Migraine Relief: Neuromuscular Dentistry and Sphenopalatine Ganglion Blocks Combination Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lynette:    
 I can get my headaches at any time of day. They can be minor and then suddenly spike or can stay at the same level but be bad enough to stop me achieving my daily goals. When they get really bad I have the option of going to the hospital for a largactil drip and helps a bit. I've had xray and ct scan and nothing has shown up. Iv had these for 3 1/2 years .Can you help me please


Dr Shapira response:

Lynette,  It is not uncommon to hear stories like yours.  You have done the right initial approach of ruling out organic disease.  Radiographs, CT Scans, MRI's and other diagnostic testing rules out organic disease.  

I look forward to seeing patients just like you because it is usually very easy to get 50-80 percent improvement in the early diagnostic phase of treatment.

I frequently utilize simple techniques to reduce headache at the first consultation appointment.  Many patients report more relief at that first appointment then they have had in years or decades.  

The first visit allows me to understand your problem by temporarily relieving your symptoms.  Once you thoroughly understand your we move on to treatment planning in how to make this temporary relief permanent and how to give you control of your symptoms.

IT IS IMPORTANT TO UNDERSTAND THERE ARE NO MAGIC CURES, DRUGS OR SURGERIES.  YOU MUST UNRAVEL THE PROBLEM BUT LIVING WITH CHRONIC PAIN HAS PERMANENTLY CHANGED BOTH YOU AND YOUR BRAIN.  THE ONLY TRUE "CURE" WOULD TO BE TO HAVE A DO-OVER FOR THE LAST THREE YEARS.

TREATMENT IS TO IMPROVE YOUR QUALITY OF LIFE AS SOON AS POSSIBLE.  I always tell my patients to expect 50-80% improvement initially.  We continually strive to eliminate 50-80% of remaining pain and dysfunction.

Most of my patients begin treatment with a Neuromuscular Diagnostic Orthotic as part of a comprehensive approach to giving you rapid relief of symptoms.

Learning how to use Sphenopalatine Ganglion Blocks as an abortive measure to prevent severe exacerbations may let you quickly eliminate most hospital visits.  Eliminating a long term chronic pain problem is complex and we break it down into small pieces to address specific aspects.  There is sometime changes in lifestyle.

I utilize a whole person approach to therapy and treatment.  The use of trigger point injections and trigger point deactivation utilizing vapocoolants and stretch quickly eliminate much of the myofascial pain, a main cause of headache and gives you techniques to turn headaches off before they become severe.

While you are not close to Chicago I do see long distance patients.  To find a Neuromuscular Dentist near you go to www.iccmo.org.  I would also suggest working with a Diplomat of the American Board of Dental Sleep Medicine is many of these problems have a nocturnal problem associated, especially Sleep Disordered breathing.  The American Academy of Pain Management also has Diplomats trained in treating chronic pain.

I am pleased to announce that my new Highland Park, Il office will be opening in September and it is a tow minute walk from the Fort Sheridan Metra Station for my Chicago and Milwaukee patients who depend on public transportation.

Trigeminal Nerve Pain or TMJ? Neuromuscular Dentistry or SPG Blocks may help solve problems.

Question: My dentist diagonesed that I might have a TMJ problem, previously had MRI scan for trigeminal nerve pain but came negative, what could the problem be?

Dr Shapira Response: The trigeminal nerve supplies approximately 50% of all input to the brain. Because the MRI scan was normal does not mean the pain is not from or mediated by the trigeminal nerve. This can include TM Joint problems, TMD, Myofascial Pain, otalgia (trigeminal). All of these problems are mediated by the trigeminal nerve which is why neuromuscular dentistry is such an effective approach to chronic pain of the head and neck.

Sphenopalatine Ganglion Blocks can address the autonomic connections of the trimeninal nerve. It is usually a simplification to just call something a "TMJ" problem because there are usually multiple concerns based on symptomatology.

I normally spend an hour or more reviewing the history of patients with pain. The patient gave me no information about the SYMPTOMS that caused her to seek treatment. An accurate chronological history is an essential element in understanding how to approach a problem to bring relief. An MRI will show organic problems but are rarely the diagnostic approach to chronic pain. It is helpful in that it rules out tumors, growths, etc.

An examination of the craniomandibular and cervical musculature is incredibly important in anyone with headaches, facial pain, migraines, trgeminal pain, ear or jaw pain. Evaluation of the TM Joints and jaw motion is also very important.

The Neuromuscular Diagnostic work-up includes EMG evaluation of the jaw and/or neck muscles, Computerized scans of jaw movement and function, Sonography is sometimes used as well.

Quality of Life Destroyed By Chronic Daily Headache according to Cephalgia article. Neuromuscular Dentistry can improve Quality of Life

A total of 34 studies were reviewed in this paper. Chronic Daily Headache (CDH) and Chronic Daily Headache with Medication Overuse (MOH) consistently created a lower quality of life. The Cephagia Article "Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: A systematic review." include 25 studies of patients and 9 studies of the general population.

I strongly recommend Neuromuscular Intervention as soon as possible when chronic headaches begin. These studies clarify the importance of utilizing a diagnostic neuromuscular orthotic early in the course of the problem. Almost every study done on headache treatment with a neuromuscular diagnostic orthotic shows at least a 50-80% improvement with NMD and frequently far superior results than medication.

Chronic Daily Headache frequently responds extremely well to Neuromuscular Dentistry but unfortunately a diagnostic orthotic is rarely offered to patients in pain centers and neurology offices. The biggest complaint about Neuromuscular Dentistry is that it can be expensive and time consuming when compared to writing a perscription. Long term savings and improvement in quality of life are essential considerations that must be taken into consideration. Insurance companies frquently are uncooperative using sneaky contract language to deny medically necessary treatment. One of the most common and unquetionably fraudulant techniques is to call all headaches and migraines treated by a dentist TMJ or TMD and then place an artificially low coverage maximum on that treatment. The article clearly states "Chronic Daily Headache was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than Episodic Headache, it is essential."

The principal conclusions of this review were"the findings of this review underline the detriment to Quality of Life and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache."

Reducing medication use and overuse is one of the real advantages of Neuromuscular Dental treatment of Chronic Migaine and Chronic Daily Headache. The side effects of massive drug use in headache and migraine often worsen the problem.

Prior to treating migraines, Tension -type headaches sinus headaches, and chronic daily headaches with dangerous medications it is logical to utilize a Dignostic Neuromuscular Orthotic, if relief is obtained the Medication Overuse is diminished. Medication Overuse Headaches are one of the worst headache types in destroying quality of Life.

The Neuromuscular Dental Institute (Institute for the Study of Neuromuscular Dentistry) is my answer to this disaster. Dr Barry Cooper, a leading Neuromuscular Dentistry Educator will teach his introduction to Neuromuscular Dentistry course to small groups of 4-6 dentists. We hope large numbers of these students will continue their Neuromuscular Dental Education at ICCMO (International College of CranioMandibular Orthopedics) meetings and at the Las Vegas Institue (LVI)

This wll be in addition to the current course I give on Sleep Apnea Treatment with oral appliance (Dental Sleep Medicine) as well as coverage of nerve blocks including the SPG block. The SPG or Sphenopalatine Ganglion Block can be incredibly effective in preventing and eliminating migraines. Ideally patients can learn to utilze and self administer SPG blocks to prevent or Amelliorate migraine headaches early in their course. It is simple, inexpensive and frequently incredibly effective.

The Alliance of TMD organizations (I am the ICCMO representative to the TMD Alliance) is working to prevent patients from being denied care that will mprove their overall quality of life and subsequently result in enormous long term savings in costs and expenses associates with chronic headaches and migraines.

The way TMJ, TMD and Neuromuscular Dentistry is dealt with by insurance companies is an example of Discrimination against women since the vast majority of patients with headaches, migraines and TM Joint disorders are female.

I will continue to treat patients at my Gurnee Dental practice, Delany Dental Care Ltd in our current locatin and in our new location that has a better layout for giving continuing educational courses to dentists, physicians and allied medical practitioners. Contact my office at 847-623-5530 for information on becoming a patient.

We do make special arrangements for long distance patients to make treatment requre less time and travel.

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


Pub Med Abstract follows:

Cephalalgia. 2011 Apr 4. [Epub ahead of print]
Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: A systematic review.
Lantéri-Minet M, Duru G, Mudge M, Cottrell S.

CHU de Nice - Hôpital Pasteur, France.
Abstract
Objective : To evaluate the evidence for quality of life (QoL) impairment, disability, healthcare resource use and economic burden associated with chronic daily headache (CDH), focusing on chronic migraine (CM) with or without medication overuse. Methods : A systematic review and qualitative synthesis of studies of patients/subjects with CDH that included CM, occurring on at least 15 days per month. Main findings: Thirty-four studies were included for review (25 studies of patients and nine of subjects from the general population). CDH and CDH with medication overuse headache (MOH) were consistently associated with a lower QoL compared to control or episodic headache (EH) and CDH without MOH. CDH was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than EH. Data were not amenable to statistical pooling. Principal conclusions : The findings of this review underline the detriment to QoL and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache.

PMID: 21464078 [PubMed - as supplied by publisher]

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.

Headaches since June, Back of head that last 1 1/2 days and end with throwing up.

Rachel: I have on going headaches since June. They are in the back area of the head and I usually have them for 1 day and half. Most of the time I end up throwing up

Dr Shapira response: Dear Rachel,

I assume that you have visited you physician to discuss your headaches due to the dramatic change. If nothing is found medically occipital headaches are frequently helped by a neuromuscular orthotic. Symptoms that you describe can also be caused by Atlas/Axis problems and you might want to consider seeing an Atlas Orthogonal or NUCCA chiropracter..

If the pain is primarily muscle ait may be easy to relieve utilizing Travell vapocoolant spray and stretch. Does the pain go away immediately after vomiting? When you vomit it causes instant but temporary release of closing jaw muscles.

It is always important to consider organic disease when a new type of headache occurs. Never assume that there is not an undrlying disease process. Neuromuscular Dentistry is probably one of the safest and most effective treatments for chronic headaches and migraines but when a new type of headache occurs it is important to rule out other medical causes.

Objective diagnosis is the key, you do not want to become a drug guinea pig diagnosed by serial drug experiments.

Chronic daily headaches and meds don't work. What should I do? Neuromuscular Dentistry may be the answer.

Chronic headaches without a cause are frequently related to the Trigeminal nervous system and have no specific diagnosis. When headaches are not helped by routine medical care a neuromuscular dentist may be the best answer.

Question from Tiffany: I have been having headaches everyday now for about a year and 9 months now. Had no accidents or head trama btu i have headaches everyday ..No meds work for me only excedrin for about an hours and the head aches is right back. I really dont know the cause but i would like to find out more or what could be causing this.

Dr Shapira Response.

Tiffany, chronic headaches are usually coming from head and neck musculature, especially those muscle innervated by the Trigeminal Nerve. There may or may not be any joint noise or discomfort. A thorough medical evaluation with your physician to rule out organic disease is alway in order.

I start patients with a consultation appointment and usually can relieve a significant amount of pain during the appointment. Most muscle pains can be allieviated or eliminated temporarily with vapocoolant spray and stretch techniques to confirm muscle problems.
I start treatment with a thorough head and neck exam and a neuromuscular dental work up and than a neuromuscular diagnostic orthotic. Most patients see drastic improvement in just a couple of visits. There are no magic cures and it takes time for a chronic problem to unwind completely.

Relief of 30 years of constant Headache: Brief relief may provide clue to long term relief.

KEN:I Have had headaches for 30 years going away only once when having a root canal done on an upper tooth. While everything was numbed up I had complete brain function and no headache. They are located directly behind my nose area and I feel a constant pressure.

Dr Shapira response: The anaesthetic relieved the pain probably confirming that it is from the trigeminal nerve. I would be very interested is a spenopalatine ganglion block could give more long term relief. It is a easy procedure that I have taught patients to do at home with a q-tip and anaesthetic thru the nose. There are also other diagnostic blocks that can be done to determine the cause of your headaches.

A diagnostic neuromuscular orthotic would be an excellent first step in treatment. If the headaches are eliminated or significantly relieved a permenant stabilization could be done. I have referred you to an excellent Dr who knows both of the procedures mentioned.

Frontal and Occipital Headaches with Facial Numbness

From Vicki:

I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.

Dr Shapira response:

I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.

The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.

The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.

One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.

The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.

The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.

Following complete (or close) pain relief a long term solution can be evaluated.

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

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

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

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

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

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

Retro-orbital pain and TMD (TMJ) explained anatomically in this article.

A mechanism for retro-orbital pain and TMD is presented in this anatomical dissection of the the temporal branch of the zygomatic nerve passing through an accessory canal in the sphenozygomatic suture. This anatomical placement of the nerve would allow temporal muscle tension to cause nerve irritation and retro-orbital pain. Utilization of a diagnostic neuromuscular orthotic could differentiate retro-orbital pain that is best treated by neuromuscular dentistry.

Surg Radiol Anat. 2002 May;24(2):113-6.
Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve.
Akita K, Shimokawa T, Tsunoda A, Sato T.

Unit of Functional Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. akita.fana@tmd.ac.jp
A nervous branch which passes through a small canal in the sphenozygomatic suture is sometimes observed during dissection. To examine the origin, course and distribution of this nervous branch, 42 head halves of 21 Japanese cadavers (11 males, 10 females) and 142 head halves of 71 human dry skulls were used. The branch was observed in seven sides (16.7%); it originated from the communication between the lacrimal nerve and the zygomaticotemporal branch of the zygomatic nerve or from the trunk of the zygomatic nerve. In two head halves (4.8%), the branch pierced the anterior part of the temporalis muscle during its course to the skin of the anterior part of the temple. The small canal in the suture was observed in 31 head halves (21.8%) of the dry skulls. Although this nervous branch is inconstantly observed, it should be called the temporal branch of the zygomatic nerve according to the constant positional relationship to the sphenoid and zygomatic bones. According to its origin, course and distribution, this nervous branch may be considered to be influential in zygomatic and retro-orbital pain due to entrapment and tension from the temporalis muscle and/or the narrow bony canal. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0027-4.

PMID: 12197019 [PubMed - indexed for MEDLINE]

Neuromuscular Dentistry treats Migraines, Tension-Type Headaches, Chronic Daily Headaches and Sinus Pain related to Trigeminal Nerve and TMJ Disorders

Chronic pain is frequently multifactorial in nature. Neuromuscular dentistry has been very successful in treating TMD, Migrines, Tension Type headaches and other disorders. Frequently it is not a total cure but 50-80% reduction in pain is usually attained within several visits. There are many disorders and symptoms associated with TMD including:
Ear Aches or Otalgia
Sinus Pain
TM Joint Clicking and Popping
Ear Stuffiness or Eustacian Tube Dysfunction
Dizziness
Vertigo
Temporal Pain
Occipital Headaches
Morning Headaches
Sleep Apnea
Snoring
Sore Throats
Neck pain or stiffness
Feelings of a foriegn object in the throat
Pain in or behind the eyes
Scalp pain or feeling like your hair hurts

Most of these symptoms are mediated by the Trigeminal nerve and the Trigeminovaqscular system. These Nerves also connect to facial nerves, occipital nerves, glossopharyngeal nerves and to the autonomic nervous system. What happens in these nerves cause biochemical changes in the brain. Recent stuies shown the neural plasticity can create permanent changes in the brain. If chronic pain is the stimulus it can lead to central sensitization.

Changes inthe brain can be reversed over time but the exact amount of recovery will vary with individual patients genotypes, how long the pain has been present , other comorbidities that the patient carries. Some patients experience immediate3 and almost miraculous pain relief while others have a slower longer version of recovery. I always tell my patients to work for 50 - 80% improvement in pain. That is then our new starting point and we again seek 50 - *0 % reduction in pain.

There is "no cure" for long term chronic pain because lives have been changed due to living with pain. A cure would require a do-over of the years you had pain. There are no do-overs therefore we look to improve your future quality of life to the maximum. Some patients still have to do exercises or watch diet or even continue different medications. Other patients have remarkably and incredible improvements as described by Dr Barry Cooper in Cranio where he talked about "overwhelming success". This is why we use a diagnostic orthotic as the first step of treatment. We try to avoid permanent changes until the patient feels substantially improved. This is not a judgement that any doctor can make for the patient. It is a subjective evaluation by the patient themselves. Only the patient knows how well or poorly they are doing. We may have objective data showing physical improvement but the final test is have we improved or dramatically improved the patients quality of life. If the answer is yes we can talk about long term stabilization. The diagnostic orthotic is the first phase of treatment for those patients.

If the patient has improvement, whether it is only 25-30% or if they are at 80-90% the decision that the diagnostic orthotic treatment is successful remains the patient's. If they do not feel sufficiently improved they should not feel pressured into continuing treatment or making permanent changes. You should treat the diagnostic orthotic like a CAT SCAN or MRI but instead of images we have improvement in the quality of life. If improvement is not sufficient then a diagnostic approach should continue.

While NEUROMUSCULAR DENTISTRY IS REMARKABLY EFFECTIVE AT TREATING MANY CONDITIONS THERE ARE OTHER CONDITIONS THAT ARE NOT RELATED TO THE TRIGEMINAL NERVOUS SYSTEM, MYOFASCIAL PAIN OR JAW JOINTS.

TMJ disorders are frequently called The Great Imposter ("SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IS A MUST READ FOR ANY PATIENTS WITH MIGRAINES OR TMD http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor) but we must remember that other disorders can also masquerade or more frequently coexist with these problems. Many times a diagnostic orthotic relieves many of the symptoms but the remaining symptoms have a different cause. The expression that "you can't see the forest for the trees" applies. When the majority of symptoms are relieved you now find that you can identify a particular problem that was lost in a long and winding maze of symptoms. As NMD unravels the maze a specific problem can now be identified and treated.

NEUROMUSCULAR DENTISTRY FINDING A NEUROMUSCULAR DENTIST DIRECTORY TIRED OF HEADAXCHES? WE WILL HELP YOU LOCATE A NEUROMUSCULAR DENTIST

I have had an enormous respones from visitors to this website looking for a neuromuscular dentist and not finding one listed in their area. If you need help find a neuromuscular dentist we try our best to connect you with one.

I do ask for feedback on doctors because I do not know all of them personally. I am most happy when I can refer to an excellent clincian that I trust.

While I believe that neuromuscular dentistry is essential for a majority of patients it does not exclude many other varieties of treatment in conjunction with NMD.

Quality of Life is the name of the game. We want to help you on your journey to that better quality of life.

Chicaqgo: Headache Treatment and Neuromuscular Dentistry

I have received several e-mails from patients who tell me that there are no dentists listed in their area. We will help you find a Neuromuscular Dentist in your area. I practice in Gurnee, Illinois and see patients primarily from Northern Illinois and Southern Wisconsin. I can do some procedures and initial consults on TMJ disorders at the offices of Chicagoland Dental Sleep Medicine Associates in Skokie and Schaumburg but patients with difficult headaches usually need to come to Gurnee. My office is especially convenient for North Shore suburbs of Chicago as well as Northwest suburbs.

I teach a course in Dental Sleep Medicine to dentists from around the U.S. and my team can arrange for out of own patients who want to travel to Chicago for Neuromuscular Dental Treatment.

Neuromuscular Dentistry for Treatment of headaches involves at least two extended appointments at the start of treatment. Ideally out of town patients will spend three days to begin treatment. The first visit for local patients is usually a consultation we can start treatment for long distance patience if previous arrangements are made.

Following the consultation appointment, treatment begins at the first appointment with a comprehensive examination and neuromuscular work up. The diagnostic orthotic is deliverd at the second visit visit. Long distance patients actually have a full day of treatment (the equivlant of two appointments) with the appliance being delivered on the first day. The patient will be seen early the next day for correcting the diagnostic orthotic to rflect changes in posture as muscles continual to release and normalize. A second visit in the afternoon will often include nerve blocks or trigger points if there is still residual pain. Some patients will leave after the second day but I prefer to have their next appointment the morning of the third day before they go home. We will usually schedule the next vist for 2 weeks later but if pain is completely relieved we may postpone the next appointment.

All patients are different and bring unique challenges and treatment is adjusted to individual patients. Many patients bring their spouse to the first series of appointments though this is not necessary.

Diagnostic orthotics are used in phase I treatment. The diagnostic orthotic is meant for a few months of use decrese pain and stbilize posture. If the patient decides they are substantially improved we recommend a second phase of treatment for long term stabilization. Long term stanilization and permanent changes are usually avoided at the initial series of visits.

Long term stabilization can take many different forms but it is designed to maintain the relief afforded by the diagnostic orthotic.