A new article in Cephalgia discusses the comorbidities of sleep and headache. It is well established that the two most commmon causes of "Morning Headache" are TMJ disorders and Sleep Apnea. There is an excellent paper fron the National Heart Lung and Blood Institute on the relation of these two disorders. The paper "CCARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" can be found at
www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
The article in Cephalgia stated
Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa."
The two primary sleep disorders associated with headache in my experience are sleep apnea and maintenance insomnia. Maintenance insomnia is usually the result of sleep apnea/ UARS (upper airway resistance syndrome) or restless legs (periodic leg movements in sleep PLMS)
Patients pesenting with severe stree frequently have sleep onset insomnia. Chronic pain frequently leads to stress(cortisol) disorders.
Treatment of Sleep Apnea is considered the Gold Standard for Sleep Apnea but most patients do not tolerate treat and abandon it completely (up to 60%) or more commonly use it only a few hours a night which is leaves significant residual disease and risks of cardiovascular disease, excessive daytime sleepiness, tiredness, headaches and migraines.
An excellent alternative treatment for sleep apnea is an oral appliance (http://www.ihatecpap.com) It is extremely effective for Upper Airway Resistances Syndrome, Snoring Arousals, and mild to moderate sleep apnea. It has been shown to be effective in severe sleep apnea but is usually not effectively in the morbidly obese. Morbidily obese patients with headaches and migraines are probably CPAP candidates but oral appliance therapy can be used if they do not tolerate CPAP.
Treatment of Sleep Disordered Breathing can be remrkably effective in treating many types of headaches, especially morning headaches. Oral Appliances are preferred by the majority patients over CPAP when they are offered a choice. A side effect of oral appliance therapy is bite changes. Exercises taught to patients can prevent most changes but many patients chose not to do the exercises. The reason is that when the jaw is advanced for 8 hours it "heals" in this new position frequently eliminating headaches and migraines. While dentists treating sleep apnea with oral appliances usually try to prevent bite changes dentists treating patients for TMJ disorders (TMD) chronic tension headaches and migraines actually welcome bite changes.
Daytime headaches are very effectively treated with a different type of oral appliance called a neuromuscular orthotic. If the headaches are eliminated a second phase of treatment can make these changes permanent. Understanding that TMD and Sleep Apnea are different faces of the same structural/developmental disorder.
Another pertinent and timely study J Headache Pain. 2011 Aug 17. "Clinical features of headache patients with fibromyalgia comorbidity." looks at chronic heqdaches and fibromyalgia comorbidities with tension headache, chronic daily headacahe and migraine. These are
Cephalalgia. 2011 Apr;31(6):648-53. Epub 2011 Jan 10.
Headaches and sleep problems among adults in the United States: findings from the National Comorbidity Survey-Replication study.
Lateef T, Swanson S, Cui L, Nelson K, Nakamura E, Merikangas K.
Source
National Institute of Mental Health, USA. TLateef@cnmc.org
Abstract
BACKGROUND:
Several studies have demonstrated an association between headache and disturbed sleep. None have examined this association across the headache spectrum. Our goal was to determine whether migraine and migraine with aura differ from nonmigraine headache in terms of associated insomnia complaints or severity of sleep problems.
METHODS:
A probability sample of US adults was used. A structured interview administered by trained interviewers was used. Diagnostic criteria for migraine and migraine with aura were based on the International Headache Society classification. The presence or absence of four forms of sleep disturbance associated with an insomnia diagnosis was ascertained.
RESULTS:
There was a significant association between frequent severe headache, including migraine with and without aura, and disordered sleep. Adults with headache reported more frequently difficulty initiating sleep (odds ratio [confidence interval] = 2.0 [1.6-2.5]), difficulty staying asleep (2.5 [2.1-3]), early morning awakening (2.0 [1.7-2.5]) and daytime fatigue (2.6 [2.2-3.2]) and also were more than twice as likely to report three or more of these symptoms(2.5 [2-3.1]) compared to the individuals without headache.
DISCUSSION:
Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.
PubMed abstracts below:
Comment in * Cephalalgia. 2011 Apr;31(6):643-4.
J Headache Pain. 2011 Aug 17. [Epub ahead of print]
Clinical features of headache patients with fibromyalgia comorbidity.
de Tommaso M, Federici A, Serpino C, Vecchio E, Franco G, Sardaro M, Delussi M, Livrea P.
Source
Neurophysiopathology of Pain Unit, Neurological and Psychiatric Sciences Department, Medical Faculty, Policlinico General Hospital, Aldo Moro University, Neurological Building, Piazza Giulio Cesare 11, 70124, Bari, Italy, m.detommaso@neurol.uniba.it.
Abstract
Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type headache. We aimed to update our previous results, considering a larger cohort of primary headache patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123 patients was screened. Frequency of FM in the main groups and types of primary headaches; discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety, depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and probability of FM membership in groups; and types of primary headaches were assessed. FM was present in 174 among a total of 889 included patients. It prevailed in the tension-type headache main group (35%, p < 0.0001) and chronic tension-type headache subtype (44.3%, p < 0.0001). Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and chronic tension-type headache had a higher probability of sharing the FM profile (Bonferroni test, p < 0.01). A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain in headache patients.
PMID:
21847547
[PubMed - as supplied by publisher]
Showing posts with label tension-type headaches. Show all posts
Showing posts with label tension-type headaches. Show all posts
Monday, August 22, 2011
Sunday, April 3, 2011
HEADACHES AND MYOFASCIAL TRIGGER POINTS: HIGH POWER ULTRASOUND VS TRIGGER POINT INJECTIONS EQUIVILANT FOR TRAPEZIUS MUSCLE TPs
I have found that trigger point injections are extremely effective in reducing tension-type headaches and frequently can completely eliminate them when combined with a neuromuscular orthotic. This current study from the Archives of Physical Medicine and Rehabilitation shows high-power ultrasound as effective as trigger point injections in treating the Trapezius muscle.
The Trapezius muscle is a large easily treated muscle that can cause referred headache pain. Trigger point injections took less therapy sessions but there was equal effectiveness to both treatments. When treating headaches many of the muscles that cause tension-type headaches are not good candidates for high-power ultrasound. Treating headaches without medication usually requires elimination of muscle trigger points. Neuromuscular Dentistry uses Ultra-Low Frequency TENS to eliminate the underlying cause of Trigger Points and headaches. Trigger Point injections and and Spray and Stretch as described by Travell and Simons is extremely effective in eliminating and preventing re-occurence of trigger points that cause tension-type headaches.
This new study (see abstract below) shows that high-power ultrasound was as effective as trigger point injections when treating trapezius pain and reduction in motion. Treatment of headaches is usually much more effective with trigger point injections. Ultrasound is of little use in treating medial and lateral pterygoid muscles, TMJ oints, Temporalis Muscles, and supra and ifra hyoid muscles.
Tension-Type headaches and Myofascial trigger points are frequently triggers for Migraines.
The use of a diagnostic neuromuscular orthotic is a safe and effective method to evaluate patient's response to Neuromuscular Dentistry. I sometimes consider utilizing trigger point injections, spray and stretch techniques, SPG blocks and other treatment modalities as cheating. Neuromuscular dentistry is such a powerful tool but utilizing these other procedures can drastically enhance the therapeutic effect.
Arch Phys Med Rehabil. 2011 Apr;92(4):657-62.
Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle.
Unalan H, Majlesi J, Aydin FY, Palamar D.
Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Abstract
Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local ınjection in the treatment of active myofascial trigger points of the upper trapezius muscle.
OBJECTIVE: To compare the effects of high-power pain threshold ultrasound (HPPTUS) therapy and local anesthetic injection on pain and active cervical lateral bending in patients with active myofascial trigger points (MTrPs) of the upper trapezius muscle.
DESIGN: Randomized single-blinded controlled trial.
SETTING: Physical medicine and rehabilitation department of university hospital.
PARTICIPANTS: Subjects (N=49) who had active MTrPs of the upper trapezius muscle.
INTERVENTIONS: HPPTUS or trigger point injection (TrP).
MAIN OUTCOME MEASURES: Visual analog scale, range of motion (ROM) of the cervical spine, and total length of treatments.
RESULTS: All patients in both groups improved significantly in terms of pain and ROM, but there was no statistically significant difference between groups. Mean numbers of therapy sessions were 1 and 1.5 in the local injection and HPPTUS groups, respectively.
CONCLUSIONS: We failed to show differences between the HPPTUS technique and TrP injection in the treatment of active MTrPs of the upper trapezius muscle. The HPPTUS technique can be used as an effective alternative to TrP injection in the treatment of myofascial pain syndrome.
Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21440713 [PubMed - in process]
The Trapezius muscle is a large easily treated muscle that can cause referred headache pain. Trigger point injections took less therapy sessions but there was equal effectiveness to both treatments. When treating headaches many of the muscles that cause tension-type headaches are not good candidates for high-power ultrasound. Treating headaches without medication usually requires elimination of muscle trigger points. Neuromuscular Dentistry uses Ultra-Low Frequency TENS to eliminate the underlying cause of Trigger Points and headaches. Trigger Point injections and and Spray and Stretch as described by Travell and Simons is extremely effective in eliminating and preventing re-occurence of trigger points that cause tension-type headaches.
This new study (see abstract below) shows that high-power ultrasound was as effective as trigger point injections when treating trapezius pain and reduction in motion. Treatment of headaches is usually much more effective with trigger point injections. Ultrasound is of little use in treating medial and lateral pterygoid muscles, TMJ oints, Temporalis Muscles, and supra and ifra hyoid muscles.
Tension-Type headaches and Myofascial trigger points are frequently triggers for Migraines.
The use of a diagnostic neuromuscular orthotic is a safe and effective method to evaluate patient's response to Neuromuscular Dentistry. I sometimes consider utilizing trigger point injections, spray and stretch techniques, SPG blocks and other treatment modalities as cheating. Neuromuscular dentistry is such a powerful tool but utilizing these other procedures can drastically enhance the therapeutic effect.
Arch Phys Med Rehabil. 2011 Apr;92(4):657-62.
Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle.
Unalan H, Majlesi J, Aydin FY, Palamar D.
Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Abstract
Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local ınjection in the treatment of active myofascial trigger points of the upper trapezius muscle.
OBJECTIVE: To compare the effects of high-power pain threshold ultrasound (HPPTUS) therapy and local anesthetic injection on pain and active cervical lateral bending in patients with active myofascial trigger points (MTrPs) of the upper trapezius muscle.
DESIGN: Randomized single-blinded controlled trial.
SETTING: Physical medicine and rehabilitation department of university hospital.
PARTICIPANTS: Subjects (N=49) who had active MTrPs of the upper trapezius muscle.
INTERVENTIONS: HPPTUS or trigger point injection (TrP).
MAIN OUTCOME MEASURES: Visual analog scale, range of motion (ROM) of the cervical spine, and total length of treatments.
RESULTS: All patients in both groups improved significantly in terms of pain and ROM, but there was no statistically significant difference between groups. Mean numbers of therapy sessions were 1 and 1.5 in the local injection and HPPTUS groups, respectively.
CONCLUSIONS: We failed to show differences between the HPPTUS technique and TrP injection in the treatment of active MTrPs of the upper trapezius muscle. The HPPTUS technique can be used as an effective alternative to TrP injection in the treatment of myofascial pain syndrome.
Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21440713 [PubMed - in process]
Sunday, March 13, 2011
FORWARD HEAD POSTURE, MYOFASCIAL TRIGGER POINTS, TMJ, TMD, AND TENSION-TYPE HEADACHE ALL CLOSELY RELATED
A PRIMARY DIAGNOSTIC FINDING IN TMJ, TMD, TMJ DISORDERS IS MYOFASCIAL TRIGGER POINTS. THEY ARE FREQUENTLY ASSOCIATED WITH FORWARD HEAD POSTURE A COmMON FINDING IN TMJ PATIENTS. A 2006 ARTICLE "Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache." IN HEADACHE JOURNAL CLEARLY DESCRIBES HOW TRIGGER POINT IN "upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH CHRONIC TENSION-TYPE HEADACHES)"
NEUROMUSCULAR DENTISTRY UTILIZES A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS TO ELIMINATE THE FACTORS THAT CAUSE TRIGGER POINTS TO FORM AND PROPAGATE. ELIMINATION OF THESE TRIGGER POINTS CAN PREVENT TMJ DISORDERS, TREAT TMD AND CHRONIC TENSION TYPE HEADACHES. PATIENTS WITH INCREASED MYOFASCIAL TRIGGERS ALSO HAVE INCREASED INTENSITY AND DURATION OF HEADACHE ATTACKS.
A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS A SAFE AND EFFECTIVE FIRST STEP IN THE DIAGNOSIS, TREATMENT AND ELIMINATION OF MYOFASCIAL TRIGGERS AND RELATED TMJ AND HEADACHE DISORDERS.
Headache. 2006 Sep;46(8):1264-72.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA.
Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Abstract
OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.
BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role.
DESIGN: A blinded, controlled, pilot study.
METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01).
CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.
NEUROMUSCULAR DENTISTRY UTILIZES A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS TO ELIMINATE THE FACTORS THAT CAUSE TRIGGER POINTS TO FORM AND PROPAGATE. ELIMINATION OF THESE TRIGGER POINTS CAN PREVENT TMJ DISORDERS, TREAT TMD AND CHRONIC TENSION TYPE HEADACHES. PATIENTS WITH INCREASED MYOFASCIAL TRIGGERS ALSO HAVE INCREASED INTENSITY AND DURATION OF HEADACHE ATTACKS.
A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS A SAFE AND EFFECTIVE FIRST STEP IN THE DIAGNOSIS, TREATMENT AND ELIMINATION OF MYOFASCIAL TRIGGERS AND RELATED TMJ AND HEADACHE DISORDERS.
Headache. 2006 Sep;46(8):1264-72.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA.
Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Abstract
OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.
BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role.
DESIGN: A blinded, controlled, pilot study.
METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01).
CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.
WHY IS NEUROMUSCULAR DENTISTRY SO SUCCESSFUL IN TREATING TMJ (TMD) DISORDERS AND HEADACHES. THE PRESENCE OF MYOFASCIAL PAIN IS THE LINK
TREATMENT OF TMD, TMJ DISORDERS, TENSION-TYPE HEADACHE AND MIGRAINE HAVE WIDE AREAS OF OVERLAP. THIS OVERLAP IS IN SYMPTOMS AND CAUSES BUT MYOFASCIAL TRIGGER POINTS ARE A MAJOR SOURCE OF PAIN.
NEUROMUSCULAR DENTISTRY IS VERY SUCCESSFUL AT TREATING TMJ, TMD AND MYOFASCIAL PAIN DISORDERS OF THE HEAD AND NECK. PATIENTS WHO DO NOT WANT LONG TERM DRUG THERAPY SHOULD CONSIDER THE NEUROMUSCULAR DENTISTRY APPROACH TO IMPROVING THE HEALTH OF THE MASTICATORY SYSTEM, RELIEVING CHRONIC MUSCLE PAIN AND MYOFASCIAL TRIGGER POINTS AND PREVENTING CENTRAL SENSITIZATION.
THE LITERATURE STRONGLY SUPPORTS THE ROLE OF MUSCLES IN CHRONIC PAIN. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS AN IDEAL FIRST STEP FOR LONG TERM TREATMENT OF TMJ (TMD) DISORDERS AND HEADACHES. NEUROMUSCULAR DENTISTS FREQUENTLY WORK IN CONJUNCTION WITH PHYSICAL THERAPISTS, CHIROPRACTERS, OSTEOPATHS AND MASSAGE THERAPISTS.
IMPROVING THE QULITY OF LIFE OF PATIENTS ARISING FROM MUSCULAR DISORDERS AND IDEALIZING HOMEOSTASIS ARE BASIC TO NEUROMUSCULAR DENTAL TREATMENT.
There are 576 scientific articles that come up on a PubMed search using key terms of Myofascial Pain and TMJ. 221 PubMed articles come up searching Myofascial pain and Headache, and 61 articles when searching Myofascial Pain and Migraine. There are another 80 articles that come up searching Myofascial Pain and Tension-type Headaches.
Myofascial Pain is a constant in these searches. Myofascial pain results from repetitive overuse syndromes and is commonly considered a major component of TMD.
Neuromuscular Dentistry is directed toward treating myofascial pain, muscle spasm and other muscular disorders of the masticatory system.
An article "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." published in Feb 2011 Clinical Journal of Pain (abstract below) found that " TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved."
Central facillitation is central to many theories on why some patients get chronic headaches and migraines. Another article, "Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache." in the Feb 2011 Journal of Headache Pain (abstract below) confirms that tension type headaches in children are associated with myofascial pain.
The article states that "TrPs (myofascial trigger points) were identified with palpation and considered active when local and referred pains reproduce headache pain attacks." and that "The total number of TrPs was significantly greater in children with CTTH (chronic tension type headache) as compared to healthy children"
More significantly it stated "Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack.
THIS MEANS THAT TRIGGER POINTS CAUSE TENSION TYPE HEADACHES IN CHILDREN, THE MORE TRIGGER POINTS THAT WERE PRESENT THE LONGER THE HEADACHES LASTED.
The study found a similar association with neck pain and trigger points " Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children."
Another 2011 article "The relationship of temporomandibular disorders with headaches: a retrospective analysis." (abstract below)found that "The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach."
THIS MEANS THAT HEADACHES, ESPECIALLY TENSION-TYPE HEADACHES ARE FREQUENTLY CAUSED ASSOCIATED WITH TMD OR TMJ DISORDERS.
ANOTHER STUDY FROM DECEMBER 2010 JOURNAL PAIN "Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain." SHOWED CORRELATIONS OF HEADACHE FREQUENCY TO TMD.
THEY CONCLUDED THAT "these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches."
THIS MEANS THAT THE CENTRAL SENSITIZATION FOUND IN HEADACHES, MIGRAINES AND FIBROMYALGIA ARE POSSIBLY DUE TO TMD.
THE ARTICLE "Pure tension-type headache versus tension-type headache in the migraineur." FROM Curr Pain Headache Rep. 2010 Dec;14(6):465-9. STATES THAT IT CAN BE DIFFICULT TO DIFFERENTIATE MIGRAINE, TENSION TYPE HEADACHES AND SYMPTOMS OF TMD ESPECIALLY IN THE CASE OF CHRONIC PAIN.
Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.
Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.
*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract
OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.
METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.
RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.
DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.
PMID: 21368664 [PubMed - as supplied by publisher]
J Headache Pain. 2011 Feb 27. [Epub ahead of print]
Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.
Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain, cesar.fernandez@urjc.es.
Abstract
Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.
PMID: 21359873 [PubMed - as supplied by publisher]
Agri. 2011 Jan;23(1):13-7.
The relationship of temporomandibular disorders with headaches: a retrospective analysis.
Cakır Özkan N, Ozkan F.
Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Abstract
Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.
PMID: 21341147 [PubMed - in process]
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
Curr Pain Headache Rep. 2010 Dec;14(6):465-9.
Pure tension-type headache versus tension-type headache in the migraineur.
Blumenfeld A, Schim J, Brower J.
The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract
Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.
PMID: 20878271 [PubMed - indexed for MEDLINE]
NEUROMUSCULAR DENTISTRY IS VERY SUCCESSFUL AT TREATING TMJ, TMD AND MYOFASCIAL PAIN DISORDERS OF THE HEAD AND NECK. PATIENTS WHO DO NOT WANT LONG TERM DRUG THERAPY SHOULD CONSIDER THE NEUROMUSCULAR DENTISTRY APPROACH TO IMPROVING THE HEALTH OF THE MASTICATORY SYSTEM, RELIEVING CHRONIC MUSCLE PAIN AND MYOFASCIAL TRIGGER POINTS AND PREVENTING CENTRAL SENSITIZATION.
THE LITERATURE STRONGLY SUPPORTS THE ROLE OF MUSCLES IN CHRONIC PAIN. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS AN IDEAL FIRST STEP FOR LONG TERM TREATMENT OF TMJ (TMD) DISORDERS AND HEADACHES. NEUROMUSCULAR DENTISTS FREQUENTLY WORK IN CONJUNCTION WITH PHYSICAL THERAPISTS, CHIROPRACTERS, OSTEOPATHS AND MASSAGE THERAPISTS.
IMPROVING THE QULITY OF LIFE OF PATIENTS ARISING FROM MUSCULAR DISORDERS AND IDEALIZING HOMEOSTASIS ARE BASIC TO NEUROMUSCULAR DENTAL TREATMENT.
There are 576 scientific articles that come up on a PubMed search using key terms of Myofascial Pain and TMJ. 221 PubMed articles come up searching Myofascial pain and Headache, and 61 articles when searching Myofascial Pain and Migraine. There are another 80 articles that come up searching Myofascial Pain and Tension-type Headaches.
Myofascial Pain is a constant in these searches. Myofascial pain results from repetitive overuse syndromes and is commonly considered a major component of TMD.
Neuromuscular Dentistry is directed toward treating myofascial pain, muscle spasm and other muscular disorders of the masticatory system.
An article "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." published in Feb 2011 Clinical Journal of Pain (abstract below) found that " TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved."
Central facillitation is central to many theories on why some patients get chronic headaches and migraines. Another article, "Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache." in the Feb 2011 Journal of Headache Pain (abstract below) confirms that tension type headaches in children are associated with myofascial pain.
The article states that "TrPs (myofascial trigger points) were identified with palpation and considered active when local and referred pains reproduce headache pain attacks." and that "The total number of TrPs was significantly greater in children with CTTH (chronic tension type headache) as compared to healthy children"
More significantly it stated "Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack.
THIS MEANS THAT TRIGGER POINTS CAUSE TENSION TYPE HEADACHES IN CHILDREN, THE MORE TRIGGER POINTS THAT WERE PRESENT THE LONGER THE HEADACHES LASTED.
The study found a similar association with neck pain and trigger points " Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children."
Another 2011 article "The relationship of temporomandibular disorders with headaches: a retrospective analysis." (abstract below)found that "The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach."
THIS MEANS THAT HEADACHES, ESPECIALLY TENSION-TYPE HEADACHES ARE FREQUENTLY CAUSED ASSOCIATED WITH TMD OR TMJ DISORDERS.
ANOTHER STUDY FROM DECEMBER 2010 JOURNAL PAIN "Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain." SHOWED CORRELATIONS OF HEADACHE FREQUENCY TO TMD.
THEY CONCLUDED THAT "these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches."
THIS MEANS THAT THE CENTRAL SENSITIZATION FOUND IN HEADACHES, MIGRAINES AND FIBROMYALGIA ARE POSSIBLY DUE TO TMD.
THE ARTICLE "Pure tension-type headache versus tension-type headache in the migraineur." FROM Curr Pain Headache Rep. 2010 Dec;14(6):465-9. STATES THAT IT CAN BE DIFFICULT TO DIFFERENTIATE MIGRAINE, TENSION TYPE HEADACHES AND SYMPTOMS OF TMD ESPECIALLY IN THE CASE OF CHRONIC PAIN.
Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.
Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.
*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract
OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.
METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.
RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.
DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.
PMID: 21368664 [PubMed - as supplied by publisher]
J Headache Pain. 2011 Feb 27. [Epub ahead of print]
Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.
Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain, cesar.fernandez@urjc.es.
Abstract
Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.
PMID: 21359873 [PubMed - as supplied by publisher]
Agri. 2011 Jan;23(1):13-7.
The relationship of temporomandibular disorders with headaches: a retrospective analysis.
Cakır Özkan N, Ozkan F.
Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Abstract
Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.
PMID: 21341147 [PubMed - in process]
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
Curr Pain Headache Rep. 2010 Dec;14(6):465-9.
Pure tension-type headache versus tension-type headache in the migraineur.
Blumenfeld A, Schim J, Brower J.
The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract
Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.
PMID: 20878271 [PubMed - indexed for MEDLINE]
Saturday, March 5, 2011
Bent Face Syndrome, THJ Disorders and Chronic Tension Headache and Migraines
TMJ disorders and headaches are closely related. There are distinct differences in underlying structural differences in patients who experience Tension-Type Headaches and Migraine.
The pain can be primarily related to cervical and cranial musculature but can also be secondary to postural distortions that effect the central nervous system.
Bent Face Syndrome is caused by orthopedic displacement of cranial bones or Cranial Orthopedic Distortions. Other patients have Dental Distortions but the Cranial bones are correctly positioned. Most frequently patients have simultaneous cranial and dental distortions.
Symptoms can be headaches, ear aches, ear pressure, retro-orbital eye pain or pressure, ear stuffiness or mild, moderate, or severe and immobolizing headaches or migraines.
Correction of bites may not correct the underlying cranial bone distortion. As I write this I am in the middle of a course with Dr Bob Walker (founder of Chirodontics) who has developed simple methods to diagnose and treat both the cranial and dental problems. Inn addition to reductions in pain there is also major improvements in facial esthetics.
These methods can lead to rapid correction of these problems and improve final positioning. I first saw Bob present this information at the ICCMO meeting in October. What he accomplished was "impossible". After spending a full day with him I now know it is not only possible but relatively quick and easy. He also helps point out which patients are most likely to be very difficult to treat.
The pain can be primarily related to cervical and cranial musculature but can also be secondary to postural distortions that effect the central nervous system.
Bent Face Syndrome is caused by orthopedic displacement of cranial bones or Cranial Orthopedic Distortions. Other patients have Dental Distortions but the Cranial bones are correctly positioned. Most frequently patients have simultaneous cranial and dental distortions.
Symptoms can be headaches, ear aches, ear pressure, retro-orbital eye pain or pressure, ear stuffiness or mild, moderate, or severe and immobolizing headaches or migraines.
Correction of bites may not correct the underlying cranial bone distortion. As I write this I am in the middle of a course with Dr Bob Walker (founder of Chirodontics) who has developed simple methods to diagnose and treat both the cranial and dental problems. Inn addition to reductions in pain there is also major improvements in facial esthetics.
These methods can lead to rapid correction of these problems and improve final positioning. I first saw Bob present this information at the ICCMO meeting in October. What he accomplished was "impossible". After spending a full day with him I now know it is not only possible but relatively quick and easy. He also helps point out which patients are most likely to be very difficult to treat.
Tuesday, February 1, 2011
Why you want to find the most experienced Neuromuscular Dentist to Treat TMJ, TMD, Headaches and Migraines.
Neuromuscular Dentistry can give incredible relief of headaches, TMJ symptoms migraines and numerous other chronic pain disorders. It is important to chose your Neuromuscular Dentist wisely.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
NEW ARTICLE IN JOURNAL PAIN LINKS TEMPLE HEADACHES TO TMJ DISORDERS
TENSION-TYPE Headaches in the temples are positively correlated to TMD dysfunction. This correlation extends to all of the various TMJ symptoms.
It has long been known that headaches are almost a universal symptom of TMJ disorders. Treatment of TMJ disorders usually leads to significant reduction in headache pain. Neuromuscular Dentistry should always be considered diagnostic work-up of chronic headache patients. The majority of patients experience elimination or very significant pain relief within a brief time period after being treated with a diagnostic neuromuscular orthotic. PPatients frequently consider the results "miraculous"
Learn more about Neuromuscular Dentistry:
Sleep and Health Journal
http://www.sleepandhealth.com/neuromuscular-dentistry
What is not as well known is that TMD is only one of a large family of craniomandibular disorders and problems related to the trigeminal nervous system. The Trigeminal Nerve and its central nervous system connections are involved in almost all headaches. The use of Neuromuscular Dentistry is extremely effective in treating TMJ disorders and associated headaches.
Neuromuscular Dentistry is also extremely effective in treating Chronic Daily Headaches, Tension-Type Headaches, Classic Migraine, Atypical Migraine , Migraine Staticus, Sinus and facial pain, occiptal headache and other chronic pains of the head and neck.
Physicians who do not have the same thorough understanding of the Trigeminal Nerve frequently underplay the importance of the Trigeminal Nerve in almost all headaches. This leads them to approach treatment of headaches with powerful drugs that often have dangerous side effects.
Neuromuscular Dentistry works by reducing noxious input to the central nervous system thru the Trigeminal Nerve.
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
It has long been known that headaches are almost a universal symptom of TMJ disorders. Treatment of TMJ disorders usually leads to significant reduction in headache pain. Neuromuscular Dentistry should always be considered diagnostic work-up of chronic headache patients. The majority of patients experience elimination or very significant pain relief within a brief time period after being treated with a diagnostic neuromuscular orthotic. PPatients frequently consider the results "miraculous"
Learn more about Neuromuscular Dentistry:
Sleep and Health Journal
http://www.sleepandhealth.com/neuromuscular-dentistry
What is not as well known is that TMD is only one of a large family of craniomandibular disorders and problems related to the trigeminal nervous system. The Trigeminal Nerve and its central nervous system connections are involved in almost all headaches. The use of Neuromuscular Dentistry is extremely effective in treating TMJ disorders and associated headaches.
Neuromuscular Dentistry is also extremely effective in treating Chronic Daily Headaches, Tension-Type Headaches, Classic Migraine, Atypical Migraine , Migraine Staticus, Sinus and facial pain, occiptal headache and other chronic pains of the head and neck.
Physicians who do not have the same thorough understanding of the Trigeminal Nerve frequently underplay the importance of the Trigeminal Nerve in almost all headaches. This leads them to approach treatment of headaches with powerful drugs that often have dangerous side effects.
Neuromuscular Dentistry works by reducing noxious input to the central nervous system thru the Trigeminal Nerve.
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
Saturday, January 29, 2011
TREAT HEADACHES, MIGRAINES AND FACIAL PAIN WITHOUT DANGEROUS DRUGS AND ASSOCIATED SIDE EFFECTS. NEUROMUSCULAR DENTISTRY IS A SAFE AND EFFECTIVE.
Neuromuscular Dentistry may be one of the most effective treatments for a wide variety of conditions including various types of "migraine", tension-type headaches, facial pain, trigeminal neuralgia, TMJ disorders, myofascial ain and muscular and neurogenic headaches. Drugs do not cure the underlying problems that cause the problems and frequently their mechanism of action is unknown. Many drugs are recalled due to dangerous or deadly side effects and a large number of patients experience rebound headaches. These patients frequently require higher doses of medication over time.
There are many varied and diverse advantages to neuromuscular dentistry over standard medical approaches. The single biggest problem in treating headaches utilizing neuromuscular dental technology is that it can be expensive. Insurance companies are aware that 50% reduction in symptoms almost always occurs with treatment. This is a higher positive respone than almost any drug regimens. Insurance companies frequently chose to deny coverage to increase profits to shareholders. Patients who have undergone numerous CAT Scans, MRI's ,Drug therapies and surgeries without adequate control of their pain frequently find that Neuromuscular Dentistry gives amazing relief and improves the quality of their lives and the lives of their loved ones and are then denied coverage for treatment. Many of these patients have exhausted their resources on unsuccessful therapies prior to learning about and experiencing relief thru neuromuscular dentistry.
The Alliance of TMD Organizations is working to address the unfair practices of insurance companies relative to the treatment of TMJ disorders and Headaches related to the masticatory system. They are also the primary group protecting the rights of TMJ patients. There is a large group of clinicians in dentistry who believe the problems patients experience are psychosocial and not physical and want medication to become the only treatment available to most patients. They would like to take away patients right to chose non-drug alternative treatments. Unfortunately this group has enormous political influence and exert control over most research funds often to the detriment of patients. This remains true even after scandals in FDA hearings led removal of some of their members from FDA panels. There are also numerous instances of unethical conflicts of interest that were not disclosed to the FDA. Additional information on the TMD alliance is available at: http://www.tmdalliance.org/
I would like to disclose that I am a representative of ICCMO to the Alliance and that I am a long term member of The American Equilibration Society, The American Academy of CranioFacial Pain and a member of The International Academy of Comprehensive Aesthetics. I am also a Diplomate of the American Academy of Pain Management. These are member organizations of the TMD Alliance. I am the chair of the insurance reimbursement commitee.
Neuromuscular Dental Treatment of headaches is usually divided into two phases: the initial treatment phase (pain reduction and elimination) and long term stabilization (long term maintenance of improved quality of life).
The initial treatment phase includes the diagnostic protocols established by the particular neuromuscular dentist, comprehensive exam including medical histroy review (extremely important), muslce palpation exam, range of motion evaluation radiographs. The use of EMG (electomyography) and computerized mandibular scans (CMS or MKG), sonography, ultra low frequency TENS and transcranial neurostimulation are frequently useful in understanding the variable in the course of the doctor establishing a working diagnosis. More advanced practitioners frequently wil do diagnostic trigger point injections, nerve blocks or autonomic blocks such as spenopalatine ganglion blocks.
The mainstay in neuromuscular dental treatment of TMJ disorders (TMD), migraines, tension-type headaches, atypical migraine, chronic daily headaches and facial pain is the diagnostic neuromuscular orthotic. THIS ORTHOTIC IS UTILIZED TO ESTABLISH A HEALTHY "LANDING POINT" THAT HAS MINIMAL MUSCULAR AND NEUROMUSCULAR ADAPTATION. This allows the body and all of the neuromuscular components a healthy environment to heal.
Doctors do not cure patients! The best doctors remove the impediments to healing! The body than returns to a healthy homeostatic condition. This is what is accomplished with the neuromuscular orthotic over a series of several appointment. If the patient experiences complete relief and /or total elimination of symptoms for an extended period the stabilization phase can be initiated. When patient have substantial relief but still have remaining symptoms they will determine whether they are ready for stabilization.
Long term stabilization can be a very expensive full mouth reconstruction but this is usually one of many possible treatments. Long term removable orthotics, orthodontics and semi-permanent appiances allow pain control without the expense of a reconstruction. WHAT IS IMPORTANT IS THAT THE PATIENT IS READY FOR LONG TERM STABILIZATION. The diagnostic orthotic is not a long term treatment. Frequently patients have dramatic improvements with their orthotics but do not precede to long term stabilization and see their symptoms return as the appliance wears down or breaks.
Sleep disturbances frequently accompany craniomandibular disorders and headaches. Patients with tiredness, morning headaches, nocturnal headaches, high blood pressur and memory problems usuallly need to be evaluated at a sleep lab utilizing a full polysomnograph array.
There are many varied and diverse advantages to neuromuscular dentistry over standard medical approaches. The single biggest problem in treating headaches utilizing neuromuscular dental technology is that it can be expensive. Insurance companies are aware that 50% reduction in symptoms almost always occurs with treatment. This is a higher positive respone than almost any drug regimens. Insurance companies frequently chose to deny coverage to increase profits to shareholders. Patients who have undergone numerous CAT Scans, MRI's ,Drug therapies and surgeries without adequate control of their pain frequently find that Neuromuscular Dentistry gives amazing relief and improves the quality of their lives and the lives of their loved ones and are then denied coverage for treatment. Many of these patients have exhausted their resources on unsuccessful therapies prior to learning about and experiencing relief thru neuromuscular dentistry.
The Alliance of TMD Organizations is working to address the unfair practices of insurance companies relative to the treatment of TMJ disorders and Headaches related to the masticatory system. They are also the primary group protecting the rights of TMJ patients. There is a large group of clinicians in dentistry who believe the problems patients experience are psychosocial and not physical and want medication to become the only treatment available to most patients. They would like to take away patients right to chose non-drug alternative treatments. Unfortunately this group has enormous political influence and exert control over most research funds often to the detriment of patients. This remains true even after scandals in FDA hearings led removal of some of their members from FDA panels. There are also numerous instances of unethical conflicts of interest that were not disclosed to the FDA. Additional information on the TMD alliance is available at: http://www.tmdalliance.org/
I would like to disclose that I am a representative of ICCMO to the Alliance and that I am a long term member of The American Equilibration Society, The American Academy of CranioFacial Pain and a member of The International Academy of Comprehensive Aesthetics. I am also a Diplomate of the American Academy of Pain Management. These are member organizations of the TMD Alliance. I am the chair of the insurance reimbursement commitee.
Neuromuscular Dental Treatment of headaches is usually divided into two phases: the initial treatment phase (pain reduction and elimination) and long term stabilization (long term maintenance of improved quality of life).
The initial treatment phase includes the diagnostic protocols established by the particular neuromuscular dentist, comprehensive exam including medical histroy review (extremely important), muslce palpation exam, range of motion evaluation radiographs. The use of EMG (electomyography) and computerized mandibular scans (CMS or MKG), sonography, ultra low frequency TENS and transcranial neurostimulation are frequently useful in understanding the variable in the course of the doctor establishing a working diagnosis. More advanced practitioners frequently wil do diagnostic trigger point injections, nerve blocks or autonomic blocks such as spenopalatine ganglion blocks.
The mainstay in neuromuscular dental treatment of TMJ disorders (TMD), migraines, tension-type headaches, atypical migraine, chronic daily headaches and facial pain is the diagnostic neuromuscular orthotic. THIS ORTHOTIC IS UTILIZED TO ESTABLISH A HEALTHY "LANDING POINT" THAT HAS MINIMAL MUSCULAR AND NEUROMUSCULAR ADAPTATION. This allows the body and all of the neuromuscular components a healthy environment to heal.
Doctors do not cure patients! The best doctors remove the impediments to healing! The body than returns to a healthy homeostatic condition. This is what is accomplished with the neuromuscular orthotic over a series of several appointment. If the patient experiences complete relief and /or total elimination of symptoms for an extended period the stabilization phase can be initiated. When patient have substantial relief but still have remaining symptoms they will determine whether they are ready for stabilization.
Long term stabilization can be a very expensive full mouth reconstruction but this is usually one of many possible treatments. Long term removable orthotics, orthodontics and semi-permanent appiances allow pain control without the expense of a reconstruction. WHAT IS IMPORTANT IS THAT THE PATIENT IS READY FOR LONG TERM STABILIZATION. The diagnostic orthotic is not a long term treatment. Frequently patients have dramatic improvements with their orthotics but do not precede to long term stabilization and see their symptoms return as the appliance wears down or breaks.
Sleep disturbances frequently accompany craniomandibular disorders and headaches. Patients with tiredness, morning headaches, nocturnal headaches, high blood pressur and memory problems usuallly need to be evaluated at a sleep lab utilizing a full polysomnograph array.
Friday, January 28, 2011
Continuous headache with earache and eye ache.
David: I have had continous Headaches for 3-4 months now. sides and back of head mainly. Earache and eye ache as well
Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.
An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial pain. If stretch and spray gives relief of the headache, earache and eye ache you will confirm the muscular component.
Because almost all Tension Type Headaches are influences by the Trigeminal Nervous system you will probably do well by tring a Diagnostic Neuromuscular Orthotic as a non-invasive safe diagnostic and treatment entity. If yo get complete relief you will confirm that the headache is muscular and trigeminally modulated.
Occasionally trigger point injections are needed to break-up long standing muscle issues.
Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.
An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial pain. If stretch and spray gives relief of the headache, earache and eye ache you will confirm the muscular component.
Because almost all Tension Type Headaches are influences by the Trigeminal Nervous system you will probably do well by tring a Diagnostic Neuromuscular Orthotic as a non-invasive safe diagnostic and treatment entity. If yo get complete relief you will confirm that the headache is muscular and trigeminally modulated.
Occasionally trigger point injections are needed to break-up long standing muscle issues.
Sunday, December 12, 2010
TENSION-TYPE HEADACHES AND MIGRAINES OFTEN HAVE COMMON CO-MORBIDITIES OF TEMPOROMANDIBULAR DISORDERS, MYOFASCIAL PAIN AND FORWARD HEAD POSITION
A new article "Pure tension-type headache versus tension-type headache in the migraineur." in Curr Pain Headache Rep. 201:465-9.0 Dec;14(6) (PubMed abstract below) looks at primary headache disorders. What is most interesting is that they state that differential diagnosis is made difficult to the frequent presence of co-morbidities including temporomandibular disorders and myofascial pain.
I wish the authors could realize that what they classify as co-morbidities are actually underlying triggers and causes of both migraines and tension-type headaches. When they assume that these headaches are primary they miss the opportunity to actually treat and prevent them from occuring. The authors go on to state "chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache" and missing the fact that central sensitiztion and chronicity is due to not treating the primary trigeminal nerve problem that is secondary to repetitive motion injuries from underlying dysfunction that leads to myofascial pain disorders.
There is a musclar component as well as a neurogenic/vascular component to all headaches. The real issue is the elimination of the conditions that trigger tension-type headaches, migraines and TMJ (TMD) disorders. Neuromuscular dentistry is extremely effective in preventing and eliminating tension-type headaches and migraines because it eliminates the repetitive strain injuries by idealizing the physiologic status of the entire trigeminal nervous system that is responsible in whole or in part for almost all migraines and tension-type headaches as well as other head, neck and facial pain.
Curr Pain Headache Rep. 201:465-9.0 Dec;14(6)
Pure tension-type headache versus tension-type headache in the migraineur.
Blumenfeld A, Schim J, Brower J.
The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract
Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.
PMID: 20878271 [PubMed - in process]
I wish the authors could realize that what they classify as co-morbidities are actually underlying triggers and causes of both migraines and tension-type headaches. When they assume that these headaches are primary they miss the opportunity to actually treat and prevent them from occuring. The authors go on to state "chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache" and missing the fact that central sensitiztion and chronicity is due to not treating the primary trigeminal nerve problem that is secondary to repetitive motion injuries from underlying dysfunction that leads to myofascial pain disorders.
There is a musclar component as well as a neurogenic/vascular component to all headaches. The real issue is the elimination of the conditions that trigger tension-type headaches, migraines and TMJ (TMD) disorders. Neuromuscular dentistry is extremely effective in preventing and eliminating tension-type headaches and migraines because it eliminates the repetitive strain injuries by idealizing the physiologic status of the entire trigeminal nervous system that is responsible in whole or in part for almost all migraines and tension-type headaches as well as other head, neck and facial pain.
Curr Pain Headache Rep. 201:465-9.0 Dec;14(6)
Pure tension-type headache versus tension-type headache in the migraineur.
Blumenfeld A, Schim J, Brower J.
The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract
Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.
PMID: 20878271 [PubMed - in process]
Sunday, November 7, 2010
Facial Pain, Normal Sinus CT scans, Headache, Migraine and TMD
An older study in the Laryngescope is on 104 patients with facial pain who had normal CT scans. Twenty nine of the patients had previous unsuccessful sinus surgery. The patients were approximately 80% women, TMJ disorders are usually (80%) found in female patients.
The study showed " Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis." It is essential that organic neurologic causes are ruled out but the 100 remaining patients had headaches of undetermined causes. Facial pain and sinus pain are a alert for MPD (myofascial pain) and TMD (temporomandibular pain). Treatment of patients with chronic headaches, migraines sinus and/or facial pain is frequently done without a neuromuscular dental evaluation even though NMD has extremely high success rates.
The Trigeminal nerve innervates the sinus cavities. It is often called the Dentist's nerve because the trigeminal nerve primarily goes to the teeth, jaw muscles, jaw joints, periodontal ligaments and is responsible in full or part for most headaches. It also controls blood flow to the anterior 2/3 of the brain thru the meninges.
Correction of underlying neuromuscular problems often allows drug free effective treatment. When CT scans are normal patients with sinus pain and facial pain should always be evaluated by a neuromuscular dentist. Neurologists should evaluate all patients with organic brain disorders but functional treatment is preferred to heavy drug therapy for the majority of patients.
Frequently Chiropracters and dentists can get miraculous results by working together especially NUCCA and A/O (Atlas Orthogonal) chiropracters. The Dentists can correct nociceptive trigeminal nerve input while the chiropracters correct cervical and head posture. Long term correction of those problems usually requires correction of descending conditions associated with improper jaw function.
Laryngoscope. 2004 Nov;114(11):1992-6.
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.
Paulson EP, Graham SM.
Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USA.
Abstract
OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.
STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board.
METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.
RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).
CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.
PMID: 15510029 [PubMed - indexed for MEDLINE]
The study showed " Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis." It is essential that organic neurologic causes are ruled out but the 100 remaining patients had headaches of undetermined causes. Facial pain and sinus pain are a alert for MPD (myofascial pain) and TMD (temporomandibular pain). Treatment of patients with chronic headaches, migraines sinus and/or facial pain is frequently done without a neuromuscular dental evaluation even though NMD has extremely high success rates.
The Trigeminal nerve innervates the sinus cavities. It is often called the Dentist's nerve because the trigeminal nerve primarily goes to the teeth, jaw muscles, jaw joints, periodontal ligaments and is responsible in full or part for most headaches. It also controls blood flow to the anterior 2/3 of the brain thru the meninges.
Correction of underlying neuromuscular problems often allows drug free effective treatment. When CT scans are normal patients with sinus pain and facial pain should always be evaluated by a neuromuscular dentist. Neurologists should evaluate all patients with organic brain disorders but functional treatment is preferred to heavy drug therapy for the majority of patients.
Frequently Chiropracters and dentists can get miraculous results by working together especially NUCCA and A/O (Atlas Orthogonal) chiropracters. The Dentists can correct nociceptive trigeminal nerve input while the chiropracters correct cervical and head posture. Long term correction of those problems usually requires correction of descending conditions associated with improper jaw function.
Laryngoscope. 2004 Nov;114(11):1992-6.
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.
Paulson EP, Graham SM.
Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USA.
Abstract
OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.
STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board.
METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.
RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).
CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.
PMID: 15510029 [PubMed - indexed for MEDLINE]
Thursday, July 15, 2010
Frontal and Occipital Headaches with Facial Numbness
From Vicki:
I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.
Dr Shapira response:
I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.
The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.
The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.
One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.
The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.
The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.
Following complete (or close) pain relief a long term solution can be evaluated.
I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.
Dr Shapira response:
I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.
The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.
The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.
One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.
The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.
The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.
Following complete (or close) pain relief a long term solution can be evaluated.
Wednesday, June 2, 2010
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
"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
Wednesday, March 17, 2010
MYOFASCIAL EXAMINATION LEADS TO DIAGNOSIS AND SUCCESSFUL TREATMENT OF MIGRAINE HEADACHE
A new article in the Journal of Musculoskeletal Pain by Michael Sorrell, MD of Tufts University showed excellent results in treating Migraine utilizing trigger point injections and physical therapy with supervised home stretching. The examination of the myofascial trigger points is a step rarely done in working up migraine patients,The majority of patients had received previous diagnosis of migraine and had undergone unsuccessful drug treatment. These patients were unaware that their pain could be referred from muscles until the examination of the muscles revealed the referred pain.
The examination did not include all of the the masticatory muscles but did include masseter and temporalis muscles,the sternocleidomastoid muscle,the trapezius muscle, the corrugater supercilius, the semispinalis, splenius cevicus and capitus muscles, as well as the suboccipitalis and levator scapulae muscles. If muscle palpation examination reproduced the headache the patients were included in the trial.
This study only included patients with chronic migraine and migraine without aura whose pain could be reproduced from muscle examination. A subgroup of 11 patients with Migraine with aura (5 of 11 patients migraine symptoms reproduced on examination) was also included in the study. Those patients did remarkably well with 68% mean improvement in those receiving physical therapy and home stretching compared to 5% improvement in the group not utilizing physical medicine. Over 88% of the study group reported over 50% improvment.
This is an important article primarily because it is from a neurology group treating migraines. It is well known that tension type headaches respond to physical medicine and treatment of myofascial trigger point. Migraines are usually very responsive to physical medicine as well. The field of Neuromuscular Dentistry actively focuses on the elimination trigger through use of TENS, TP injections, Spray and Stretch and other techniques as well. More importantly use of neuromuscular trigger points prevents the formation of new trigger points.
The examination in the above article ignored many of the masticatory muscles known to creat migraine like symptoms.
There is also an important concept of myofascial triggers serving as a trigger for migraines. Removal of these triggers can eliminate future migraines.
I have frequently seen migraine patients achieve complete relief thru a combination of a neuromuscular diagnostic orthotic and physical medicine modalities. I have seen other patient who have greatly reduced frequency of migraine but when a migraine does occur medication is still necessary due to severity. This is common with hormonal headaches and migraines. I will have a patient with severe diaily migraines that are eliminated but the patient qwill still have a tension type headache or migraine at ovulation or prior to Menses.
These are patients who I believe we have relieved the myofascial components of their pain but the hormonal triggers remain. The headaches that are then present are less severe. Other patients may only get the aura when presented with triggers but no pain. I do believe that evaluation and elimination of myofascial triggers is important for all migraine patients but in some patients the myofacial trigger points are a secondary result of the migraine pain rather that a primary cause of migraine. It is still important to eliminate these secondary trigger points so the do not increase and become a primary problem.
The examination did not include all of the the masticatory muscles but did include masseter and temporalis muscles,the sternocleidomastoid muscle,the trapezius muscle, the corrugater supercilius, the semispinalis, splenius cevicus and capitus muscles, as well as the suboccipitalis and levator scapulae muscles. If muscle palpation examination reproduced the headache the patients were included in the trial.
This study only included patients with chronic migraine and migraine without aura whose pain could be reproduced from muscle examination. A subgroup of 11 patients with Migraine with aura (5 of 11 patients migraine symptoms reproduced on examination) was also included in the study. Those patients did remarkably well with 68% mean improvement in those receiving physical therapy and home stretching compared to 5% improvement in the group not utilizing physical medicine. Over 88% of the study group reported over 50% improvment.
This is an important article primarily because it is from a neurology group treating migraines. It is well known that tension type headaches respond to physical medicine and treatment of myofascial trigger point. Migraines are usually very responsive to physical medicine as well. The field of Neuromuscular Dentistry actively focuses on the elimination trigger through use of TENS, TP injections, Spray and Stretch and other techniques as well. More importantly use of neuromuscular trigger points prevents the formation of new trigger points.
The examination in the above article ignored many of the masticatory muscles known to creat migraine like symptoms.
There is also an important concept of myofascial triggers serving as a trigger for migraines. Removal of these triggers can eliminate future migraines.
I have frequently seen migraine patients achieve complete relief thru a combination of a neuromuscular diagnostic orthotic and physical medicine modalities. I have seen other patient who have greatly reduced frequency of migraine but when a migraine does occur medication is still necessary due to severity. This is common with hormonal headaches and migraines. I will have a patient with severe diaily migraines that are eliminated but the patient qwill still have a tension type headache or migraine at ovulation or prior to Menses.
These are patients who I believe we have relieved the myofascial components of their pain but the hormonal triggers remain. The headaches that are then present are less severe. Other patients may only get the aura when presented with triggers but no pain. I do believe that evaluation and elimination of myofascial triggers is important for all migraine patients but in some patients the myofacial trigger points are a secondary result of the migraine pain rather that a primary cause of migraine. It is still important to eliminate these secondary trigger points so the do not increase and become a primary problem.
Wednesday, February 17, 2010
Sleep and Headaches linked in article in Current Treatment Options in Neurology
An article by Jeanetta C. Rains1 and J. Steven Poceta gives an opinion paper on the relation of sleep to headache. They feel that headache is linked to a wide variety of sleep disorders that may impact treatment results and headache management.
They believe that after standard diagnosis of headache a sleep history should be collected according to headache problems. Initally they state that you should rule out sleep apnea in patients with headaches on awakening. I agree and have frequently said that the two main causes of morning headaches are TMJ disorders, Sleep Apnea and Bruxing. The NHLBI of the NIH published a report "Cardiovascular and Sleep Related Consequences of Temoporomandibular Disorders" Morning headaches can also be caused by jaw clenching but newer evidence relates clenching to awakenings by sleep disordered breathing.
They believe that cluster headaches, chronic migraine and chronic tension-type headache should have sleep apnea ruled out as a cause. I believe that looking at the neuromuscular system to evaluate patients for TMJ disorders, muscle disorders and trigeminal nervous disorders related to the bite is also essential. Neuromuscular Dentistry is a method that has been shown to be "overwhelmingly successful according to Dr Barry Cooper and as published in Cranio Journal.
If there are signs and symptoms of sleep apnea they Rx polysomnography and treatment with CPAP. While CPAP is effective I feel patients with headaches and sleep apnea would be much better served by combining treatments by utilizing an intra-oral apnea appliance that will also help decrease headaches of trigeminal orgin, or almost all types of headaches. Studies with oral appliances for headache treatment show a minimal 50% improvement in the majority of patients. They do not advocate suspending regular headache treatment when treating apnea but many of the patients treated with oral appliances report complete relief of headaches. CPAP can also be effective but 60% of patients reject it and it causes negative side effects in a significant number of patients who use it leading to discontinuation of CPAP and/or poor compliance.
The authors stated that use of oral appliance, surgery and weight loss are untested displaying a suprising amout of ignorance about the current parameters of care for treating sleep apnea that considers oral appliances to be a first line of treatment for mild to moderate sleep apnea and an alternative for severe apnea when CPAP is not tolerated. The percentage of patients that do not tolerate CPAP is the same for mild, moderate and severe sleep apnea patients.
The authors reported "patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients." They did not specify it is was sleep onset insomnia or maintenance of sleep insomnia.
The authors also stated "All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management."
I believe it in incumbent on physicians and dentists treating headaches be acutely aware of the effect of sleep disorders on headache.
They should also be aware that psychiatric disorders and depression frequently occur in chronic pain patients as a direct result of the chronic pain.
Treatment of sleep disorders and headache with a combination of a neuromuscular daytime orthotic and a n intraoral sleep apnea appliance or use of a 24 hour orthotic is "overwhelming successful" as published in Cranio Journal.
They believe that after standard diagnosis of headache a sleep history should be collected according to headache problems. Initally they state that you should rule out sleep apnea in patients with headaches on awakening. I agree and have frequently said that the two main causes of morning headaches are TMJ disorders, Sleep Apnea and Bruxing. The NHLBI of the NIH published a report "Cardiovascular and Sleep Related Consequences of Temoporomandibular Disorders" Morning headaches can also be caused by jaw clenching but newer evidence relates clenching to awakenings by sleep disordered breathing.
They believe that cluster headaches, chronic migraine and chronic tension-type headache should have sleep apnea ruled out as a cause. I believe that looking at the neuromuscular system to evaluate patients for TMJ disorders, muscle disorders and trigeminal nervous disorders related to the bite is also essential. Neuromuscular Dentistry is a method that has been shown to be "overwhelmingly successful according to Dr Barry Cooper and as published in Cranio Journal.
If there are signs and symptoms of sleep apnea they Rx polysomnography and treatment with CPAP. While CPAP is effective I feel patients with headaches and sleep apnea would be much better served by combining treatments by utilizing an intra-oral apnea appliance that will also help decrease headaches of trigeminal orgin, or almost all types of headaches. Studies with oral appliances for headache treatment show a minimal 50% improvement in the majority of patients. They do not advocate suspending regular headache treatment when treating apnea but many of the patients treated with oral appliances report complete relief of headaches. CPAP can also be effective but 60% of patients reject it and it causes negative side effects in a significant number of patients who use it leading to discontinuation of CPAP and/or poor compliance.
The authors stated that use of oral appliance, surgery and weight loss are untested displaying a suprising amout of ignorance about the current parameters of care for treating sleep apnea that considers oral appliances to be a first line of treatment for mild to moderate sleep apnea and an alternative for severe apnea when CPAP is not tolerated. The percentage of patients that do not tolerate CPAP is the same for mild, moderate and severe sleep apnea patients.
The authors reported "patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients." They did not specify it is was sleep onset insomnia or maintenance of sleep insomnia.
The authors also stated "All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management."
I believe it in incumbent on physicians and dentists treating headaches be acutely aware of the effect of sleep disorders on headache.
They should also be aware that psychiatric disorders and depression frequently occur in chronic pain patients as a direct result of the chronic pain.
Treatment of sleep disorders and headache with a combination of a neuromuscular daytime orthotic and a n intraoral sleep apnea appliance or use of a 24 hour orthotic is "overwhelming successful" as published in Cranio Journal.
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