Can Neuromuscular Dentistry Treatment Prevent and Eliminate Migraines, Cluster Headaches and Chronic Daily Headaches

There is big money in the treatment of migraines.  Can Neuromuscular Dentistry prevent migraines better than drug therapy?

Learn more at www.IHateHeadaches.org   www.ThinkBetterLife.com

 According to the Tevapharm.com website Teva and Hepartes entered in an agreement to discover and develop novel, small-molecule CGRP Antagonists for treatment of migraine.  Hepartes may receive potential payments of $400 million.  This is excellent news because much of the current drug regimens have safety and effectiveness issues.

Is there a better alternative to CGRP Antagonists for migraine?  It is important to understand the underlying physiology of headache and migraine when considering this question.

Calcitonin gene-related peptide is a vaso-active neuropeptide released by branches of the Trigemino-vascular system of the Trigeminal Nerve.  CGRP and other neurotransmitters released at nerve synapses have been implicated in migraine headaches. 

Drug therapy for migraines are big business worldwide.  The question is there a better method of preventing and eliminating migraines available.

It is unlikely that funding to evaluate neuromuscular dentistry as migraine prevention will ever materialize.  This is in spite of the fact that it is well established that almost 100% of all headaches and migraines (including Trigeminal Autonomic cephalgias) are Trigeminally controlled.

The Trigeminal Nerve is often called the Dentist's nerve because it innervates the teeth (ie. dental pulp), the Periodontal Ligaments, the Jaw Muscles, the Jaw Joints, the anterior two thirds of the tongue, the tensor of the ear drum, the tensor of soft palate (opens and closes eustacian tubes).

The Trigemino-Cervical Complex descends cervically and connects to the sympathetic chain and is responsible for neck and occipital headaches.

The TrigeminoVascular System controls blood flow to the anterior two thirds of the meninges of the brai.  It is in this location that CGRP are released causing vaso dilation asociated with migraines.

The question is not can these drugs work but rather is it possible to prevent the release of the vasoactive neuropeptides by changing input to the trigeminal nervous system?

After accounting for amplification in the Reticular Activating System the Trigeminal Nervous System accounts for more that half of all input to the brain.

If we think of the brain as our central computer we can discuss the computer concept

GARBAGE IN- GARBAGE OUT  as a cause of all migraines and headaches.

Noxious input to the Trigeminal Nervous System causes release of neurotransmitters and vaso-active neuropeptides to the meninges of the brain  that are trigeminally innervated.

Can changing input correct migraine physiology.  The Sphenopalatine Ganglion (SPG) is the Largest Parasympathetic Ganglion of the head.  The SPG Block is extremely effective is stopping and preventing migraines and since it is generally done with lidocaine it is very safe.

Trigeminal fibers pass thru the Ganglion but do not have cell bodies there.  There are currently numerous implantable devices being studied that can change neural input to the Sphenopalatine Ganglion and treat Migraines, Cluster Headaches, Anxiety, Depression and many other disorders.  The block turns of the sympathetic overload of the fight or flight response.  In the parasympathetic mode we feel relaxation, safety, satiety, sexual,  loving, etc

This is proof of fact that changing neural input can treat, prevent and eliminate migraines and other headaches.

Neuromuscular Dentistry also has been shown to be very effective in treating patients with chronic headaches and migraines.  Unfortunately thousands of individual case studies do not carry the same evidence based medicine weight of double blind drug studies.  By its nature it is not possible to do double blind studies with neuromuscular Dentistry.......

There is a situation that clearly showed  the effectiveness of a Neuromuscular TMJ treatment program at Chicago HMO in the 1980's until 1993.

In the 1980's until 1993 I worked closely with Dr Mitchell Trubitt the Medical Director of Chicago HMO.  What started as a fight for insurance coverage for a single patient moved on to a test with six patients to see if Neuromuscular Dentistry could lead to cost savings for insurance compaines.  The initial test was six patients who were treated with neuromuscular orthotics for their TMJ and Headache problems.   All six patients had two surgical opinions stating TMJoint surgery was needed.  All six patients were treated without surgery.  The patients all reported being very happy with results that included relief of headaches and migraines.

The results were that we demonstrated estimated massive savings $250,000 on  just those six patients.  Because of the positive results of that test Chicago HMO began to cove 100% of the cost of Phase one Neuromuscular TMJ treatment .  These savings reflected hospitalization and surgery costs, surgical fees, anaesthesia and physical therapy.  Chicago HMO did not cover phase two treatment so all patients were fitted with appliances made on vitallium frameworks to prevent breakage.  Patients desiring orthodontics or crowns were not reimbursed by medical insurance.

Chicago HMO did not decide to cover  TMJ, disorders, in fact contract language specifically stated non-surgical treatment of TMJ problems were not covered.  In spite of that language Dr Trubitt authorized coverage due to cost savings.  Chicago HMO doctors who referred patients for non-surgical treatment actually were charged less for out of network referrals.  TMJ was given the same cost for referring physicians as Cancer and Heart Disease.

Patients not only experienced improvements in TMJ disorders but also reduction and elimination of headaches and migraines.  TMJ has been called "The Great Imposter" because so many diverse ymptoms are associated with it.  At the time Chicago HMO had no means of tracking drug savings nor did they consider costs of other related disorders.

When insurance coverage and out of pocket costs were taken out of the picture with a guarantee payment we were no longer in a pay per procedure mode but a global fee.  Trigger point injections, SPG Blocks and other procedures were used without additional costs leading to rapid patient improvement.

While there were no patient complaints during the program there were several complaints from oral surgeons objecting to a general dentist seeing patients for non-surgical treatment on patients they deemed surgery necessary.

In 1993 United Health Care bought out Chicago HMO (parent HMO America) and the program ended abruptly even though it had demonstrated significant savings over several years.

I met with the new medical director along with Dr Trubitt in an attempt to keep this very successful treatment and cost containment program going but was told that since United Health Care didn't pay for surgery they would save money treating TMJ non-surgically.

Four years after this experience The Shimshak article was  published that showed that patients carrying a TMJD diagnosis had a 200% increase in total medical expenses.  Shimshak stated "The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories."  (Pubmed abstract below)

One year later a follow-up study showed that the increased costs were actually 300% over patients not carrying TMJ diagnosis.  Shimshak stated "For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects." (pubmed abstract below)

Cranio. 1997 Apr;15(2):150-8.

Medical claims profiles of subjects with temporomandibular joint disorders.

Shimshak DG1, Kent RL, DeFuria M.

Author information

Abstract

The primary goal of this study was to evaluate the claims profiles of subjects with TMJ disorders relative to a control group without the disorders and to provide a characterization of the type of healthcare services received and the associated costs of healthcare for patients with TMJ disorders. The administrative data base of a major medical insurer was used to compare the claims history of 1,819 patients diagnosed with TMJ disorders to matched controls. The analysis was based only on medical claims. The study found that total medical claim payments for the patients with TMJ disorders were double that of the subjects without TMJ disorders, and similarly, the utilization of institutional and professional care services was found to be approximately twice as high, though not uniformly distributed across all Major Diagnostic Categories, physician specialties or types of service. The level and nature of the differences in the quantity and costs of healthcare between subjects with and without TMJ disorders were unexpectedly large. The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories.

Cranio. 1998 Jul;16(3):185-93.

Health care utilization by patients with temporomandibular joint disorders.

Shimshak DG1, DeFuria MC.

Author information

Abstract

The claims data base of a large New England managed care organization was used to compare the health care utilization patterns of patients with TMJ disorders to non-TMJ subjects. Inpatient, outpatient and psychiatric claims data were examined over a wide range of diagnostic categories. Age and sex adjusted results showed that, overall, patients with TMJ disorders were greater utilizers of health care services and had higher associated costs than non-TMJ subjects. For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects.

Learn more at www.IHateHeadaches.org   www.ThinkBetterLife.com

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.

TMJ Treatment, Sleep Apnea Treatment, ADHD Prevention and Improving People's Lives: A Message of Hope

Originally printed Highland Park Landmark

By Alan P. Henry

"Highland Park dentist Dr. Ira Shapira has a message for anyone suffering from TMJ disorders including migraines or for those looking for a way to deal with issues related to sleep apnea and snoring, including but not limited to ADD and ADHD.

“I want people out there who have problems and feel like there is no hope to know there is hope,” he said.

Dr. Shapira, a resident of Highland Park for 34 years and practicing dentist for almost four decades, has just opened an office at 3500 Western Ave. in Highland Park. Unlike his general dental practice in Gurnee, this office serves as a resource for people suffering chronic pain.

“I love changing people’s lives,” he said. “You have someone who has chronic pain, when you take away their headaches and their face pain, to me this is the most rewarding part of anything I do.”

Dr. Shapira’s approaches to headache treatment are not unique, but neither are they universal. Most doctors treating headaches are physicians or neurologists, he said, and if after tests they see no obvious issues involving the brain or tumors, they typically “make the assumption that it is a chemical problem” and turn to drugs to treat the problem.

But according to Dr. Shapira, the origin of most headaches is the trigeminal nerve, a nerve that is responsible for sensation in the face and motor functions such as biting and chewing, and it is from that direction that treatment is best directed.

He founded www.Ihateheadaches.org, an online resource designed to help people find ways to combat chronic neurological pain. The site, which includes a blog written by Dr. Shapira, can be used to find a doctor and also as an educational tool where a person can discover all they need to know about the kind of headache they may have.

“Many people in pain and desperate for an end to their headaches will look to CAT Scans, powerful medication and more to help them. Very few will look to a dentist who is able to find a solution through neuromuscular science,” writes Dr. Shapira. “Our site is designed to assist you in taking the first steps of pursuing neuromuscular eduction, diagnosis and treatment.”

Dr. Shapira was initially inspired to take on the treatment of issues related to sleep apnea and snoring by way of an experience his son Billy had when he was five.

After observing a limited attention span, excessive tiredness and unusual behavior in Billy, Dr. Shapira took his son to pediatricians, ENTs and allergy doctors, who said he had ADHD. “Basically, they told us he couldn’t start kindergarten and they wanted to put him on ritalin for life,” he said.

But Dr. Shapira also took Billy to the sleep center at Rush, where a sleep test showed he had severe sleep apnea — his heart stopped beating 60 times an hour when he was sleeping. “We took his tonsils and adenoids out when he was five and widened his mouth orthodontically, so the same kid who couldn’t start school because he had ADHD ended up graduating college magna cum laude with double majors and double minors,” said Dr. Shapira. “Turns out his drug of choice was oxygen. He needed to breath. Because he couldn’t breath, he had disturbed sleep. Back then we didn't know it, but now we know now that disruptive sleep can give you exactly the same symptoms of ADHD.”

Seeing the positive changes in his son after his airways were opened, Dr. Shapira turned his attention to the field, and the relief proper treatment can give.

“There are airway issues that start young and go all the way through life,” said Dr. Shapira. “If I can help make somebody’s quality of life better, that is huge.”

Currently, he said, as many as 80 percent of children have “underdeveloped jaws” which means they run the risk of having problematic airways. “If you have a child that is snoring, that is not normal,” he said.

Dr. Shapira now has child patients as young as two for whom he makes appliances that can be worn at night. “We can grow them bigger airways,” he said.

Dr. Shapira founded www.IHateCPAP.com, a one stop source for information about sleep apnea. Severe sleep apnea affects more than 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness. Most people with mild sleep apnea are aware that they snore and feel overtired or fatigued but are unaware of potentially serious medical problems which may exist, he said.

Dr. Shapira, DDS, D,ABDSM, D,AAPM, FICCMO is a Diplomat of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a Fellow and current Secretary of the International College of CranioMandibular Orthopedics, and a former Assistant Professor at Rush Medical School, where he researched effect of jaw position on sleep apnea.

He has written a chapter on anti-aging dentistry in an anti-aging medicine textbook; is Dental Section Editor of Sleep and Health Journal; has lectured in the US and abroad on TMJ disorders, sleep apnea, dental sleep medicine and anti-aging medicine, and has several patents on stem cell collection from developing wisdom teeth and currently are awaiting NIH funding of a study at UIC and Baylor.

He recently started Sleep Well Illinois, a company that promotes universal sleep screening in physician offices, and just became the Chair of the Alliance of TMD organizations for a two year term.

His Highland Park office is Chicagoland Dental Sleep Medicine and the Website is www.ThinkBetterLife.com"

TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep ......Is Dr Shapira's guest editorial in Cranio Journal

Originaly seen in Sleep and Health Journal

Sat, 02/02/2013 - 09:36 — ilshapira

Important information for all patients with Headaches, Chronic Daily Headaches and Migraines:

The relation of Sleep Disorders and/ or TM Joint Disorders (TMD) is presented that is vital to patients with poor sleep or chronic pain, especially Chronic headaches and Migraine

Cranio, The Journal of CranioMandibular Practice is dedicated to the diagnosis and treatment of TMJ, TMD, and related disorders. In a monumental move Riley Lunn the editor is changing the journal to Cramino Mandibular and Sleep Practice. Cranio is the first journal to embract the close ties between TMJ disorders, Chronic Pain and Sleep Disorders.

The entire editorial is available free of charge from Cranio at:
http://cranio.com/volume31/issue1/tmj-alias-great-imposter-has-co-conspi...

This is vital information with all patients who have TMJ disorders, Fibromyalgia, Myofascial Pain & Dysfunction, Sleep Apnea, Snoring, Headaches and/or Migraines. Cranio is leading the way into a new world where these diaparate disorders are all seen as different faces of similar closely related disorders.

The treatment of headaches and migraines and how Neuromuscular Dentistry can drastically improve the life of headache sufferers is discussed at I HATE HEADACHES .... www.ihateheadaches.org

Treatment of Sleep Apnea is primarily with CPAP and Oral Appliances. A side effect of oral appliance therapy is bite changes. Studies have shown that over long term treatment there are rarely TMD problems whether or not their are bite changes. The bite changes seen in treating sleep apnea with an oral appliance are similar to those seen when wearing a diagnostic neuromuscular orthotic. THESE CHANGES ARE ACTUALLY THE PHYSIOLOGIC HEALING THAT OCCURS DURING THE NIGHT WITH ORAL APPLIANCES. The normal advice is to do morning exercises to return the bite to its original pathology (I call this position pathologic because it does not allow for normal breathing the single most important function of the jaw, and tongue)

The use of neuromuscular diagnostic orthotics combined with oral appliances for treating sleep apnea will allow more permanent changes to occur and this healed position may be the ultimate cure for sleep apnea. To better understand Neuromuscular Dentistry I suggest reading.....http://www.sleepandhealth.com/neuromuscular-dentistry

Permanent correction of the bite following the diagnostic phase and dignostic neuromuscuar orthotic can be accomplished with orthodontics, dental reconstruction, long term orthotics and on rare occasions surgery. Patients seeking help with Sleep Apnea should seek out a practitioner trained in treating TMJ disorders, ideally a trained Neuromuscular Dentist.

Migraines, Morning Headaches and nocturnal headaches are usually associated with pathologic jaw positioning that does not maintain a health airway or with nociceptive input into the Trigeminal Nervous System. Neuromuscular Dentistry lets the clinician utilize sophisticated measurements to idealize bite and jaw position to physioogic healthy positions.

Learn more about Neuromuscular Dentistry at http://www.sleepandhealth.com/neuromuscular-dentistry

http://cranio.com/volume31/issue1/tmj-alias-great-imposter-has-co-conspirator-poor-sleep/

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]

Headache and Migraine: Elimination and Prevention Through Neuromuscular Dentistry - Improve The Quality Of Your Life and Live Pain Free!

Reprint of 24/7 press release below:

"Quality of life is destroyed when you live with chronic pain. Migraines, chronic daily headaches and other chronic head and neck pain can frequently be eliminated through the science of Neuromuscular Dentistry and Trigeminal Nervous system relief."

URNEE, IL, June 02, 2010 /24-7PressRelease/ -- A recent patient who suffered a constant headache for over 50 years is now pain free without dependence on medication. Patient M was married to a physician and had access to the finest care available but still lived in continuous pain for over 50 years. Patient M met Dr Ira L Shapira by accident. Her husband had sleep apnea and loud snoring and found Dr Sapira through the website http://www.IHateCPAP.com.

M was at her husband's consultation and Dr Shapira noticed she held her temple during the appointment and asked if she had a headache. She did, and he used a simple technique to turn off a trigger point and to relieve her pain. This was a first for M who had never experienced this in 50 years of living with chronic headache pain. Neuromuscular Dentistry was discussed briefly at that visit and at the second visit her husband received his oral appliance to eliminate his sleep apnea and snoring and M began her Neuromuscular Dentistry treatment.

M recieved a Diagnostic Neuromuscular Orthotic that day and except for one day has been headache free since that time. M does report that when she is sick she may get a headache but it is different than the headaches she lived with for most of her life.

What is Neuromuscular Dentistry and what is a Diagnostic Neuromuscular Orthotic and how does it work?

An article that Dr Shapira was asked to write for the American Equilibration Society is one of the best explanations available online and has been reprinted in Sleep and Health Journal @ http://www.sleepandhealth.com/neuromuscular-dentistry.

A second article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal discusses typical patient stories.

In the most simple terms the way Neuromuscular Dentistry works is change input and output from our brains and central nervous system to muscles, joints, and nervous system end organs in the Trigeminal Nervous System. Our brains are similar to computers. GARBAGE IN- GARBAGE OUT explains in computer lingo how bad input leads to bad output. The brain is basically a biological computer and GARBAGE IN- GARBAGE OUT holds true when it comes to our brains.

Input to the brain comes from two sources, input from the spinal column which accounts for 20% of the total input to the brain and input from 12 pairs of cranial nerves that accounts for 80% of brain input. The cranial nerves are responsible for sight, smell, taste, vision, hearing, proprioception and control of the autonomic nervous system.

The trigeminal nerve accounts for approximately 70% of the input to the brain from the 12 cranial nerves or more than half of total brain input. The Trigeminal Nerve is also known as the Dentist's Nerve. It goes to the teeth, jaw joints, jaw muscles, the periodontal ligaments of the teeth, the muscle that tenses the eardrum, the muscle that opens and closes the eustacian tubes, that innervates the lining of the sinuses and nasal mucosa. It also controls the blood flow to the anterior 2/3 of the meninges of the brain. When we smell menthol that is another trigeminal nerve function which may be why Vicks Vapor Rub works for many pains.

The trigeminal nerve also has a enormous autonomic component and is a chief cause of central sensitization. Central Sensitization is a primary aspect of most headaches and migraines, facial pains, fibromyalgia and almost all other chronic pain syndromes.

GARBAGE IN - GARBAGE OUT takes on new meaning when we are talking about the majority of input to the brain. Neuromuscular Dentistry turns bad data our brain receives into good data. Central Sensitization can turn good input into bad output. Examples are Hyperesthesia where there is an over-reaction to pain stimuli and Allodynia where non-painful input is received as Nociceptive of Pain impulses. Fibromyalgia is considered a disease caused by or accompanied by Central Sensitization. The Trigeminal Nerve is also vital for controlling respiration and airway patency. The National Heart Lung and Blood Institute issued a report "Cardiovascular and Sleep Related Consequences Of Temporomandibular Disorders" which is available at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf.

Dr Shapira created http://www.ihateheadaches.org to help patients understand headaches, migraines and how Neuromuscular Dentistry is an essential and vital treatment resource.

Why do patients suffer for years if there is a treatment that can so drastically improve their lives?

Do problems addressed Neuromuscular Dentistry actually affect health and medical costs?

Cranio, The Journal for CranioMandibular Practice published two articles that answer that question. The studies by Shimshak et al showed that patients with TMJ disorders had a 300% increase in medical utilization in all fields of medicine except obstetrics. In other words, aside from not getting pregnant these patients utilize three times the average in medical expenses. Treatment of Temporomandibular disorders and the neuromuscular pathology that cause them can drastically improve patients lives and possibly drastically decrease medical expenses.

The NHLBI report discusses how respiratory disorders related to TMJ disorders can effect many body systems. Dental Sleep Medicine is an extremely effective approach to treating sleep apnea. It is more effective overall than surgery. CPAP is still considered the Gold Standard of treatment for Sleep Apnea but has horrendous issues with patients compliance.

Poor compliance means it works well if used but most patients do not use it. CPAP that is not used is worthless and dangerous because the patient remains untreated. A recent study showed that 60% of patients did not use their CPAP. Other patients refuse to even have a sleep test because they do not want to use CPAP. One study cited at the Trucking and Sleep Apnea conference presented by the American Sleep Apnea Association showed only 5% of truckers using their CPAP. This is a frightening fact considering than patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents. Patients overwhelmingly prefer oral appliances to CPAP when they offered a choice but most patients are never given a choice. That would be understandable if CPAP compliance wasn't an issue. Studies of patients who do use their CPAP show that they average only 4-5 hours a night of use not 7-7 1/2 that is ideal.

Patients with untreated sleep apnea have up to a six-fold increase of risk of heart attacks and strokes which usually occur in the early morning hours. Most CPAP users have already stopped utilizing their CPAP during the early morning hours when the risk is greatest.

Dr Shapira created the website I HATE CPAP! to help the majority of patients who could not tolerate treatment with CPAP. Thousands and thousands of patients visit this website every single month which leads them to appropriate and scientifically supported treatment.

Treatment and prevention sleep apnea with oral appliances is now well accepted but is still fighting for its proper place in medicine. In a few years oral appliances will probably account for a vast majority of treatment of mild to moderate sleep apnea.

Morning headaches have two primary causes, TMJ disorders and Sleep Apnea. The NHLBI says Sleep Apnea is a TMJ disorder. There is an FDA approved appliance for preventing migraines the the NTI-TSS appliance.

The Aqualizer appliance, invented by Dr Martin Lerman is an a simple inexpensive appliance that can produce incredible success but does not offer permanent correction. IAn Aqualizer was used to keep M free of pain between her first and second appointment until her diagnostic neuromuscular orthotic was delivered.

Neuromuscular Dental treatment starts with a Diagnostic Orthotic. When treatment effectiveness is assured patients can proceed with long term phase 2 treatment of a permanent removable orthotic, orthodontic correction or a Neuromuscular Reconstruction. Patient M chose reconstruction which not only eliminated her headaches but also gave her a beautiful new smile. Reconstruction can be accomplished in just a few appointments for patients who do not wish to go through extended treatment with orthodontics or wear a long term orthotic.

The Aqualizer and NTI-TSS are excellent tools but they do not provide definitive treatment.

Dr Shapira studied Neuromuscular Dentistry with Barney Jankelson who founded the science and with his son Robert Jankelson. His 30 years of neuromuscular dentistry and pioneer work in Dental Sleep Medicine makes him uniquely suited to treating patients with chronic head and neck pain.

The Las Vegas Institute is the primary educator in Neuromuscular Dentistry and has appointed Dr Norman Thomas to head educational and research studies into Neuromuscular Dentistry. Dr Thomas is a world leading expert in the field of Neuromuscular Dentistry and how it relates to Physiology and Anatomy of masticatory and postural systems.

Dr Barry Cooper also does a superb job at introducing dentists to the field of Neuromuscular Dentistry. Dr Shapira strongly recommends dentists begin their training with Dr Cooper because he teaches small groups of 1-6 doctors which is the ideal learning environment. Dr Shapira limits his sleep apnea and Dental Sleep Medicine classes to six doctors as well. This allows for one on one interaction and follow-up during the most difficult period of the learning curve.

The international college of craniomandibular orthopedics or iccmo is the leading organization representing neuromuscular dentistry. Dr shapira stronly suggests you find a neuromuscular dentist who is a member of iccmo. Iccmo was founded by dr barney jankelson, the father of neuromuscular dentistry.

Patients in Northern Illinois and southern Wiscosin looking for a Neuromuscular Dentist are a comfortable drive to Dr Shapira's general dentistry office, Delany Dental Care Ltd in Gurnee and to the offices of Chicagoland Dental Sleep Medicine Associates. Dr Shapira currently sees patients in Skokie and Schaumburg and recently announced a new office will open soon in Highland Park, Illinois.

Dr Shapira's team can make arrangements for patients from outside of the Chicago Metropolitan area
to have an intensive course of treatment. Dr Shapira will consider accepting long distance patients on a case by case basis. Patients wishing to see Dr Shapira can contact his office toll-free at 1-800-TM-Joint or 1-8-NO-PAP-MASK or 847-623-5530

Patients can contact Dr Shapira through the following websites:
http://www.ihatecpap.com
http://ww.ihateheadaches.org
http://delanydentalcare.com
http://www.chicagoland.ihatecpap.com/

Dr Shapira will help patients locate a Sleep Apnea Dentist or Neuromuscular Dentist anywhere in the country. Dr Shapira strongly advises patients to seek out treatment of Sleep Apnea only from dentists trained in treating TMJ disorders preferably by Neuromuscular Dentists.

The American Academy of Sleep Medicine (AASM) advised that patients receive oral appliances from dentists trained in Dental Sleep Medicine and treatment of Temporomandibular Disorders (TMD). The American Academy of Dental Sleep Medicine (AADSM) endorsed the position of the AASM.

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President of I Hate Headaches LLC, President Dato-TECH, and has a General Dental Practice, Delany Dental Care Ltd with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin

Prevention of Migraines: Press Release reprint

It is widely accepted that almost all headaches wether classified as vascular, neurogenic , hormonal or muscular in orgins are caused primarily by the Trigeminal Nervous system. While there are many drugs that can be utilized in the treatment of migraines and other headaches one of the best diagnostic proceures may not only clarify why the headaches occur but eliminate, decrease and/or prevent them entirely without the use of dangerous and/or adicting meication.

Neuromuscular Dentistry May Be The Best Migraine Prevention Available For Many Patients. I HATE HEADACHES website provides extensive information on Neuromuscular Dentistry.

The Trigeminal Nerve is so closely tied to headaches that prevention of noxious input can be a permanent cure for many patients. Patients who are tired of their lives being controlled or ruined by headaches should approach treatment cautiously. Initial treatment of headaches should always be preceded by a consultation appointmet with an experienced Neuromuscular Dentist. Patients should expect to spend at least an hour at this initial visit to determine if they are apprpriate canidates for a diagnostic appointment.

Dr Ira L Shapira in Gurnee, Illinois has 30 years experience in utilizing Neuromuscular Dentistry to elimnate, prevent and treat migraines and othe chronic headaches. He will usually spend 60-90 minutes with patients at the initia consultation and will then prescribe a diagnostic appointment appropriate for the patients specific disorders. Patients with more complex problems and longer history of pain are usually given a more comprehensive assessment.

During the consultation it is frequently possible to turn off a head or neck pain in just a few seconds by deactivating myofascial trigger points. Dr Shapira, a Diplomate of the American Academy of Pain Manage explains that he can sometimes see amazing transformations in patients as they realize that finally some knows how to turn off their pain. "I recently saw a patient who accompanied her husband to my office for treatment of his sleep apnea. I noticed that "M" was holding her right temple and asked if she was having headache which she confirmed. I asked if I could try to "turn it off" and she agreed to let me attempt to relieve it. we spent less than five minutes deactivating trigger points and she was "pain free". She then told me she had had a continuos headache for over 50 years which her husband, a retired physcian, confirmed. A appointment was made to deliver her husbands snoring and sleep apnea appliance and to do a consultation and begine treatment the following week. At the next a diagnostic evaluation was done and a diagnostic neuromuscular orthotic was deliverd to "M". One week later M and her husband returned and she reported being headache free and sleeping much better because we had eliminated her husbands snoring s well. M has now been reconstructed to this Neuromuscular Position and remains headache free. She loves to tell stories about how her children and grandaughter are constantly asking if she still doesn't have a headache. She also feels she has never looked as good as she does now since the dental reconstruction."

The use of a diagnostic orthotic is n essential element of both diagnosis and treatment of headache patients. It allows for the corrction of the jaw joints, jaw muscles and most importantly the correction of the input to the Trigeminal Nervous system. It allows the patient to understand and evaluate treatment prior to making any irreversible change. Neuromuscular Dentistry is extremely conservative in it avoids the risk of making problems worse by making permanent bite changes as an initial treatment. If patients decide to make permanent changes they have multiple treatment choices but most importantly they have "test driven" their new bite and know the effects before embarking on the second phase of treatment. The diagnostic orthotic patient is essential to determine treatment direction and to protect the patient.

Centric Relation dentistry is another approach to treating patients. Dr Shapira was both a patient and practitiner of CR dentistry before becoming a strong advocate for the Neuromuscular Approach. "The problem with centric relation treatment" in Dr Shapira's opinion "is that permanent changes are made early in treatment and if a patient becomes worse instead of better ther treatment is not reversible. Centric Relation is determined by the dentist manipulating the patients mandible to position utilizing the dentist's muscles but Neuromuscular Dentistry on the other hand utilizes the patients own muscles to guide treatment. Removal of underlying pathology lets the body heal" according to Dr Shapira, "and then we just have to adjust the diagnostic orthotic to match the healthier position that naturally occurs."

Dr Shapira has created two excellent website to help patients find answers to difficult medical problems:

http://www.ihateheadaches.org for headache and migraine disorders

http://www.ihatecpap.com for patients with sleep apnea and snoring and who want a comfortable alternative to CPAP

There are two excellent articles that should be read by anyone suffering from chronic headaches, Migraines or TMJ disorders published in Sleep and Health Journal:

http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

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

The first article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses patients symptoms and stories and the second discusses Dr Shapira's explanation of the science of Neuromuscular Dentistry.

Dr Shapira can be contacted for treatment of headaches, sleep apnea, and TMJ disorders at his Delany Dental Care practice where he also practices general dentistry with his partner Dr Mark Amidei.http://www.delanydentalcare.com