Showing posts with label headaches. Show all posts
Showing posts with label headaches. Show all posts

Monday, March 19, 2018

HEADACHES due to Prevertebral Muscles and Retropharyngeal Tendonitis: Headaches often related to turning head upwards.

The prevertebral muscles and tendons are difficult to address and oftey interfere with healing and recovery.  They are frequently injured in whiplash injures and symptoms can linger for years or even decades.

"Headache attributed to retropharyngeal tendonitis" is classified by "The Third Classification of Headache Disorder, 3rd addition" 
Diagnosis Code 11.2.2

Raising of the eyes by tilting of the head can cause both referred pain, aching and headache.  These muscles and tendons extend over the top 3-4 vertebrae to the skull.   There is a frequent involvement of the upper cervicl complex.

While Neuromuscular Dental Orthotics address the majority of head and neck symptoms by  restoring structural and muscular balance NMD does not correct upper cervical vertebrae.

These can be addressed by specially trained osteopaths and chiropractors.  Atlas-Orthoganol chiropractors wok on the first vertebre (the Atlas) and the second vertebrae (the Axis) and their relation to the skull.   They deliver a precice adjustment to the upper cervical region.  NUCCA chiropractors address the same area utilizzing different techniques.  Both work well as does the osteopathic approach.

It is important to have a stable neuromuscular orthotic before doing the adjustment (on combination cases) and it is often necessary for a patient to have both adjustments on the same day.  Typically, the nuromuscular orthotic is corrected after the A/O adjustment.

I work closely with Dr Mark Freund on patients requiring upper cervical corrections.  https://www.northshoreatlas.com/atlas-orthogonal.

Addressing the fascial and muscular disorders of the prevertebral region is usually started by a very gradual passive gentle stretch with the patient laying on the floor with a very small towel roll under the shoulders allowing the head to extend and tip backwards.  If there is pain or discomfort the size of the towel roll is reduced.  Typically 20 minute sessions that also combine very slow diaphragmatic breathing will let these muscle release their taut bands and tension.  Overdoing the stretch impedes progress.

The scalene muscles are usually also involved in  creating problems but they can be addressed with ULF-TENS (Myomonitor), Spray and Stretch techniques, correction of paradoxical breathing issues and other physical modalities.

Sufficient Magnesium and calcium levels are important for muscle relaxation.
Feldenkrais and Alexander techniques work well in patients with these disorders as do Paul St John techniques.

All of these techniques work best with well balanced neuromuscular orthotics.  The Aqualizer appliance is a self balancing hydrostatic appliance that can also be extremely useful.  Italian studies show it relaxes muscles throughout the body.

I frequently have my patients walk and run up and down stairs in these appliances to let the body and spine unwind and the muscles relax prior to adjusting neuromuscular appliance.

Aqualizers are almost a necessity when having A/O adjustments for patients traveling from one office to another.

Cranial Manipulation is another instance where the Aqualizer is incredibly useful as a patient goes from cranial doctor to have his Neuromuscular Orthotic adjusted.

Dr Mark Freund also utilizes Cranial work.   https://www.northshoreatlas.com/cranial-suture-release

His Highland Park office is across the hall from my Highland Park office:
www.ThinkBetterLife.com

Prevertebral muscle and tendon issues can be very difficult and working with multiplle professionals is key to success.



Wednesday, March 9, 2016

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

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

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

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

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

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

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

Sunday, August 9, 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Shapira's Response:


DEAR PAUL,

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

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

These conditions were well described by Dr Janet Travell in her landmark text 
"Myofascial Pain and Dysfuntion:   A Trigger Point Manual"

You did not mention having SPG blocks which may help butare not the ultimate answer.  Atlas /Axis problems with the first two vertebrae can give a host of strange symptoms.
The SpenoPalatine Ganglion is the largest parasympathetic ganglia of the head and neck and is implicated in a wide variety of wierd and inexplicable cases of chronic pain and dysfunction.  It was made famous in the best selling book "Miracles on Park Avenue" which is a worthwhile read.

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

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

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

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

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

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

Chair, Alliance of TMD Organizations




Wednesday, April 1, 2015

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

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

In the Chicago area I have two locations for patients;

Highland Park, Il www.ThinkBetterLife.com

 Gurnee   www.DelanyDentalCare.com

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

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

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

 FIND A NEUROMUSCULAR DENTIST

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

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

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


Saturday, December 20, 2014

My Headaches Are Destroying My Relationships and My Family

From www. IHATEHeadaches.org e-mail
Susan: I have been having severe chronic daily headaches for over 5 years. I have been diagnosed as sinus headaches, migraines, atypical migraines, TMJ, Trigeminal Neuralgia. I have had numerous CAT Scans and MRI that all appear normal. I have tried multiple medications that seem to slightly ease the pain on a temporay basis but I do not remember the last time I was pain free. My marital life is a mess and my husband doesn't understand how I can have so much pain when all the tests are normal. I am constantly yelling at the kids and the feel horribly guilty. My friends have all but cut off contact but it is probably my fault. I wish the scans could find a tumor so everyone would know the pain was real.
I'm desperate but that just seems to make the pain even worse.
Dr Shapira:
Susan, Please do not give up. I have heard many stories similar to yours. First, because all of the tests have been negative for disease there is excellent hope for significant improvement.. I suggest you seek out a Neuromuscular Dentist who also understands chronic Myofascial Pain and the use of Trigger Point Injections, Sphenopalatine Ganglion Blocks, Spray and stretch techniques.
Susan, it is important to understand that eliminating your pain is not a cure. You have been forever changed by the hell you have been experiencing. The only real cure would be a do-over on the last five years of your life. The goal of treatment is eliminate pain and restore quality to your life and allow you to reconnect with your husband, children, family and friends. The pain you have lived with has changed who you are forever but that may just make you appreciate your life more in the future.
The medical model for Chronic Headaches is diagnostic test and then perscription medicine. I find that patients who have symptoms you describe are easier to treat than expected. I usually spend 1-2 hours on an initial consultation with new patients. Initially we talk so I can understand who you are, how the pain is affecting you, your life and your family. The next part of the consultation is to try to eliminate some or all of the pain you are experiencing at that time.
I usually begin with trigger point deactivation of the cranial and upper body muscles. It is amazing how frequently we can elimnate all or most of the pain just by utilizing techniques described by Dr Janet Travell over 50 years ago. Dt Travell was President John F Kennedy's physician.
The majority of all pain patients experience is muscular in orgin, and turning off the pain allows us to understand the undrlying processes. At this same visit we will make a trial change of proprioception into the central nervous system from the trigeminal nerves.
We can usually eliminate most pain during the first visit the hard work is to make these changes on a long term basis. I tell my patients to set a goal of 50-80% reduction in pain initially. As treatment progresses we continually try to remove 50-80% of remaining pain. This is accomplished by utilizing a diagnostic neuromuscular orthotic to change how the muscles function and to alter trigeminal nerve proprioceptive input to the brain.  Over time there are postural changes and healing.
I often find that I "meet" my patients at the third or fourth appointment.  The patient I meet initially is the person living in pain for months or years but after a few visits I meet the real person who was lost under an avalanche of pain.  There is a great joy in watching people recover and regain their lives.
I practice Neuromuscular Dentistry and Pain Treatment as part of my Chicago area TMJ practice.

Saturday, June 22, 2013

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


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

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

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



Dear Jacquelyn,

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

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

Monday, March 19, 2012

cluster headache and SPG (sphenopalatine Ganglion block) Block

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

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

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

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


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

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

Abstract

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

PMID:
22335966
[PubMed - as supplied by publisher]
Free full text
Otolaryngol Pol. 2007;61(3):319-21.

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

[Article in Polish]

Source

Poradnia ChorĂ³b Nosa Uniwersyteckiego Szpitala Klinicznego im. WAM Uniwersytetu Medycznego w Lodzi.

Abstract

AIM:

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

METHODS:

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

RESULTS:

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

CONCLUSION:

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

PMID:
17847789
[PubMed - indexed for MEDLINE]