Carolyn: Intense migrane headaches with jaw, neck, shoulder, face, sinues,eye and ear pain, also numb feeling on face. I had MRI's done of my head and neck and was diagnosed with Trigeminal Neuralgia, seeked Gamma Knife, was told I wasn't a canidate and to have an MRI of my neck, had that done, nothing showed up, then was told I had Trigeminal Neuropothy. I was diagnosed with TMJ a long time ago and had a mouth piece...it didn't do much and as time went on things got worse. I am convienced that my problem is with the Tri nerves and TMJ...no doctor has caught on. I am at my wits end and need to find out what is wrong with my neck and face. Please help me in finding a doctor who could figure out my problem. Thank you!!
Dr Shapira response: Carolyn, I am sorry your life is being destroyed by what sounds like horrible pain. I would strongly suggest avoiding Gamma Knife surgery as a first line treatment.
You did not mention trying non-invasive or minimally invasive treatment such as massage therapy, chiropractic adjustment or Ice Down Therapy which can be helpful. The beauty of Neuromuscular Dentistry is that results can be rapid, amazing and life changing in just a few visits. I would suggest starting with very simple diagnostic evaluation such as spray and stretch with vapo-coolant for myofascial pain, trigger point injections SPG blocks and most importantly a diagnostic neuromuscular orthotic.
I frequently see long distance patients and we can sometimes produce amazing results in just wo to three days of intensive therapy. We do our consultation , work-up and exam the morning of the first day and deliver an orthotic that afternoon. We deactivate trigger point injections with spray and stretch techniques as described by Dr Janet Travell. The second morning we adjust the appliance and do diagnostic/treatment trigger points and blocks and adjust again that afternoon. I work closely with an Atlas orthoganol DC who can address the cervical vertebrae during your stay.
There is no "CURE" for these problems but rapid relief is possible and the orthotic lets you maintain comfort. A real "CURE" would mean you could get back the years you lost to pain, reverse the effects on your life, your relationships and your family. The best we can do is give you a brighter future.
All of the symptoms you descibed are why TMJ disorders are called "The Great Imposter"
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
Contact my office if you would like to schedule a 3 day series of appointments for rapid evaluation and treatment or I will try to find you a knowledgable doctor in your area.
Showing posts with label chiropractic TMD. Show all posts
Showing posts with label chiropractic TMD. Show all posts
Wednesday, May 25, 2011
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]
Saturday, April 9, 2011
TMJ AND POSTURE: THE INTIMATE CONNECTION BETWEEN CHIROPRACTIC PROBLEMS AND TMJ DISORDERS (TMD) ARE CRITICAL.
PATIENTS LIVING WITH TMJ DISORDERS, CHIROPRACTIC DISORDERS, HEADACHES AND MIGRAINES are alll suffering from the same underlying disorders. It is well recognized that it is impossible to achieve long term successful treatment without addressing both the dental, TMJ and Trigeminal components in conjunction with with the Chiropractic aspects of care.
Atlas Orthoganal Chiropractic or NUCCA chiropractic focus on the first two vertebrae. Both are excellent techniques but I usually prefer working with A/O chiropracters as they take a more universal approach to care. Many NUCCA chiropracters think that they can correct everything even though research at the prestegious Las Vegas Institue has shown that NUCCA adjustments DO NOT HOLD when the Neuromuscular Dental Occlusion is not corrected. A/o Chiropracters tend to be mor inclusive in care.
Atlas Orthoganal Chiropactic focuses on the first two vertebrae, the Atlas and the Axis. According to the website http://www.atlasorthogonality.com/index.htm the website of the Roy W Sweat Foundation:
"Atlas Orthogonal (SCALE—Stereotactic Cervical ALignment methods) is a spinal healthcare program developed by Dr. Roy Sweat in the late 1960’s based on scientific and biomechanical procedures. Dr. Sweat is considered by many to be one of the world’s foremost authorities on the cervical spine. After years of extensive research he developed a non-invasive, precision instrument to restore structural integrity from cervical vertebral malposition. The percussion instrument achieves postural restoration without manipulation or surgery. This precision treatment reduces cervical spine misalignment and its related symptomatology."
I work with two excellent A/O Chiropracters Dr Mark Freund in Lindenhurst and Dr David Menner in Lake Villa. I have also worked with severl NUCCA Chiropracters.
The connection between the Trigeminovascular system, the masticatory apparatus and the TM Joints was best described by a series ofg patients called "The Quadrant Theorem of Guzay" that describes how the actual center of rotation of the mandible (lower jaw) after accounting for both rotation and translation is on the Odontoid Process of the Axis found within the confines of the Atlas. The head rests on the Atlas on two fcets and it was named for Atlas in Greek Mythology who held the world on his shoulders.
Yoy can consider A/o Chiropracters and NUCCA Chiropracters as a herois Atlas managing the balance of the head on the top of the cervical column.
The neuromuscular Dentist is the navigator who assures that the head stays balanced so Atlas Axis stability is retained. The two treatments are intimately connected.
There are many other important areas of treatment in the body but these TOP Blocks are most important for anyone with Headaches, Migraines, TMJ, TMD, Spinal Problems, Tension-Type Headaches, SUNCY, Chronic Daily Headaches and non-infectious Sinus Pain and Sinus Headaches.
Additional information on Neuromuscular Dentistry is available at: http://www.sleepandhealth.com/neuromuscular-dentistry and at Dr Shapira's Delany Dental Care Ltd website at: http://www.delanydentalcare.com/neuromuscular.html
Atlas Orthoganal Chiropractic or NUCCA chiropractic focus on the first two vertebrae. Both are excellent techniques but I usually prefer working with A/O chiropracters as they take a more universal approach to care. Many NUCCA chiropracters think that they can correct everything even though research at the prestegious Las Vegas Institue has shown that NUCCA adjustments DO NOT HOLD when the Neuromuscular Dental Occlusion is not corrected. A/o Chiropracters tend to be mor inclusive in care.
Atlas Orthoganal Chiropactic focuses on the first two vertebrae, the Atlas and the Axis. According to the website http://www.atlasorthogonality.com/index.htm the website of the Roy W Sweat Foundation:
"Atlas Orthogonal (SCALE—Stereotactic Cervical ALignment methods) is a spinal healthcare program developed by Dr. Roy Sweat in the late 1960’s based on scientific and biomechanical procedures. Dr. Sweat is considered by many to be one of the world’s foremost authorities on the cervical spine. After years of extensive research he developed a non-invasive, precision instrument to restore structural integrity from cervical vertebral malposition. The percussion instrument achieves postural restoration without manipulation or surgery. This precision treatment reduces cervical spine misalignment and its related symptomatology."
I work with two excellent A/O Chiropracters Dr Mark Freund in Lindenhurst and Dr David Menner in Lake Villa. I have also worked with severl NUCCA Chiropracters.
The connection between the Trigeminovascular system, the masticatory apparatus and the TM Joints was best described by a series ofg patients called "The Quadrant Theorem of Guzay" that describes how the actual center of rotation of the mandible (lower jaw) after accounting for both rotation and translation is on the Odontoid Process of the Axis found within the confines of the Atlas. The head rests on the Atlas on two fcets and it was named for Atlas in Greek Mythology who held the world on his shoulders.
Yoy can consider A/o Chiropracters and NUCCA Chiropracters as a herois Atlas managing the balance of the head on the top of the cervical column.
The neuromuscular Dentist is the navigator who assures that the head stays balanced so Atlas Axis stability is retained. The two treatments are intimately connected.
There are many other important areas of treatment in the body but these TOP Blocks are most important for anyone with Headaches, Migraines, TMJ, TMD, Spinal Problems, Tension-Type Headaches, SUNCY, Chronic Daily Headaches and non-infectious Sinus Pain and Sinus Headaches.
Additional information on Neuromuscular Dentistry is available at: http://www.sleepandhealth.com/neuromuscular-dentistry and at Dr Shapira's Delany Dental Care Ltd website at: http://www.delanydentalcare.com/neuromuscular.html
Thursday, April 7, 2011
Can Dentists Prevent Migraines? The Answer Is Yes According To New Research Out Of Germany.
The Journal of Neuroscience (J Neurosci. 2011 Feb 9;31(6):1937-43) recently published an article titled "Trigeminal nociceptive transmission in migraineurs predicts migraine attacks"
I have long advocated that the majority of Migraines and Tension-Type headaches are actually input-output errors. Nociceptive information entering the Trigeminovascular system are the pathology that triggers migraines and other headaches.
This study looked at fMRI or functional MRI studies of the brain.
They found that predicting migraine by trigeminal nociceptive activity could predict migraines.
Whers does most nociceptive trigeminal input arise?
In the Jaw Muscles, Muscle Spindles, Golgi Tendon Organs and periodontal ligaments of the teeth.
Neuromuscular Dentistry is very effective in eliminating and preventing migraines and muscular tension-type headaches. The majority of "sinus headaches" are actually referred muscle pain. The reason for the success of Neuromuscular Dentistry is the ability to eliminate nociceptive input.
Input/output errors are often described in computer lingo as Garbage In / Garbage Out.
The neurofeedback loops from periodontal ligaments , muscles, muscle spindles etc send nociceptive input (ie Garbage in) into the trigeminovascular system.
Migraines and other headaches are the "Garbage Out " part of the equation.
The article states that:
"Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event."
Another article in Neurology. 2011 Jan 18;76(3):206-7 states "Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other."
The photophobia or sensitivity to light during a migraine attack is also due, in part to trigeminal nociception (Garbage in. The nociceptive input from the teeth,jaws, periodontal ligaments are the "garbage in" and the migraines and photophobia are the Garbage out".
Experimental studies on rats "J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain." confirm the effect of trigeminanl nociception on meningeal migraines. The Trigeminovascular system is always paramount in migraine. The Trigeminal nerve controls the blood flow to the anterior 2/3 of the meninges of the brain.
Primary Stabbing Headaches are also trigeminally innervated as reported in"
J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic." The article states that "Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve." The trigeminal nerve you will remember is the Dentist's nerve.
PubMed Abstract below:
J Neurosci. 2011 Feb 9;31(6):1937-43.
Trigeminal nociceptive transmission in migraineurs predicts migraine attacks.
Stankewitz A, Aderjan D, Eippert F, May A.
Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany.
Abstract
Several lines of evidence suggest a major role of the trigeminovascular system in the pathogenesis of migraine. Using functional magnetic resonance imaging (fMRI), we compared brain responses during trigeminal pain processing in migraine patients with those of healthy control subjects. The main finding is that the activity of the spinal trigeminal nuclei in response to nociceptive stimulation showed a cycling behavior over the migraine interval. Although interictal (i.e., outside of attack) migraine patients revealed lower activations in the spinal trigeminal nuclei compared with controls, preictal (i.e., shortly before attack) patients showed activity similar to controls, which demonstrates that the trigeminal activation level increases over the pain-free migraine interval. Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event.
PMID: 21307231 [PubMed - indexed for MEDLINE]
Neurology. 2011 Jan 18;76(3):213-8. Epub 2010 Dec 9.
A PET study of photophobia during spontaneous migraine attacks.
Denuelle M, Boulloche N, Payoux P, Fabre N, Trotter Y, Géraud G.
Service de Neurologie et Explorations Fonctionnelles du Système Nerveux, CHU Rangueil, Toulouse, France. denuelle.m@chu-toulouse.fr
Comment in:
* Neurology. 2011 Jan 18;76(3):206-7.
Abstract
BACKGROUND: Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other.
METHODS: We used H(2)(15)O PET to study photophobia induced by continuous luminous stimulation covering the whole visual field in 8 migraineurs during spontaneous migraine attacks, after headache relief by sumatriptan and during attack-free interval. The intensity of the luminous stimulation provoking photophobia with subsequent headache enhancement was specifically determined for each patient.
RESULTS: We found that low luminous stimulation (median of 240 Cd/m(2)) activated the visual cortex during migraine attacks and after headache relief but not during the attack-free interval. The visual cortex activation was statistically stronger during migraine headache than after pain relief.
CONCLUSION: These findings suggest that ictal photophobia is linked with a visual cortex hyperexcitability. The mechanism of this cortical hyperexcitability could not be explained only by trigeminal nociception because it persisted after headache relief. We hypothesize that modulation of cortical excitability during migraine attack could be under brainstem nuclei control.
PMID: 21148120 [PubMed - indexed for MEDLINE]
J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain.
Noseda R, Constandil L, Bourgeais L, Chalus M, Villanueva L.
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Abstract
Alterations in cortical excitability are implicated in the pathophysiology of migraine. However, the relationship between cortical spreading depression (CSD) and headache has not been fully elucidated. We aimed to identify the corticofugal networks that directly influence meningeal nociception in the brainstem trigeminocervical complex (Sp5C) of the rat. Cortical areas projecting to the brainstem were first identified by retrograde tracing from Sp5C areas that receive direct meningeal inputs. Anterograde tracers were then injected into these cortical areas to determine the precise pattern of descending axonal terminal fields in the Sp5C. Descending cortical projections to brainstem areas innervated by the ophthalmic branch of the trigeminal nerve originate contralaterally from insular (Ins) and primary somatosensory (S1) cortices and terminate in laminae I-II and III-V of the Sp5C, respectively. In another set of experiments, electrophysiological recordings were simultaneously performed in Ins, S1 or primary visual cortex (V1), and Sp5C neurons. KCl was microinjected into such cortical areas to test the effects of CSD on meningeal nociception. CSD initiated in Ins and S1 induced facilitation and inhibition of meningeal-evoked responses, respectively. CSD triggered in V1 affects differently Ins and S1 cortices, enhancing or inhibiting meningeal-evoked responses of Sp5C, without affecting cutaneous-evoked nociceptive responses. Our data suggest that "top-down" influences from lateralized areas within Ins and S1 selectively affect interoceptive (meningeal) over exteroceptive (cutaneous) nociceptive inputs onto Sp5C. Such corticofugal influences could contribute to the development of migraine pain in terms of both topographic localization and pain tuning during an attack.
J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic.
Guerrero AL, Herrero S, Peñas ML, Cortijo E, Rojo E, Mulero P, Fernández R.
Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005, Valladolid, Spain, gueneurol@gmail.com.
Abstract
Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve. Population studies have shown that PSH is a common headache. However, most people suffer attacks of low frequency or intensity and seldom seek for medical assistance. There are few clinic-based studies of PSH, and its real influence as a primary cause for referral to neurology outpatient offices is to be determined. We aim to investigate the burden of PSH as main complaint in an outpatient headache clinic. We reviewed all patients with PSH (ICHD-II criteria), attended in an outpatient headache clinic in a tertiary hospital during a 2.5-year period (January 2008-June 2010). We considered demographic and nosological characteristics and if PSH was main cause of submission. 36 patients (26 females, 10 males) out of 725 (5%) were diagnosed of PSH. Mean age at onset 34.1 ± 2.9 years (range 10-72). Mean time from onset to diagnosis 68.8 ± 18.3 months. Twenty-four patients fulfilled ICHD-II criteria for other headaches (14 migraine, 6 tension-type headache, 2 hemicrania continua, 1 primary cough headache and 1 primary exertional headache). 77.7% of patients were submitted from primary care. In 14 patients (39%), PSH was main reason for submission, its intensity or frequency in 5 (35.7%) and fear of malignancy in 9 (74.3%). Only two patients of those who associated other headaches were submitted due to PSH. In conclusion, PSH is not an uncommon diagnosis in an outpatient headache office. However, and according to our data, it is not usually the main cause of submission to a headache clinic.
PMID: 21210176 [PubMed - as supplied by publisher]
I have long advocated that the majority of Migraines and Tension-Type headaches are actually input-output errors. Nociceptive information entering the Trigeminovascular system are the pathology that triggers migraines and other headaches.
This study looked at fMRI or functional MRI studies of the brain.
They found that predicting migraine by trigeminal nociceptive activity could predict migraines.
Whers does most nociceptive trigeminal input arise?
In the Jaw Muscles, Muscle Spindles, Golgi Tendon Organs and periodontal ligaments of the teeth.
Neuromuscular Dentistry is very effective in eliminating and preventing migraines and muscular tension-type headaches. The majority of "sinus headaches" are actually referred muscle pain. The reason for the success of Neuromuscular Dentistry is the ability to eliminate nociceptive input.
Input/output errors are often described in computer lingo as Garbage In / Garbage Out.
The neurofeedback loops from periodontal ligaments , muscles, muscle spindles etc send nociceptive input (ie Garbage in) into the trigeminovascular system.
Migraines and other headaches are the "Garbage Out " part of the equation.
The article states that:
"Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event."
Another article in Neurology. 2011 Jan 18;76(3):206-7 states "Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other."
The photophobia or sensitivity to light during a migraine attack is also due, in part to trigeminal nociception (Garbage in. The nociceptive input from the teeth,jaws, periodontal ligaments are the "garbage in" and the migraines and photophobia are the Garbage out".
Experimental studies on rats "J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain." confirm the effect of trigeminanl nociception on meningeal migraines. The Trigeminovascular system is always paramount in migraine. The Trigeminal nerve controls the blood flow to the anterior 2/3 of the meninges of the brain.
Primary Stabbing Headaches are also trigeminally innervated as reported in"
J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic." The article states that "Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve." The trigeminal nerve you will remember is the Dentist's nerve.
PubMed Abstract below:
J Neurosci. 2011 Feb 9;31(6):1937-43.
Trigeminal nociceptive transmission in migraineurs predicts migraine attacks.
Stankewitz A, Aderjan D, Eippert F, May A.
Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany.
Abstract
Several lines of evidence suggest a major role of the trigeminovascular system in the pathogenesis of migraine. Using functional magnetic resonance imaging (fMRI), we compared brain responses during trigeminal pain processing in migraine patients with those of healthy control subjects. The main finding is that the activity of the spinal trigeminal nuclei in response to nociceptive stimulation showed a cycling behavior over the migraine interval. Although interictal (i.e., outside of attack) migraine patients revealed lower activations in the spinal trigeminal nuclei compared with controls, preictal (i.e., shortly before attack) patients showed activity similar to controls, which demonstrates that the trigeminal activation level increases over the pain-free migraine interval. Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event.
PMID: 21307231 [PubMed - indexed for MEDLINE]
Neurology. 2011 Jan 18;76(3):213-8. Epub 2010 Dec 9.
A PET study of photophobia during spontaneous migraine attacks.
Denuelle M, Boulloche N, Payoux P, Fabre N, Trotter Y, Géraud G.
Service de Neurologie et Explorations Fonctionnelles du Système Nerveux, CHU Rangueil, Toulouse, France. denuelle.m@chu-toulouse.fr
Comment in:
* Neurology. 2011 Jan 18;76(3):206-7.
Abstract
BACKGROUND: Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other.
METHODS: We used H(2)(15)O PET to study photophobia induced by continuous luminous stimulation covering the whole visual field in 8 migraineurs during spontaneous migraine attacks, after headache relief by sumatriptan and during attack-free interval. The intensity of the luminous stimulation provoking photophobia with subsequent headache enhancement was specifically determined for each patient.
RESULTS: We found that low luminous stimulation (median of 240 Cd/m(2)) activated the visual cortex during migraine attacks and after headache relief but not during the attack-free interval. The visual cortex activation was statistically stronger during migraine headache than after pain relief.
CONCLUSION: These findings suggest that ictal photophobia is linked with a visual cortex hyperexcitability. The mechanism of this cortical hyperexcitability could not be explained only by trigeminal nociception because it persisted after headache relief. We hypothesize that modulation of cortical excitability during migraine attack could be under brainstem nuclei control.
PMID: 21148120 [PubMed - indexed for MEDLINE]
J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain.
Noseda R, Constandil L, Bourgeais L, Chalus M, Villanueva L.
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Abstract
Alterations in cortical excitability are implicated in the pathophysiology of migraine. However, the relationship between cortical spreading depression (CSD) and headache has not been fully elucidated. We aimed to identify the corticofugal networks that directly influence meningeal nociception in the brainstem trigeminocervical complex (Sp5C) of the rat. Cortical areas projecting to the brainstem were first identified by retrograde tracing from Sp5C areas that receive direct meningeal inputs. Anterograde tracers were then injected into these cortical areas to determine the precise pattern of descending axonal terminal fields in the Sp5C. Descending cortical projections to brainstem areas innervated by the ophthalmic branch of the trigeminal nerve originate contralaterally from insular (Ins) and primary somatosensory (S1) cortices and terminate in laminae I-II and III-V of the Sp5C, respectively. In another set of experiments, electrophysiological recordings were simultaneously performed in Ins, S1 or primary visual cortex (V1), and Sp5C neurons. KCl was microinjected into such cortical areas to test the effects of CSD on meningeal nociception. CSD initiated in Ins and S1 induced facilitation and inhibition of meningeal-evoked responses, respectively. CSD triggered in V1 affects differently Ins and S1 cortices, enhancing or inhibiting meningeal-evoked responses of Sp5C, without affecting cutaneous-evoked nociceptive responses. Our data suggest that "top-down" influences from lateralized areas within Ins and S1 selectively affect interoceptive (meningeal) over exteroceptive (cutaneous) nociceptive inputs onto Sp5C. Such corticofugal influences could contribute to the development of migraine pain in terms of both topographic localization and pain tuning during an attack.
J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic.
Guerrero AL, Herrero S, Peñas ML, Cortijo E, Rojo E, Mulero P, Fernández R.
Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005, Valladolid, Spain, gueneurol@gmail.com.
Abstract
Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve. Population studies have shown that PSH is a common headache. However, most people suffer attacks of low frequency or intensity and seldom seek for medical assistance. There are few clinic-based studies of PSH, and its real influence as a primary cause for referral to neurology outpatient offices is to be determined. We aim to investigate the burden of PSH as main complaint in an outpatient headache clinic. We reviewed all patients with PSH (ICHD-II criteria), attended in an outpatient headache clinic in a tertiary hospital during a 2.5-year period (January 2008-June 2010). We considered demographic and nosological characteristics and if PSH was main cause of submission. 36 patients (26 females, 10 males) out of 725 (5%) were diagnosed of PSH. Mean age at onset 34.1 ± 2.9 years (range 10-72). Mean time from onset to diagnosis 68.8 ± 18.3 months. Twenty-four patients fulfilled ICHD-II criteria for other headaches (14 migraine, 6 tension-type headache, 2 hemicrania continua, 1 primary cough headache and 1 primary exertional headache). 77.7% of patients were submitted from primary care. In 14 patients (39%), PSH was main reason for submission, its intensity or frequency in 5 (35.7%) and fear of malignancy in 9 (74.3%). Only two patients of those who associated other headaches were submitted due to PSH. In conclusion, PSH is not an uncommon diagnosis in an outpatient headache office. However, and according to our data, it is not usually the main cause of submission to a headache clinic.
PMID: 21210176 [PubMed - as supplied by publisher]
Sunday, March 13, 2011
FORWARD HEAD POSTURE, MYOFASCIAL TRIGGER POINTS, TMJ, TMD, AND TENSION-TYPE HEADACHE ALL CLOSELY RELATED
A PRIMARY DIAGNOSTIC FINDING IN TMJ, TMD, TMJ DISORDERS IS MYOFASCIAL TRIGGER POINTS. THEY ARE FREQUENTLY ASSOCIATED WITH FORWARD HEAD POSTURE A COmMON FINDING IN TMJ PATIENTS. A 2006 ARTICLE "Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache." IN HEADACHE JOURNAL CLEARLY DESCRIBES HOW TRIGGER POINT IN "upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH CHRONIC TENSION-TYPE HEADACHES)"
NEUROMUSCULAR DENTISTRY UTILIZES A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS TO ELIMINATE THE FACTORS THAT CAUSE TRIGGER POINTS TO FORM AND PROPAGATE. ELIMINATION OF THESE TRIGGER POINTS CAN PREVENT TMJ DISORDERS, TREAT TMD AND CHRONIC TENSION TYPE HEADACHES. PATIENTS WITH INCREASED MYOFASCIAL TRIGGERS ALSO HAVE INCREASED INTENSITY AND DURATION OF HEADACHE ATTACKS.
A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS A SAFE AND EFFECTIVE FIRST STEP IN THE DIAGNOSIS, TREATMENT AND ELIMINATION OF MYOFASCIAL TRIGGERS AND RELATED TMJ AND HEADACHE DISORDERS.
Headache. 2006 Sep;46(8):1264-72.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA.
Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Abstract
OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.
BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role.
DESIGN: A blinded, controlled, pilot study.
METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01).
CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.
NEUROMUSCULAR DENTISTRY UTILIZES A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS TO ELIMINATE THE FACTORS THAT CAUSE TRIGGER POINTS TO FORM AND PROPAGATE. ELIMINATION OF THESE TRIGGER POINTS CAN PREVENT TMJ DISORDERS, TREAT TMD AND CHRONIC TENSION TYPE HEADACHES. PATIENTS WITH INCREASED MYOFASCIAL TRIGGERS ALSO HAVE INCREASED INTENSITY AND DURATION OF HEADACHE ATTACKS.
A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS A SAFE AND EFFECTIVE FIRST STEP IN THE DIAGNOSIS, TREATMENT AND ELIMINATION OF MYOFASCIAL TRIGGERS AND RELATED TMJ AND HEADACHE DISORDERS.
Headache. 2006 Sep;46(8):1264-72.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA.
Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Abstract
OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.
BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role.
DESIGN: A blinded, controlled, pilot study.
METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01).
CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.
Saturday, February 5, 2011
New Article ties Joint hypermobility syndrome to migraines. This has long been known to be a factor in TMJ disorders and associated headaches.
Studies have shown that hypermobility syndrome is associated with chronic headache disorders. This new study shows that 75% of study group with the syndrome had migraines compared to only 43% of controls.
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Sunday, December 5, 2010
TMJ disorders and Neck Pain are closely linked. New study shows mechanical and kinematic movement of neck is altered by neck pain.
A recent article (Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.) showed changes in neck function when pain was present. Neck pain is one of the most frequently helped conditions during neuromuscular treatment of TMD disorders. If treating the pain can return normal function this would be an incredible finding.
The article concludes "Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management."
The unanswered question is whether the limitation and pain have a common orgin or if the pain is the cause of the changes noted. If the pain alone causes these changes than more debilitating problems would occur over time. An interesting follow-up study would be to examine changes after treatment of pain.
The PPM, Pure Power Mouthguard has been shown to increse flexibility and balance in athletes. A Rutger's study confirmed this. I have frequently seen normalization in pain and function in patients treated with neuromuscular orthotics but these are subjective improvements. This "virtual reality assesment" may be a more objective method to measure improvement in neck function following rehabilatative medicine, physical therapy, chiropractic or osteopathic adjustments and TMD treatment.
Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.
The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
Bahat HS, Weiss PL, Laufer Y.
Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
Abstract
Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.
DESIGN: Clinical comparative trial.
SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic.
PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.
RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.
CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.
Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112430 [PubMed - in process]
The article concludes "Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management."
The unanswered question is whether the limitation and pain have a common orgin or if the pain is the cause of the changes noted. If the pain alone causes these changes than more debilitating problems would occur over time. An interesting follow-up study would be to examine changes after treatment of pain.
The PPM, Pure Power Mouthguard has been shown to increse flexibility and balance in athletes. A Rutger's study confirmed this. I have frequently seen normalization in pain and function in patients treated with neuromuscular orthotics but these are subjective improvements. This "virtual reality assesment" may be a more objective method to measure improvement in neck function following rehabilatative medicine, physical therapy, chiropractic or osteopathic adjustments and TMD treatment.
Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.
The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
Bahat HS, Weiss PL, Laufer Y.
Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
Abstract
Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.
DESIGN: Clinical comparative trial.
SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic.
PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.
RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.
CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.
Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112430 [PubMed - in process]
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