Migraines: Amazing Relief and Prevention with Spenopalatine Ganglion Blocks. The safest most effective treatment has minimal side effects and low cost.

This was originally released on 24/7 press release and released by media outlets across the country.

The Sphenoalatine Ganglioon block is considered both new and exciting and has been historically been shown to be highly effective.  Sometimes the best tratments get lost in press coverage of new rugs.  The pharmaceutical companies spend hundreds of millions of dollars to adLabelsvertise and market extremely expensive drugs but that does not mean they are nearly as effective as older less publicized treatments.

There is a historical record of over 100 years of safe and effective treatments utilizing SPG Blocks.

These simple effective blocks can be self administered for less than $1.00 /day and only are required on a periodic basis.  The side effects include decreased depression and anxiety among others.

Chicago, Highland Park, Northbrook, Lake Forest, Deerfield, Barrington and N orthern Illinois hheadache and migraine treatment with neuromuscular dentistry and SPG Blocks

Originally Published as 24/7 Press Release

Migraine Relief and Prevention: The Sphenopalatine Ganglion Block (SPG) This Amazing Treatment is Often Referred to as the Miracle Migraine Treatment. Doctors Learn Hands on Techniques at ICCMO

The SPG Block not only treats and prevents migraines and headaches but can be utilized to reduce blood pressure, treat anxiety and depression and many other symptoms of dysautonomia or autonomic neuropathy.throughout the body.

  CHICAGO, IL, October 10, 2015 /24-7PressRelease/ -- The Sphenopalatine Ganglion Block or SPG Block is an amazing treatment for a wide variety of disorders. It was made popular in the late 1980's by the popular book "Miracles on Park Avenue" discussing a New York Otolaryngologist who utilized the SPG Block to treat thousands of patients

The Sphenopalatine Ganglion is the largest Parasympathetic Ganglia of the head and is also called the pterygopalatine ganglion, Meckel's Ganglion and the nasal ganglion. 

Most physicians and dentists are not aware of this procedure despite it being incredibly successful in treating vascular and neurogenic headaches, facial pain, TMJ Disorders, sinus pain and a wide variety of other problems.

Historically, the block was given by injections.. The intraoral injection is commonly used by dentists and oral surgeons for maxillary anaesthesia and the blocking of the SPG is done as part of normal dental procedures.

The extra-oral approach is the most effective and can often almost instantly give relief to cluster headaches and chronic daily headache. Te most common approach is to access the ganglion by an intranasal approach. There are three new devices that are being made to deliver Sphenopalatine Ganglion Blocks, the Sphenocath, the TX360 and the Allevio. All three are essential high tech squirt guns that deliver anesthetic thru the nose to the mucosa covering the ganglion.

Dr Ira L Shapira has been utilizing and teaching the use of Sphenopalatine Ganglion Blocks for many years. Dr Shapira is a Diplomate of the American Academy of Pain Management and routinely utilizes the technique in his Highland Park and Gurnee offices. 

While he frequently utilizes injection techniques for relief of severe pain he prefers to teach patients how to self administer SPG Blocks in the comfort of home. This procedure is relatively easy for most patients with patent nasal access. Patients can self administer the SPG Block at the first sign of a problem or use them prophylactically to prevent problems.

The blocks are not only safe and effective but they are extremely cost effective when self administered. The Tx360 migraine protocol is a series of ten bilateral treatments at a total cost of approximately$7500. The cost of bilateral block with cotton swabs is less than $700 for initial treatment but under a dollar a day for patients to self administer. 

According to Dr Shapira it is all about improving the quality of his patients lives and "quality of life sucks when you are sitting in the doctors office". Dr Shapira wants his patients to be in control of their pain relief. The use of cotton tipped applicators to perform SPG Blocks has been used for mant years and actually has many advantages for patients. 

ICCMO, the International College of CranioMandibular Orthopedics (iccmo.org) had its annual North American meeting October 1-4 in San Diego. Dr Shapira gave two lectures, the first on the common developmental pathways of Migraine, Chronic Daily Headache, Sleep Apnea, TMJ Disorders and ADHD. The second was a hands on course to teach dentists both injection techniques for the SPG Block as well as hands on experience with SphenoCath device and intranasal swabs.

One woman dentist experience total relief of a two day migraine within minutes of her SPG block.

Patients wth Migraines, Chronic Daily Headaches, TMJ Disorders and other problems can look to the dentists at ICCMO as the experts in the physiology and neurology or the trigeminal nervous system. They utilize neuromuscular dentistry to create healthier and physiologically stable cases.
The SPG Block is one tool that they utilize in treating patients. Visit their website at:http://occlusiontmjauthority.com/

Additional information on SPG Blocks can be found at www.ThinkBetterLife.com. There are numerous patient video testimonials.

more information is available at Sleep and Health Journal.
http://www.sleepandhealth.com/node/689
http://www.sleepandhealth.com/node/663

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. ICCMO the International College of Cranio mandibular Orthopedics was founded by Dr Jankelson and it carries on his dedication to excellence in science and the highest level of patient treatment.

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.

Understanding CGRP and Why Neuromuscular Dentistry Relieves and Eliminates Migraines

Calcitonin gene-related peptide is the new target for the Pharmaceutical industry for treating Migraines!  

At least three companies are currently investigating drugs to block CGRP according to: Bloomberg July 21, 2015 in an article by David Wainer titled "The Pharma Industry Thinks It Finally Has A Fix For Migraines"

According to Bloomberg, "Amgen, Alder, Lilly and Teva are developing drugs aimed at erasing those episodes entirely -- at least in some patients -- by blocking CGRPs, or calcitonin gene-related peptides, which play a role in inflammation and transmission of pain.

The Calcitonin Gene-Related Peptide is probably the same mechanism that allows Neuromuscular Dentistry to alleviate and eliminate migraines and chronic daily headaches.  CGRP is produced by the Trigemino-Vascular System in the cell bodies of trigeminal nerves located with the Trigeminal Ganglion.  This is the primary source of CRGP related to headaches.

The way Neuromuscular Dentistry affects CGRP is by removing nociceptive input to the CNS, particularly into the Trigeminal Nervous System and negating the production of CGRP.

CGRP is a potent vasodilator and works by the Trigeminal Nervous system control of blood flow to the anterior two thirds of the meninges of the brain.  This is a primary proposed mechanism in Migraine and other neurovascular pain conditions.

The drug companies want to block CGRP's that play a significant role in inflammation and transmission of pain.    They also want to partake in the estimated 8 billion dollars or more that the migraine market can generate.

According to Wikipedia:

• "In the spinal cord, the function and expression of CGRP may differ depending on the location of synthesis. CGRP is derived mainly from the cell bodies of motor neurons when synthesized in the ventral horn of the spinal cord and may contribute to the regeneration of nervous tissue after injury. Conversely, CGRP is derived from dorsal root ganglion when synthesized in the dorsal horn of the spinal cord and may be linked to the transmission of pain."

If the drug companies treat with CGRP blocking agents will this adversely interfere with healing or could it contribute to Dementia, Alzheimers or other neurological problems.  

Correcting CGRP by changing neural input into the Trigeminal Nervous System via neuromuscular dentistry is probably the safest, most physiologic and efficient means of reducing or eliminating migraines thru reduction in CGRP Levels.

Unfortunately for Migraine patients the value of treatment with drugs is 8 Billion dollars so all research is directed toward the largest financial returns.  Effective and safe migraine alleviation and elimination with SPG Blocks and Neuromuscular Dentistry receive minimal funding for studies in spite of effectiveness.

Warnings on NSAIDS: Ibuprofen, Advil, Alieve, Motrin and similar drugs.

This post from the American Headache Society makes a case for alternative treatments for Headaches including SPG Blocks and Neuromuscular Dentistry.

Just taking non-steroidals drugs for pain may be ok but read this new warning from the American Headache Society:

American Headache Society Wants Patients, Physicians to Know About New FDA Warning on NSAIDs About Heart Attack and Stroke Risk

July 16, 2015 12:00 PM (not rated)

For Immediate Release

AMERICAN HEADACHE SOCIETY WANTS PATIENTS, PHYSICIANS TO KNOW ABOUT NEW FDA WARNING ON NSAIDS ABOUT HEART ATTACK AND STROKE RISK

People Taking These Anti-inflammatory Drugs Should Speak With Their Physician; When Prescribed, Low Dose and Short Duration Recommended

MOUNT ROYAL, NJ (July 16, 2015)– The American Headache Society wants people with migraine and other headache disorders, as well as their physicians, to know that the U.S. Food & Drug Administration (FDA) has issued a new warning about possible heart attack and stroke risk for people taking nonsteroidal anti-inflammatory drugs (NSAIDs). The FDA has identified an elevated risk, even for those who have no known heart disease or stroke risk factors. The FDA will require manufacturers to include information in their drug packaging that discusses these risks. The warning covers popular over-the-counter NSAIDs such as Advil®, Motrin® and Aleve®, as well as prescription medications. The new warning does not apply to aspirin, which is a different type of NSAID.

            "Physicians should prescribe NSAIDs with caution, and consider other treatment options, especially for longer term treatment," said Lawrence C. Newman, MD, FAHS, President of the American Headache Society and Director of the Headache Institute at Mount Sinai-Roosevelt Hospital (New York City). "If NSAIDs must be used, it would be prudent to give the lowest possible dose for the shortest period of time."

            According to the FDA, heart attack or stroke risk can occur as early as a few weeks after beginning NSAIDs, and longer use may further increase risk.  Use of NSAIDs after a heart attack raises risk of death within the first year.  The use of NSAIDs also increases the chances of developing heart failure.  It is unknown if some NSAIDs are riskier than others.

"Many people with migraine and headache take NSAIDs on a daily or occasional basis," added Dr. Newman. "The take home for patients is to become educated about this new warning, and speak with their doctor. They should also reduce their controllable heart attack and stroke risk factors by not smoking, keeping their weight within normal limits, avoiding excess alcohol intake and working with their physician to keep cholesterol, blood pressure and diabetes under control."

            The FDA has stated that the risk of heart attack or stroke for those taking NSAIDs is even greater than originally thought when it was first identified in 2005.   

            People taking NSAIDs should be aware of symptoms of heart attack and stroke, and seek immediate medical attention if any of these are present:

· Chest pain

· Shortness of breath

· Difficulty breathing

· Weakness on one side of the body

· Slurred speech

For more information, go to http://www.americanmigrainefoundation.org/fda-see​s-stronger-link-between-popular-pain-meds-and-heart-attack-or-stroke/ or http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm

ABOUT MIGRAINE: Some 36 million Americans live with migraine, more than have asthma and diabetes combined. An estimated three to seven million Americans live with chronic migraine, a highly disabling neurological disorder. Migraine can be extremely disabling and costly, accounting for more than $20 billion in direct (e.g. doctor visits, medications) and indirect (e.g. missed work, lost productivity) expenses each year in the United States.

ABOUT THE AMERICAN HEADACHE SOCIETY: The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting, a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, and publication of the journal Headache.  www.americanheadachesociety.org

SEVERE HEADACHES, MIGRAINES, FACIAL PAIN or TMD RELIEF : DR SHAPIRA CAN ARRANGE THREE DAY EVALUATION AND TREATMENT APPOINTMENT IN HIS OFFICE.

DON'T KNOW WHERE TO GO FOR PAIN RELIEF?

I frequently receive requests for referrals from across the country for patients with severe pain problems. While I usually try to find a Neuromuscular Dentist close to where you live some patients need more a very experienced practioner. I have been treating chronic pain for over 34 years since graduating dental school. While in school I was a pain patient and often experienced severe headaches and facial pain that even excessive doses of Fiorinal #3 did not touch.

Some patients who have been in severe pain want relief as soon as possible and I understand wanting to experience relief as soon as possible. A "JUMP START" appointment in my office is possible. My team can arrange a 3 day visit where we start with diagnostics on the first morning and deliver a neuromuscular orthotic in the afternoon. We can utilize SPG blocks, trigger point injections and other modalities to achieve rapid results.

I work with Dr Mark Freund who can arrange for an Atlas Axis evaluation and do Atlas-Orthogonol adjustments, if indicated.

Prior to making an appointment I require that patients submit an extensive history as well as fill out some forms.

I like patients to give me a complete history of their pain, what age it started, any history of trauma and/or surgical proceedures as well as a list of previous treatments, length of treatment and success of treatment. I will personally review this information before you are accepted as a patient. I see a maximum of two patients/month for "JUMP START" treatment due to time and scheduling constraints.

My team will arrange for a convenient hotel near the office. This is the same hotel I use for doctors and their teams when I give course. My patients fly in Sunday I meet with them at 8 AM and do an exam followed by a neuromuscular work-up. This takes approximately 4 hours. I then customize a Diagnostic Neuromuscular Orthotic in the afternoon.

I clearly want all patients to understand that there are no guarantees of success.

If we are successful in eliminating or relieving your pain and dysfunction significantly and you believe that you are substantially improved we will schedule ongoing visits as needed. The Diagnostic Orthotic is for initial treatment, healing and short-term stabilization. Long term stabilization is frequently required and can take many different forms. These alternatives will be discussed but may take many forms such as long-term orthotics, orthodontics, reconstruction, surgery. Each patient is unique so your treatment will be customized for you.

Can Dentists Prevent Migraines? The Answer Is Yes According To New Research Out Of Germany.

The Journal of Neuroscience (J Neurosci. 2011 Feb 9;31(6):1937-43) recently published an article titled "Trigeminal nociceptive transmission in migraineurs predicts migraine attacks"

I have long advocated that the majority of Migraines and Tension-Type headaches are actually input-output errors. Nociceptive information entering the Trigeminovascular system are the pathology that triggers migraines and other headaches.

This study looked at fMRI or functional MRI studies of the brain.

They found that predicting migraine by trigeminal nociceptive activity could predict migraines.

Whers does most nociceptive trigeminal input arise?

In the Jaw Muscles, Muscle Spindles, Golgi Tendon Organs and periodontal ligaments of the teeth.

Neuromuscular Dentistry is very effective in eliminating and preventing migraines and muscular tension-type headaches. The majority of "sinus headaches" are actually referred muscle pain. The reason for the success of Neuromuscular Dentistry is the ability to eliminate nociceptive input.

Input/output errors are often described in computer lingo as Garbage In / Garbage Out.

The neurofeedback loops from periodontal ligaments , muscles, muscle spindles etc send nociceptive input (ie Garbage in) into the trigeminovascular system.

Migraines and other headaches are the "Garbage Out " part of the equation.
The article states that:
"Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event."

Another article in Neurology. 2011 Jan 18;76(3):206-7 states "Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other."

The photophobia or sensitivity to light during a migraine attack is also due, in part to trigeminal nociception (Garbage in. The nociceptive input from the teeth,jaws, periodontal ligaments are the "garbage in" and the migraines and photophobia are the Garbage out".

Experimental studies on rats "J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain." confirm the effect of trigeminanl nociception on meningeal migraines. The Trigeminovascular system is always paramount in migraine. The Trigeminal nerve controls the blood flow to the anterior 2/3 of the meninges of the brain.

Primary Stabbing Headaches are also trigeminally innervated as reported in"
J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic." The article states that "Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve." The trigeminal nerve you will remember is the Dentist's nerve.


PubMed Abstract below:

J Neurosci. 2011 Feb 9;31(6):1937-43.
Trigeminal nociceptive transmission in migraineurs predicts migraine attacks.

Stankewitz A, Aderjan D, Eippert F, May A.

Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany.
Abstract

Several lines of evidence suggest a major role of the trigeminovascular system in the pathogenesis of migraine. Using functional magnetic resonance imaging (fMRI), we compared brain responses during trigeminal pain processing in migraine patients with those of healthy control subjects. The main finding is that the activity of the spinal trigeminal nuclei in response to nociceptive stimulation showed a cycling behavior over the migraine interval. Although interictal (i.e., outside of attack) migraine patients revealed lower activations in the spinal trigeminal nuclei compared with controls, preictal (i.e., shortly before attack) patients showed activity similar to controls, which demonstrates that the trigeminal activation level increases over the pain-free migraine interval. Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event.

PMID: 21307231 [PubMed - indexed for MEDLINE]


Neurology. 2011 Jan 18;76(3):213-8. Epub 2010 Dec 9.
A PET study of photophobia during spontaneous migraine attacks.

Denuelle M, Boulloche N, Payoux P, Fabre N, Trotter Y, Géraud G.

Service de Neurologie et Explorations Fonctionnelles du Système Nerveux, CHU Rangueil, Toulouse, France. denuelle.m@chu-toulouse.fr

Comment in:

* Neurology. 2011 Jan 18;76(3):206-7.

Abstract

BACKGROUND: Photophobia is an abnormal sensitivity to light experienced by migraineurs during attacks. The pathophysiology of photophobia is poorly understood. Nevertheless, 2 facts appear to have a link with photophobia: visual cortex hyperexcitability on the one hand and interactions between visual pathway and trigeminal nociception on the other.

METHODS: We used H(2)(15)O PET to study photophobia induced by continuous luminous stimulation covering the whole visual field in 8 migraineurs during spontaneous migraine attacks, after headache relief by sumatriptan and during attack-free interval. The intensity of the luminous stimulation provoking photophobia with subsequent headache enhancement was specifically determined for each patient.

RESULTS: We found that low luminous stimulation (median of 240 Cd/m(2)) activated the visual cortex during migraine attacks and after headache relief but not during the attack-free interval. The visual cortex activation was statistically stronger during migraine headache than after pain relief.

CONCLUSION: These findings suggest that ictal photophobia is linked with a visual cortex hyperexcitability. The mechanism of this cortical hyperexcitability could not be explained only by trigeminal nociception because it persisted after headache relief. We hypothesize that modulation of cortical excitability during migraine attack could be under brainstem nuclei control.

PMID: 21148120 [PubMed - indexed for MEDLINE]

J Neurosci. 2010 Oct 27;30(43):14420-9.
Changes of meningeal excitability mediated by corticotrigeminal networks: a link for the endogenous modulation of migraine pain.

Noseda R, Constandil L, Bourgeais L, Chalus M, Villanueva L.

Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Abstract

Alterations in cortical excitability are implicated in the pathophysiology of migraine. However, the relationship between cortical spreading depression (CSD) and headache has not been fully elucidated. We aimed to identify the corticofugal networks that directly influence meningeal nociception in the brainstem trigeminocervical complex (Sp5C) of the rat. Cortical areas projecting to the brainstem were first identified by retrograde tracing from Sp5C areas that receive direct meningeal inputs. Anterograde tracers were then injected into these cortical areas to determine the precise pattern of descending axonal terminal fields in the Sp5C. Descending cortical projections to brainstem areas innervated by the ophthalmic branch of the trigeminal nerve originate contralaterally from insular (Ins) and primary somatosensory (S1) cortices and terminate in laminae I-II and III-V of the Sp5C, respectively. In another set of experiments, electrophysiological recordings were simultaneously performed in Ins, S1 or primary visual cortex (V1), and Sp5C neurons. KCl was microinjected into such cortical areas to test the effects of CSD on meningeal nociception. CSD initiated in Ins and S1 induced facilitation and inhibition of meningeal-evoked responses, respectively. CSD triggered in V1 affects differently Ins and S1 cortices, enhancing or inhibiting meningeal-evoked responses of Sp5C, without affecting cutaneous-evoked nociceptive responses. Our data suggest that "top-down" influences from lateralized areas within Ins and S1 selectively affect interoceptive (meningeal) over exteroceptive (cutaneous) nociceptive inputs onto Sp5C. Such corticofugal influences could contribute to the development of migraine pain in terms of both topographic localization and pain tuning during an attack.

J Headache Pain. 2011 Jan 6. [Epub ahead of print]
Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic.

Guerrero AL, Herrero S, Peñas ML, Cortijo E, Rojo E, Mulero P, Fernández R.

Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005, Valladolid, Spain, gueneurol@gmail.com.
Abstract

Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve. Population studies have shown that PSH is a common headache. However, most people suffer attacks of low frequency or intensity and seldom seek for medical assistance. There are few clinic-based studies of PSH, and its real influence as a primary cause for referral to neurology outpatient offices is to be determined. We aim to investigate the burden of PSH as main complaint in an outpatient headache clinic. We reviewed all patients with PSH (ICHD-II criteria), attended in an outpatient headache clinic in a tertiary hospital during a 2.5-year period (January 2008-June 2010). We considered demographic and nosological characteristics and if PSH was main cause of submission. 36 patients (26 females, 10 males) out of 725 (5%) were diagnosed of PSH. Mean age at onset 34.1 ± 2.9 years (range 10-72). Mean time from onset to diagnosis 68.8 ± 18.3 months. Twenty-four patients fulfilled ICHD-II criteria for other headaches (14 migraine, 6 tension-type headache, 2 hemicrania continua, 1 primary cough headache and 1 primary exertional headache). 77.7% of patients were submitted from primary care. In 14 patients (39%), PSH was main reason for submission, its intensity or frequency in 5 (35.7%) and fear of malignancy in 9 (74.3%). Only two patients of those who associated other headaches were submitted due to PSH. In conclusion, PSH is not an uncommon diagnosis in an outpatient headache office. However, and according to our data, it is not usually the main cause of submission to a headache clinic.

PMID: 21210176 [PubMed - as supplied by publisher]

CENTRAL SENSITIZATION AND TMD: THE CONNECTION TO MYOFASCIAL PAIN, FIBROMYALGIA, HEADACHE, MIGRAINE AND RELATED DISORDERS.

I have frequently discussed the relation between headache, TMD and central sensitization. The trigeminal nerve is a frequent culprit in development of central sensitization which is why neuromuscular dentistry can be such an effective treatment. Decreases in nociceptive input from the trigeminal nerve can allow reversal of a sensitized state.

A new article in Pain "Pain." 2010 Oct 18. "Central sensitization: Implications for the diagnosis and treatment of pain." documents much of what we understand about central sensitization. These heightened central states are caused by noxious or nociceptive input into the brain. The trigeminal nerve carries a tremendous amount of information (nociception) into the CNS.

A recent article "Chronic Orofacial pain" proposes that "we propose the concept that because COFP and headaches share underlying pathophysiological mechanisms, clinical characteristics, and neurovascular anatomy, they should be classified together." This would be obvious to anyone who evaluates the anatomy and physiology of the brain and especially the stomatognathic system including the jaw muscles, teeth and periodontal ligaments. jaw joints and most importantly the trigeminal nerve. The trigeminal nerve is almost always indicated as a culprit or co-conspirator in chronic and episodic facial pain and headache .

The use of botox on jaw muscles to treat chronic headaches and migraines actually reduces nociceptive input to the trigeminal nerve from and brain from peripheral input. Neuromuscular dentistry also reduces nociceptive input withput the use of toxic nerve agents but utilizing antidromic TENS to relax muscles and establisha healthy physiologic rest position with minimal nociceptive input. Neuromuscular occlusion is simply a physiologic land spot that allows the muscle to return to a health rest position after function.

The computer adage "Garbage in- Garbage out" is what happens when nociceptive input to the brain exceeds our ability to comfortably adapt causing pain and central sensitization. Reduce the "garbage in" with neuromuscula dental techniques and the "garbage out" painful sequellae subside.

Curr Pain Headache Rep. 2010 Feb;14(1):33-40.
Chronic orofacial pain.
Benoliel R, Sharav Y.

Faculty of Dentistry, Department of Oral Medicine, Hebrew University-Hadassah, Jerusalem, Israel. benoliel@cc.huji.ac.il
Abstract
Chronic orofacial pain (COFP) is an umbrella term used to describe painful regional syndromes with a chronic, unremitting pattern. This is a convenience term, similar to chronic daily headaches, but is of clinically questionable significance: syndromes that make up COFP require individually tailored diagnostic approaches and treatment. Herein we describe the three main categories of COFP: musculoskeletal, neurovascular, and neuropathic. For many years, COFP and headache have been looked upon as discrete entities. However, we propose the concept that because COFP and headaches share underlying pathophysiological mechanisms, clinical characteristics, and neurovascular anatomy, they should be classified together.

PMID: 20425212 [PubMed - indexed for MEDLINE]

Migraine is Most Common Primary Headache in Patients with Temporomandibular Disorders

A recent article in the Journal of Orofacial Pain identifies Migraine as the most frequent primary headache in patients with temporomandibular disorders. The majority of migraines are actually trigeminally moderated and it is no surprise that they would be common. Tension type headaches were the second most common headache. Headaches occured in 45.6 % of control group and 85.5 % of TMD group.

Patients with chronic migraines and tension headaches who are looking for relief should consider the utilization of neuromuscular dentistry.

A neuromuscular diagnostic orthotic is the first step in changing the quality of life. It is a well established fact that the trigeminal nerves are an integral part of most chronic migraine and tension headaches. Neuromuscular dentistry is probably the best approach to correcting the physiologic causes of migraine. Aitional information on the treatment of TMJ disorders and chronic headaches utilizing neuromuscular dentistry cn be found in Sleep and Health Journal.



J Orofac Pain. 2010 Summer;24(3):287-92.
Migraine is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders.
Franco AL, Goncalves DA, Castanharo SM, Speciali JG, Bigal ME, Camparis CM.

Abstract
Aims: To assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD. Methods: The sample consisted of 158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls. The Research Diagnostic Criteria for TMD were used to diagnose the TMD patients. HAs were assessed using a structured interview and classified according to the Second Edition of the International Classification for Headache Disorders. Data were analyzed by chi-square tests with a significance level of 5% and odds ratio (OR) tests with a 95% confidence interval (CI). Results: HAs occurred in 45.6% of the control group (30.9% had migraine and 14.7% had tension-type headache [TTH]) and in 85.5% of individuals with TMD. Among individuals with TMD, migraine was the most prevalent primary HA (55.3%), followed by TTH (30.2%); 14.5% had no HA. In contrast to controls, the odds ratio (OR) for HA in those with TMD was 7.05 (95% confidence interval [CI] = 3.65-13.61; P = .000), for migraine, the OR was 2.76 (95% CI = 1.50-5.06; P = .001), and for TTH, the OR was 2.51 (95% CI = 1.18-5.35; P = .014). Myofascial pain/arthralgia was the most common TMD diagnosis (53.2%). The presence of HA or specific HAs was not associated with the time since the onset of TMD (P = .714). However, migraine frequency was positively associated with TMD pain severity (P = .000). Conclusion: TMD was associated with increased primary HA prevalence rates. Migraine was the most common primary HA diagnosis in individuals with TMD. J Orofac Pain 2010;24:287-292.

PMID: 20664830 [PubMed - in process]