Learn to Change Lives At ICCMO! TMJ, "The Great Imposter" Amazing Patient Testimonials Videos Describe How Neuromuscular Dental Treatment Can Eliminate Headaches, Migraines, Facial Pain and Neck Pain

Improved Quality of Life: These are actual patient testimonial videos of outstanding improvements in quality of life with Neuromuscular Treatment of TMJ and Pain Disorders. Hear about recovery from a patient a Mayo Clinic MD told her was hopeless.

THIS PRESS RELEASE WAS ORIGINALLY RELEASED ON 24/7 PRESS RELEASE

EVERY DENTIST WHO CARES ABOUT THE HEALTH AND WELFARE OF THEIR PATIENTS SHOULD LEARN ABOUT NEUROMUSCULAR DENTISTRY. CREATING HAPPIER HEALTHIER PATIENTS FREE FROM PAIN IS A NOBLE UNDERTAKING!

    Every patient with chronic pain and every physician, dentist and chiropracto truly interested in changing peoples lives should plan on attending the ICCMO Meeting from October 1-October 4, 2015 in San Diego at the Catamaran Resort and Spa.

Integrated TMD Treatments: Solving CranioMandibular Dysfunction Head to Toe
Visit https://www.regonline.com/builder/site/Default.aspx?EventID=1735252 to learn more about the event.

Visit the ICCMO website at: www.ICCMO.org

This year will be of special interest to chiropractors especially NUCCA and Atlas Orthoganol doctors, pain management physicians, physical therapists, sports physicians and more.

Patients who suffer from pain should encourage their doctors and especially dentists to attend.

Headaches and Migraines affect 25% of US households. At least 10% of the population suffers from chronic headaches. Dr Ira Shapira, a long time Highland Park resident founded I Hate Headaches.org to to help patients suffering from chronic migraines, sinus headaches, chronic daily headaches, tension headaches and TMJ headaches. Over 95% of all headache patients have Trigeminal Nerve mediated headaches. His premiere website www.ihateheadaches.org has helped thousands of patients understand how the Trigeminal Nerve and the structures it innervates are responsible for the majority of all headaches.

Many patients think that TMJ (TMD) disorders are only treated with splints. Dr Ira Shapira utilizes a multifaceted approach to giving patients quick and lasting relief from their chronic pain. He utilizes Diagnostic Neuromuscular Orthotics and has over 30 years experience in Neuromuscular Dentistry. He trained with Barney Jankelson the founder of this field and with Bob Jankelson, his son. In addition to utilizing Neuromuscular Dentistry he is one of only a handful of practitioners to utilize SPG Blocks (Sphenopalatine Ganglion Blocks), Trigger Point Injections and Spray and Stretch techniques to treat Myofascial Pain and Muscle pain from Fibromyalgia. He trained with Dr Janet Travell who wrote the book Myofacial Pain and Dysfunction: A Trigger Point Manual.

The ICCMO meeting is a must for doctors wanting to truly help their patients improve their quality of life. Dr Shapira is giving a course on the developmental aspects of TMD, Sleep Apnea and ADD and ADHD. Early pediatric key can allow us to grow healthier future generations.

According to the Migraine Research Foundation
"Children Suffer from Migraine Too

Migraine is very common in children - about 10% of school-age children suffer.
Half of all migraine sufferers have their first attack before the age of 12. Even infants can have migraines. Migraine has been reported in children as young as 18 months. 
Before puberty, boys suffer from migraine more often than girls. The mean age of onset for boys is 7, and for girls it is 11. As adolescence approaches, the incidence increases more rapidly in girls than in boys. This may be explained by changing estrogen levels. 
By the time they turn 17, as many as 8 percent of boys and 23 percent of girls have experienced a migraine.
The prognosis for children with migraine is variable. However, 60% of sufferers who had adolescent-onset migraine report ongoing migraines after age 30. The prognosis for boys tends to be better than for girls.

Many if not most of these problems canbe eliminated or reduced by early intervention according to Dr Shapira.

This link leads to a YouTube Channel of Think Better Life Patient Testimonial videos.
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

Everyone with chronic TMJ pain, migraines, neck pain or facial pain should view these videos.

The Website for Dr Shapira's new Highland Park office is www.thinkbetterlife.com.


According to the Migraine Research Foundation website:

"Migraine is an extraordinarily common disease that affects 36 million men, women and children in the United States. Almost everyone either knows someone who has suffered from migraine, or has struggled with migraine themselves. Nearly 1 in 4 U.S. households includes someone with migraine. Amazingly, over 10% of the population - including children - suffers from migraine. That's more than diabetes and asthma combined! About 18% of American women and 6% of men suffer from migraine. Migraine is most common during the peak productive years, between the ages of 25 and 55."

TMJ Disorders have been dubbed "The Great Imposter" because the majority of patients are misdiagnosed or only partially diagnosed by the medical community. The Trigeminal Nerve is frequently called "The Dentists Nerve" because it goes to the teeth, periodontal ligaments,, the sinuses, the tongue, the jaw joints and jaw muscles, as well as the tongue, the tensor of the ear drum, the muscle that opens and closes the eustacian tube and a major contribution to the autonomic nervous system. The Trigeminal Nerve also controls the blood flow to the anterior two thirds of the meninges of the brain, or in simple terms the Trigeminal nerve determines whether you will have migraines. The Trigeminal Nerves or Fifth Cranial Nerves is also the single largest contributor to Chronic Headaches and Migraine. Neuromuscular Dentistry is extremely effective in eliminating and treating migraines specifically because of the trigeminal nerve connection. Neuromuscular Dentistry is specifically directed towards eliminating trigeminal nerve nociception or painful input to the central nervous system.

What the majority of the medical community does not know is that TMJ or TemporoMandibular Disorders can have effects on almost every system in the body. The NHLBI or National Heart Lung and Blood Institute of the NIH published a report entitled CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS that looked at the far reaching effects of TMJ disorders. The report recognizes the importance of "The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking."

The NIH report also state, "TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints."

The report shows that 12% of the population suffers from TMD similar to the number suffering chronic headaches and migraines. The report has a major section on "The Craniofacial Complex and its Impact on Control of Upper Airway Resistance and Cardiopulmonary Function" The report covers the pathophysiology of sleep apnea which is implicated in morning headaches, fibromyalgia and Myofascial Pain and Dysfunction. It is now well established that oral appliances are a first line approach to treatment of sleep apnea and snoring for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea.

The Autonomic portion of the Trigeminal Nerve is a key cause and cure for migraines and headaches. This is because of its innervation of the meninges of the brain and its control of blood flow to the brain. The SPG Block or Sphenopalatine Ganglion Block is sometimes considered a miracle cure for migranes. The popular book "Miracles on Park Ave" dealt specifically with the high efficacy of SPG Blocks in treating pain. The new MiRx protocol (http://www.mirxprotocol.com/) that has been show effective for preventing and treating migraines is actually just a different method of utilizing the SPG Block. Dr Shapira has been teaching utilization of the SPG Block to dentists and other healthcare professionals for many years.

Learn more about SPG Blocks @ http://chicago-headaches.blogspot.com and at www.thinkbetterlife.com.

The Mayo Clinic has also clearly stated the importance of the Trigeminal Nerve is headaches and Migraines "Although much about headaches still isn't understood, researchers think migraines may be caused by functional changes in the Trigeminal Nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which plays a regulatory role for pain messages going through this pathway."

Mayo clinic also states, "During a headache, serotonin levels drop. Researchers believe this causes the Trigeminal Nerveto release substances called neuropeptides, which travel to your brain's outer covering (meninges). There they cause blood vessels to become dilated and inflamed. The result is headache pain."

These meninges are the Trigeminally innervated meninges discussed earlier and the serotonin and neuropeptides are the chemicals produced by nerve cells. These same chemicals are involved in TMJ, TMD and Migraines. The Trigeminal Nerve always utilizes these neurotransmitters not just for migraines.

Dr Shapira spent years doing research into sleep apnea and its connection to jaw position. His early research was done as a Visiting Assistant Professor in the 1980's at Rush Medical School in The Sleep Disorder clinic. He worked closely with Dr Rosalind Cartwright the acknowledged Mother of Dental Sleep Medicine. Dr Cartwright recruited Dr Shapira to return to Rush as an Asst Professor in the 1990's till early this century.

The connections between impaired nasopharyngeal breathing and development of ADD and ADHD in children was the topic of a recent lecture Dr Shapira gave in Buenos Aires, Argentina. The development of chronic TMJ disorders, headaches, migraines and postural distortions were all discussed at his lecture to members of ICCMO, The International College of CranioMandibular Orthopedics of which Dr Shapira is a Fellow and Secretary. Dr Shapira is a representative from ICCMO to the American Alliance of TMD Organizations and current Chair of the Alliance of TMD Organizations.

In the 1990's Dr Shapira was a star lecturer for the A4M, The American Academy of Anti-Aging Medicine where he presented his work on the effect of TMJ disorders across ones lifetime. Premature aging and loss of memory and even dementia and Altzheimers disease are part of the same ongoing problem. Sleep Apnea and snoring are types of TMJ disorders according to the National Heart Lung and Blood Institute of the NIH in their report: Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders.

Dr Shapira has been utilizing a multifaceted approach toward relieving chronic pain associated with TMJ disorders for over 30 years and is now bringing his expertise to the North Shore Communities of Chicago. He created www.IHATECPAP.com which addressed Sleep Apnea and snoring and utilizing oral appliances to treat these problems. He also created www.ihateheadaches.org that focuses on many types of headaches and the role of Neuromuscular Dentistry in providing relief of these problems.

The DNA Appliance is offering a possible cure for sleep apnea and TMJ disorders by growing the jaws utilizing Epigenetic Orthodontics. Until recently it was believed these changes could only be accomplished through extensive surgical procedures.

Dr Shapira has also studied Cranial Suture Release techniques and Chirodontics. He inroduced these concepts to a Chiropracter who is his friend and colleague, Dr Mark Freund . Dr Freund has embraced these concepts in totality and has become an expert in these techniques through immersive studying both in the US and Internationally. His primary office is in Lindenhurst but he also sees Cranial patients in Gurnee in Dr Shapira's office www.delanydentalcare.com.

Dr Freund will be treating patients in Dr Shapira's Highland Park office. These techniques treat not only TMJ Dysfunction but also postural distortion such as forward head posture that leads to headaches and neck pain. These postural distortions can have negative effects throughout the entire body.

The NIH just reported over 25 million Americans suffer chronic pain or 11.2% of all Americans. See The Washington Post Story. http://www.washingtonpost.com/news/to-your-health/wp/2015/08/11/nih-m ... onic-pain/

Dr Ira L Shapira created the I HATE CPAP (www.ihatecpap.com) and I HATE HEADACHE (www.ihateheadaches.org) websites to help patients find help with these difficult medical disorders that medicine can frequently not treat adequately without a dental collaboration. Dr Shapira did research in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.

Dr Shapira is the current Chair, Alliance of TMD Organizations
http://www.tmdalliance.org/

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a Diplomate of the American Academy of Pain Management, and a Fellow of the International College of CranioMandibular Orthopedics (ICCMO). He is a former national and International Regent of ICCMO, its current Secretary and the representative to the Alliance of TMD organizations or the TMD ALLIANCE has a general dental practice (http://www.delanydentalcare.com) in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates with offices in Vernon Hills and Highland Park. Patients in Northern Illinois or southern Wisconsin can contact Dr Shapira by phone toll free at 1-8-NO-PAP-MASK OR 1-800-TM-JOINT or thru his websites at http://www.ihateheadaches.org or http://www.chicagoland.ihatecpap.com.

  

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

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

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

Alliance of TMD Organizations Fundamental Principles

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

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

2. Treatment should be based upon individual patient needs.

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

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

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

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

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

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

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

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

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

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

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

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

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

What is Neuromuscular Dentistry? How do I Find a Neuromuscular Dentist

WHAT IS NEUROMUSCULAR DENTISTRY?

If you are looking for a Neuromuscular Dentist dedicaed to the art and science of the field I strongly suggest a member of the International College of CranioMandibular Orthopedics (ICCMO) at their website
http://occlusiontmjauthority.com. That site has an extensive educational area for patients that is continually being updated.

My description of What is Neuromuscular Dentistry that was originally written for the American Equilibration Society and republished in the ICCMO anthology and by Sleep and Health Journal is considered one of the most succint and easy to understand descrptions of the basic principles of Neuromuscular Dentistry.  http://www.sleepandhealth.com/neuromuscular-dentistry

Neuromuscular Dentistry or NMD is a field of medicine and dentistry based on the work of Barney Jakelson.  There are many greats in the field including Norman Thomas BDS, PhD, Barry Cooper, Jim Geary and Barney Jankelson's son Bob Jankelson who wrote the tesxtbook on Neuromuscular Dentistry.  The International College of CranioMandibular Orthopedics is the organization devoted to the field of Neuromuscular Dentistry and is universalIy acknowledged as the primary organization representing Neuromuscular Dentistry.  There is an American Section of ICCMO representing Neuromuscular Dentists in North America, There is a South American ICCMO based in Argentina, There are large ICCMO chapters in Japa, Germany and a newly organized group in Russia. I have personally been working in the field of Neuromuscular Dentistry for over 35 years.been working in the field of Neuromuscular Dentistry for 35 years.

Dr Janet Travell famed for her work with Myofascial Pain and Dysfunction described in detail in her textbook the mechanism of trigger points, taut bands and myofascial pain.  She lectured at meetings in conjunction with ICCMO and much of her work is directly related to Neuromuscular Dentistry.  Her descriptions of how trigger points form is directly addressed by Neuromuscular Dentistry.


Neuromuscular Dentistry is the most physiological based approach to dentistry and treatment of TMJ disorders, TMD, Migraines, and  headaches.  There is more to Neuromuscular Dentistry than teeth, bones and joints which is where most of dentistry focuses.  Neuromuscular Dentistry looks at the entire nervous system including the parasympathetic and sympathetic portins of the autonomic nervous system and closely looks at physiological aspects of the somatic nervous system.  The stomatognathic must look beyond the jaws and teeth and look at how this interacts with the entire body.

Posture is a primary function of the masticatory system that is ignored by most of dentistry.  Airway maintenance is another  primary function of the the masticatory apparatus and associated systems. The Quadrant Theorem of Guzay explains from a mechanical engineering view how the TMJoint and head posture and the Atlas and Axis vertebrae interact.

Neuromuscular Dentistry utilizes objective data to measure how function and physiology work together.  Neuromuscular Dentistry utolizes EMG to measure muscle physiology and function (dysfunction).  The use of Ultra Low Frequency TENS in Neuromuscular Dentistry to create relax musculature was not discovered by Dr Barney Jankelson but was found during basic science research.  The genius of Dr Jankelson was utilizing it to relax the trigeminally innervated muscles that move the jaws.

The utilization of the Mandibular Kinesiograph now called computerized Mandibular Scans allow careful evaluation of jaw function is three dimensions in real time or in slow motion.  There are two companies that make equipment for Neuromuscular Dentists, Myotronics the company founded by Barney Jnkelson and BioResearch who also manufactures equipment for Neuromuscular Dentists.

http://www.sleepandhealth.com/neuromuscular-dentistry

Chicago area patients should visit my www.thinkbetterlife.com for more information

The Las Vegas Institute (LVI)  utilizes Neuromuscular Dentistry as the basis for its educational programs. I strongly suggest finding LVI dentists who are also members of ICCMO.   It is important to understand that not all LVI dentists are Neuromuscular Dentists.

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TMJ, TMD: Patient Friendly Video Explains TMJ, TMD, Posture, NUCCA, Atlas-Orthogano, Sleep Apnea and Snoring

My friend Curtis does an excellent job of explaining TMJ Disorders or TMD and how they are addressed with Neuromuscular Dentistry.  I like to always refer to the Neuromuscular Orthotic as a Diagnostic Neuromuscular Orthotic because we use it not just to help in the diagnosis of a patients but to evaluate the new diagnostic position and the effect it has on body posture.

I am into fascinated with the  science of TMJ, TMD and MPD and the postural effects of changing the bite.  Curtis does fabulous job in explaining difficult concepts in a simple easy to understand and entertaining format.  I enjoy watching his video every time I play it.  There is an amazing body of evidence and science into his postural discussion that includes the work of Nobel Prize winning Sherrington and the work of Tallgren.
As a Regent and Secretary of ICCMO I am currently having the pleasure of reviewing his excellent mastership thesis of ICCMO

View his you tube video @

https://www.youtube.com/watch?v=oAdKVu6vS20 

ICCMO STANDS FOR THE INTERNATIONAL COLLEGE OF CRANIO MANDIBULAR ORTHOPEDICS. ICCMO IS THE ORGANIZATION FOR NEUROMUSCULAR DENTISTRY

ICCMO, THE INTERNATIONAL COLLGE OF CRANIO MANDIBULAR ORTHOPEDICS IS THE ORGANIZATION THAT REPRESENTS THE ART AND SCIENCE OF NEUROMUSCULAR DENTISTRY. DR BARNEY JANKELSON THE FATHER OF NEUROMUSCULAR DENTISTRY IS ALSO A FOUNDER OF ICCMO.

NEUROMUSCULAR DENTISTRY UTILIZES SOPHISTICATED INSTRUMENTATION TO ASSESS AND CORRECT THE PHYSIOLOGIC POSITIONING OF THE JAWS, MUSCLES, OCCLUSION AND POSTURE TO ADDRESS CHRONIC TMJ,TMD AND MYOFASCIAL PAIN PROBLEMS IN A PHYSIOLOGIC FRAMEWORK.

NEUROMUSCULAR DENTISTRY CAN VASTLY IMPROVE RESULTS IN COSMETIC, IMPLANT AND RECONSTRUCTIVE DENTISTRY. THE BASIC THEORY OF NEUROMUCULAR DENTISTRY IS THAT IDEALING THE OCCLUSION SO THAT FUNCTION DOES NOT REQUIRE PATHOLOGIC MUSCLE DAPTATION. CREATING AN IDEAL ENVIRONMENT FOR NORAM MUSCLE FUNCTION CREATES NORMAL PHYSIOLOGIC RESPONSES AND HEALTHY MUSCLES.

THE NEUROMUSCULAR SYSTEM INVOLVES THE TEETH, JAW MUSCLES, JAW JOINTS, HEAD POSTURE, SWALLOWING VESTIBULAR FUNCTION, BREATHING, SLEEPING, PERIPHERAL NERVOUS SYSTEM AND THE CENTRAL NERVOUS SYSTEM. THE TRIGEMINAL NERVES AND TRIGEMINOVASCULAR SYSTEM ARE INTIMATELY INVOLVED NOT JUST IN TMJ DISORDERS BUT ALSO IN CHRONIC DAILY HEADACHE, TENSION-TYPE HEADACHE AND MIGRAINE.

I TREAT ALL OF THESE CONDITIONS IN MY GURNEE, IL OFFICE. I AM ALSO THE SECRETARY OF ICCMO AND THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.

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.

WHY IS NEUROMUSCULAR DENTISTRY SO SUCCESSFUL IN TREATING TMJ (TMD) DISORDERS AND HEADACHES. THE PRESENCE OF MYOFASCIAL PAIN IS THE LINK

TREATMENT OF TMD, TMJ DISORDERS, TENSION-TYPE HEADACHE AND MIGRAINE HAVE WIDE AREAS OF OVERLAP. THIS OVERLAP IS IN SYMPTOMS AND CAUSES BUT MYOFASCIAL TRIGGER POINTS ARE A MAJOR SOURCE OF PAIN.

NEUROMUSCULAR DENTISTRY IS VERY SUCCESSFUL AT TREATING TMJ, TMD AND MYOFASCIAL PAIN DISORDERS OF THE HEAD AND NECK. PATIENTS WHO DO NOT WANT LONG TERM DRUG THERAPY SHOULD CONSIDER THE NEUROMUSCULAR DENTISTRY APPROACH TO IMPROVING THE HEALTH OF THE MASTICATORY SYSTEM, RELIEVING CHRONIC MUSCLE PAIN AND MYOFASCIAL TRIGGER POINTS AND PREVENTING CENTRAL SENSITIZATION.

THE LITERATURE STRONGLY SUPPORTS THE ROLE OF MUSCLES IN CHRONIC PAIN. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS AN IDEAL FIRST STEP FOR LONG TERM TREATMENT OF TMJ (TMD) DISORDERS AND HEADACHES. NEUROMUSCULAR DENTISTS FREQUENTLY WORK IN CONJUNCTION WITH PHYSICAL THERAPISTS, CHIROPRACTERS, OSTEOPATHS AND MASSAGE THERAPISTS.

IMPROVING THE QULITY OF LIFE OF PATIENTS ARISING FROM MUSCULAR DISORDERS AND IDEALIZING HOMEOSTASIS ARE BASIC TO NEUROMUSCULAR DENTAL TREATMENT.

There are 576 scientific articles that come up on a PubMed search using key terms of Myofascial Pain and TMJ. 221 PubMed articles come up searching Myofascial pain and Headache, and 61 articles when searching Myofascial Pain and Migraine. There are another 80 articles that come up searching Myofascial Pain and Tension-type Headaches.

Myofascial Pain is a constant in these searches. Myofascial pain results from repetitive overuse syndromes and is commonly considered a major component of TMD.
Neuromuscular Dentistry is directed toward treating myofascial pain, muscle spasm and other muscular disorders of the masticatory system.

An article "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." published in Feb 2011 Clinical Journal of Pain (abstract below) found that " TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved."

Central facillitation is central to many theories on why some patients get chronic headaches and migraines. Another article, "Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache." in the Feb 2011 Journal of Headache Pain (abstract below) confirms that tension type headaches in children are associated with myofascial pain.

The article states that "TrPs (myofascial trigger points) were identified with palpation and considered active when local and referred pains reproduce headache pain attacks." and that "The total number of TrPs was significantly greater in children with CTTH (chronic tension type headache) as compared to healthy children"

More significantly it stated "Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack.

THIS MEANS THAT TRIGGER POINTS CAUSE TENSION TYPE HEADACHES IN CHILDREN, THE MORE TRIGGER POINTS THAT WERE PRESENT THE LONGER THE HEADACHES LASTED.

The study found a similar association with neck pain and trigger points " Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children."

Another 2011 article "The relationship of temporomandibular disorders with headaches: a retrospective analysis." (abstract below)found that "The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach."

THIS MEANS THAT HEADACHES, ESPECIALLY TENSION-TYPE HEADACHES ARE FREQUENTLY CAUSED ASSOCIATED WITH TMD OR TMJ DISORDERS.

ANOTHER STUDY FROM DECEMBER 2010 JOURNAL PAIN "Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain." SHOWED CORRELATIONS OF HEADACHE FREQUENCY TO TMD.

THEY CONCLUDED THAT "these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches."

THIS MEANS THAT THE CENTRAL SENSITIZATION FOUND IN HEADACHES, MIGRAINES AND FIBROMYALGIA ARE POSSIBLY DUE TO TMD.

THE ARTICLE "Pure tension-type headache versus tension-type headache in the migraineur." FROM Curr Pain Headache Rep. 2010 Dec;14(6):465-9. STATES THAT IT CAN BE DIFFICULT TO DIFFERENTIATE MIGRAINE, TENSION TYPE HEADACHES AND SYMPTOMS OF TMD ESPECIALLY IN THE CASE OF CHRONIC PAIN.








Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.

Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.

*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract

OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.

METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.

RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.

DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.

PMID: 21368664 [PubMed - as supplied by publisher]

J Headache Pain. 2011 Feb 27. [Epub ahead of print]
Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain, cesar.fernandez@urjc.es.
Abstract

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

PMID: 21359873 [PubMed - as supplied by publisher]

Agri. 2011 Jan;23(1):13-7.
The relationship of temporomandibular disorders with headaches: a retrospective analysis.

Cakır Özkan N, Ozkan F.

Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Abstract

Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.

PMID: 21341147 [PubMed - in process]

Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.

Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.

University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

PMID: 21196079 [PubMed - as supplied by publisher]

Curr Pain Headache Rep. 2010 Dec;14(6):465-9.
Pure tension-type headache versus tension-type headache in the migraineur.

Blumenfeld A, Schim J, Brower J.

The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract

Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.

PMID: 20878271 [PubMed - indexed for MEDLINE]

ICCMO: NEUROMUSCULAR DENTISTRY tREATMENT OF TMJ DISORDERS, HEADACHES AND MIGRAINES

ICCMO IS AN ACRONYM THAT STANDS FOR THE INTERNATIONAL COLLEGE OF CRANIOMANDIBULAR ORTHOPEDICS. WHEN LOOKING FOR A NEUROMUSCULAR DENTIST IT IS VITAL TO FIND A MEMBER OF ICCMO IF AT ALL POSSIBLE. WHILE THERE ARE OTHER GROUPS AND COURSES THAT BOTH TEACH AND UTILIZE NEUROMUSCULAR DENTISTRY TECHNIQUES ONLY ICCMO IS DEDICATED TO THE ADVANCEMENT OF NEUROMUSCULAR DENTISTRY AND THE RELATED PHYSIOLOGIC AND ANATOMIC RELATIONS TO THE WHOLE BODY.

BARNEY JANKELSOM THE FATHER OF NEUROMUSCULAR DENTISTRY FOUNDED ICCMO AS AN EDUCATIONAL GROUP DEDICATED TO THE ADVANCEMENT OF NEUROMUSCULAR DENTAL SCIENCE. iT WAS MY HONOR TO BE HIS STUDENT AND HE SPONSORED MY MEMBERSHIP TO ICCMO. I BECAME A FELLOW OF ICCMO AND I AM THE CURRENT SECRETARY OF ICCMO AS WELL AS THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.

ICCMO IS THE RECOGNIZED LEADER AND VOICE OF NEUROMUSCULAR DENTISTRY. iF HEADACHES, MIGRAINES, TMJ, TMD OR POSTURAL ISSUES ARE IMPORTANT ISSUES THAT YOU LOOKING TO HAVE TREATED I STRONGLY SUGGEST YOU FIND YOURSELF AN ICCMO NEUROMUSCULAR DENTIST WHO IS ACTIVE IN THE ORGANIZATION. BEWARE OF DOCTORS WHO ARE NOT NEUROMUSCULAR BURT MERELY PAY DUES TO ICCMO.