Cervicogenic Headaches, TMJ, TMD, and the Trigeminocervical System. Treatment should include trigger point injections and greater occipital blocks.

Headaches and TMJ disorders usually have multiple symptoms. According to an article in Nov 2011 Neurologist these include the following symptoms: complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain.

I firmly believe that the autonomic symptoms ot temporomandibular disorders must be addressed. A neuromuscular orthotic can alleviate many of the symptoms but SPG blocks, greater occipital blocks and trigger point injections are frequently required for more effective treatment. All of these treatments are minimally ivasive and safer and more effective than use of tiptans or topomax.

The abstract reported the following results:

Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).

Neurologist. 2011 Nov;17(6):312-7.

Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache.

Baron EP, Cherian N, Tepper SJ.

Source

Department of Neurology, Cleveland Clinic Neurological Institute, Center for Headache and Pain, Cleveland, OH.

Abstract

BACKGROUND:

: The trigeminocervical system is integral in cervicogenic headache. Cervicogenic headache frequently coexists with complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain. Controversy exists as to whether this constellation of symptoms may be cervically mediated.

OBJECTIVES:

: To determine whether a wider spectrum of cervically mediated symptoms exist, and to investigate a potential role of greater occipital nerve blocks (GON) and trigger point injections (TPI) in these patients.

METHODS:

: Retrospective review of GON/TPI performed in a tertiary otoneurology/headache clinic from May 2006 to March 2007 for suspected cervically mediated symptoms. Data included chief complaint, secondary symptoms, response to injection, pre-GON/TPI posterior vertex sensation changes to pinprick, cervical spine examination, and response to vibration of cervical and suboccipital musculature.

RESULTS:

: Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).

CONCLUSIONS:

: A wider spectrum of cervically mediated symptoms may exist by influence of trigeminocervical and vestibular circuitry through cervical afferent neuromodulation. Certain examination findings may help to predict benefit from GON/TPI.

Migraines and Vomiting for 15 Years. Neuromuscular Dentistry and SPG Blocks May Resolve Symptoms.

Anne: I've been getting migraine headaches for the past 15 or so years. I always have terrible nausea and vomiting. I have tried many many different things with no luck. I had a migraine yesterday where I vomited non-stop for 12+ hours. The migraines are typically on the right side behind my eye but this time I also noticed pain in my upper jaw.

Dr Shapira response:

Dear Anne,

A diagnostic neuromuscular orthotic can often give dramtic results in lowering the frequency and severity of migraine attacks (and associated nausea) and is especially helpful with tension-type headaches and referred muscle headaches. The muscular headaches are frequently the trigger for the migraines. The nausea is a secondary autonomic effect. The trigeminal nerve (or dentists nerve) is involved in almost all migraines and other types of headache. It is also associate with autonomic symptoms. An SPG block can sometimes offer amazing relief. There is an out of print book "Miracles on Park Avenue" that discusses some of the benefits of SPG blocks.

An Spenopalatine Ganglion Block can be done at the first sign of a headache and prevent a full attack. I usually teach my patients this easy technique.

I do see long distance patients, but I like a complete history and phone interview before scheduling. I usually will have patients come in Sunday and I see them Monday AM and PM, Tuesday AM and PM and Wednesday morning for their first set of appointments. Call my office if you would like me to see you at 847-623-5530.

A neuromuscular work-up will usually show the problems and allow for correction but their may be other factors besides the jaws, jaw muscles, jaw joints, posture and trigeminal nerves. Allergies or chemical triggers can still serve as headache triggers.