I'm growing weary, and this is all making me depressed. The side-effects of the meds also make me depressed. I'd love some input.

I have a past history of substance abuse, and have kindled with benzo's and other GABAergics. In fact, right before this happened, I was taking a substance called phenibut for my anxiety, and coming off of a high dose of gabapentin (which i was put on after coming off of Klonopin). My abuse days are over, but I wonder if it plays a role.

I am currently on the following medications:
Vyvanse (70mg/daily) - a mild amphetamine for ADD and unresponsive major depression
Klonopin .5mg 3-4x/daily PRN
Baclofen 10mg 4x/daily PRN
Soma 350mg 4x/daily PRN

I also take melatonin, magnesium, a B-complex, Fish oil/omega-3's and a multivitamin.

Any help, direction, or input would be greatly appreciated, as this leads to such a poor quality of life that living seems useless at this point and I think about death far too often.

Tell us about your headaches...:    I remember my mother taking me to the doctors when I was a child for random tension headaches. I've always been an over-thinker, which can cause anxiety and stress, potentially leading to headaches. Throughout my childhood and adult life, I had headaches hear and there (more frequent than the average person, I'd say), but nothing that a an OTC and a little time couldn't handle. It was never chronic or debilitating. All that changed on October 25th, 2014...

On that day, after a stressful year and a half, I was knocked down by the worst headache/migraine I'd ever had. I didn't know what it was, but I feared for my life. It was as though something was going to explode in my head at any moment.

In the months that followed, it never went away, and I was plagued with off neurological symptoms (felt like someone was pouring cold water on my head at times, odd sensations in random parts of my body, my eyes would hurt at night) but the most difficult thing was the pressure. Every day it felt like my head was going to pop. I was living as though any second I could die.

Though the some of the strange symptoms have subsided, the pressure and fatigue remain. The emanate from the base of my skull where my spine meets my skull. That seems to be the centerpiece, but it moves to the sides of my head just above the ears, and sometimes the top. Different positions rarely help.

I've seen two neurologists. One said it was atypical migraines. She's wrong, though they can rarely turn into migraines, that's not what they are. She started me on magnesium, melatonin and riboflavin as well as topamax to no avail. I moved on to another neurologist who's DX was Chronic Daily Headaches, and does nothing but through pills at me. I'll admit that the only thing that relieves the pressure and makes me feel somewhat normal is Soma, but it's short-lived, tolerance builds fast, and I feel we are not getting to the root of the problem. Klonopin also seems to help, which makes me think it's a muscle tension, possible TMJ issue.

I had a decaying tooth, so I even saw the dentist, who wound up doing 2 root canals and I went through a round of amoxicillin just in case there was an infection. I can say my teeth are now the best is town (after a whole summer of treatments), but dental stuff doesn't seem to be the issue. She just gave me a referral to be evaluated for TMJ.

I also saw my optometrist, he said everything looked fine; however, my vision had improved, and I had been wearing contact lenses that were too strong for awhile. He said this isn't the cause of my headaches, but it certainly isn't helping.

I am now seeing a Chiropractor 3x/week who says I have an Atlas Sublaxation, and a bone in my neck/base of skull is out of place and could be pinching nerves. Over time, he plans to put that bone back in place. I'm skeptical.

I have had a CT and MRI of the brain, all unremarkable. Last week I went for a Lumbar Puncture to rule out other things. I go over the results with my neurologist on Tuesday.

I'm growing weary, and this is all making me depressed. The side-effects of the meds also make me depressed. I'd love some input.

I have a past history of substance abuse, and have kindled with benzo's and other GABAergics. In fact, right before this happened, I was taking a substance called phenibut for my anxiety, and coming off of a high dose of gabapentin (which i was put on after coming off of Klonopin). My abuse days are over, but I wonder if it plays a role.

I am currently on the following medications:
Vyvanse (70mg/daily) - a mild amphetamine for ADD and unresponsive major depression
Klonopin .5mg 3-4x/daily PRN
Baclofen 10mg 4x/daily PRN
Soma 350mg 4x/daily PRN

I also take melatonin, magnesium, a B-complex, Fish oil/omega-3's and a multivitamin.

Any help, direction, or input would be greatly appreciated, as this leads to such a poor quality of life that living seems useless at this point and I think about death far too often.

Dr Shapira's Response:

DEAR PAUL,

You have been through a lot and even though non-diagnostic MRI and CT scans can be disappointing they are actually very good news.

Most chronic pain is from causes that are not visibile in those tests.  The number one source of pain is MPD or Myofascial Pain and Dysfunction which is always a major portion of all Temporomandibular Dysfunctions.  

These conditions were well described by Dr Janet Travell in her landmark text 

"Myofascial Pain and Dysfuntion:   A Trigger Point Manual"

You did not mention having SPG blocks which may help butare not the ultimate answer.  Atlas /Axis problems with the first two vertebrae can give a host of strange symptoms.

The SpenoPalatine Ganglion is the largest parasympathetic ganglia of the head and neck and is implicated in a wide variety of wierd and inexplicable cases of chronic pain and dysfunction.  It was made famous in the best selling book "Miracles on Park Avenue" which is a worthwhile read.

The Trigeminal Nerve is responsible for over 50% of input to the Central Nervous System after amplification in Reticular activating System.  It is an oversimplification to call it a TMJ problem but more accurate to call it a musculoskeletal/ trigemino-vacular and trigeminal nervous system dilemma.

I frequently hear stories that are similar yet different.  I assume the lumbar puncture will be negative but it is good to rule out all organic problems.

I am located in the Chicago ara but I frequently see long distance patients.

Visit my website www.ThinkBetterLife.com to learn more.

I will put some links to patients testimonials for you.  Each and every case is unique and different, but you have already ruled out all the worst alternative causes and probably are dealing with a functional issue.

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

Chair, Alliance of TMD Organizations

TMJ devastated my life. Treatment has restored me back to life.

				TMJ devastated my life. Treatment has restored me back ...
				View on www.youtube.com	Preview by Yahoo

If you're in pain there is hope!15 Years severe neck and shoulder pains that doctors could not solve

				If you're in pain there is hope!
				View on www.youtube.com	Preview by Yahoo

				15 Years severe neck and shoulder pains that doctors cou...
				View on www.youtube.com	Preview by Yahoo

9 Years of pain gone after first visit

				9 Years of pain gone after first visit
				View on www.youtube.com	Preview by Yahoo

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg