Lake Forest TMJ, Headaches, Migraines and Neuromuscular Approach To Definitive Personalized Treatment

The relationship of TMJ Disorders to Headaches and Migraines are well documented in both medical and dental literature.  The primary connection is via the Trigeminal Nerve.  The Trigeminal Nerve is often called the "Dentists Nerve" but the Trigeminal nerve is also at the center of each and every headache and migraine treated by physicians and neurologists.  The science behind this connection is two-fold.  The Trigeminal nerve also controls the blood flow to the anterior two thirds of the meninges of the brain.

Sinus headaches are usually treated by ENT's or Otolaryngologists but the Trigeminal Nerve is also front and center in both acute and chronic sinus pain.  Multiple studies have shown that most diagnosis of sinus infections causing pain are in fact incorrect.  

There are many documented cases of complete relief of all of these disorders with eliminated with Neuromuscular Dental Orthotics especially when combined with treatment of Myofascial Pain Disorders (MPD).  There are over 100 Chicago patient Testimonials at: 

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

WWW.ThinkBetterLife.com is the website of my new office dedicated to treatment of both TMJ Disorders, Sleep Disorders including Snoring & Sleep Apnea and chronic headaches and migraines.

The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) has published a report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" that should be read by every patient with TMJ disorders, Morning Headaches, Chronic Daily Headaches, Sleep Apnea, Snoring and migraines.

 https://www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf

Sphenopalatine Ganglion Blocks are an amazing adjunct for treating chronic pain disorders.  It works via the autonomic nervous system and turns off the "Fight or Flight" reflex that is implicated in tension headaches, chronic anxiety and panic attacks.  www.sphenopalatineganglionblocks.com

Facial Pain Relief in Chicago: Expertise in Trigeminal Nervous System is needed for Effective Treatment of Facial Pain, Migraine and Chronic Daily Headaches

Chronic facial pain is often seen in a very different light than other chronic pains.  For a long time Atypical Facial Pain was considered a psychiatric diagnosis   It is been reclassified and is now considered a trigeminal nerve or other cranial nerve disorder.

This type of pain is frequently associated with long term suffering and frequent misdiagnosis.  I have been treating chronic atypical facial pain for over 30 years in my Gurnee and Highland Park offices.
To learn more visit my office websites;
Highland Park:  www.ThinkBetterLife.com
Gurnee:   www.DelanyDentalCare.com

The ICD 10 coding for atypical facial pain or persistent idiopathic facial pain is as follows.

13.18.4	Persistent idiopathic facial pain [G50.1]	G44.847
Previously used terms	Atypical facial pain

THE DESCRIPTION OF THIS PAIN IS VERY SIMPLE AND COULD EASILY BE A MYOFASCIAL OR TMD CONDITION.  IT IS CONSIDERED DIFFERENT THAN HEADACHES OR MIGRAINES

Description:

Persistent facial pain that does not have the characteristics of the cranial neuralgias described above and is not attributed to another disorder.

Diagnostic criteria:

1. Pain in the face, present daily and persisting for all or most of the day, fulfilling criteria B and C
2. Pain is confined at onset to a limited area on one side of the face¹, and is deep and poorly localised
3. Pain is not associated with sensory loss or other physical signs
4. Investigations including x-ray of face and jaws do not demonstrate any relevant abnormalit

POSSIBLY THE BEST METHOD OF CLASSIFYING THESE PAINS MAY NOT BE THE DESCRIPTION OF THE PAIN BUT RATHER WHAT THE PAIN RESPONDS TO.

SPB Blocks have been used for years to treat headaches, migraines and other pain disorders.  Sluders neuralgia was origiinally described in 1908 but is sometimes considered the original TMJ diagnos prior to the diagnosis of Costen's syndrome.  

The diagnosis of contact point headaches also known as Anterior Ethmoid neuralgia, pterygopalatine ganglion neuralgia, Sluder's Neuralgia and sphenopalatine Ganglion neuralgia often presents as pain of unknown orgin .  It can respond to SPG Blocks but in general is very resistant to diagnosis.

This condition may be a nerve compression syndrome but it can spread pain anywhere in the opthalmic or maxillary divisions or the Trigeminal Nerve.

The pain follows a similar pattern as trigger points in pterygoid, masseter and temporalis muscles.  It can sometimes be relieved by decongestants such as Afrin that shrink the nasal tissues.

Neuromuscular Dentistry in conjunction with SPG Blocks, Trigger Point injections, Spray and Stretch, prolotherapy is still the most effective approach to chronic facial pain.

All work should begin with reversible therapy and permanent changes should only be done after extended relief of pain.

#ChicagoMigraines, #ChicagoContactHeadache, #ChicagoSPGBlock, #ChgicagoImprovingQualityof Life, #IllinoisFacialPain

Quality of Life Considerations in Migraine and Chronic Daily Headache Treatment

This was originally published as a Blog for www.ThinkBetterLife.com and my Highland Park Illinois office that serves Highland Park, Lake Forest, Dererfield, The entire North Shore, Chicago, Lake County and Cook County. The office is conveniently located on the Metra line North at the Fort Sheridan stop.  The office is dedicated to treatment of Chronic pian, TMJ disorders and sleep disorders including migraines, trigeminal neuralgia, and chronic daily headaches.

Migraines, Chronic Daily Headaches, Tension Headaches and the Trigeminal Autonomic Cephalgias are all extremely invasive and disruptive to overall quality of life.

Medications to treat these disorders are often dangerous and have multiple side effects that range from minor to life threatening.

Medication Overuse Headaches and Rebound Headaches can actually be worse than the original problem the medications are used to treat. Even ubiquitous drugs like Ibuprofen are responsible for thousands of deaths on a yearly basis and a host of GI problems.

The two ways to approach headaches treatment is to prevent the onset or to treat the actual headache when it occurs.

Preventing the onset can be the avoidance of headache triggers and /or drug treatment.

I am not discussing drugs for treating migraines in this paper but rather alternative to stand drug therapies.

An excellent alternative that is more effective than most drugs for most people is the Sphenopalatine Ganglion Block. There are several methods of preforming SPG Blocks some of which require a visit to the doctor and others that can be preformed by the patient in the comfort of their own homes. The Sphenopalatine Ganglion is the largest parasympathetic ganglion in the head. The block turns off sympathetic overload often called the Fight or Flight reflex that can be a major headache/migraine trigger.

The best method is the intranasal approach by the patient to be reviewed later in this article.

There are multiple methods of injection. The injection thru the Greater Palatine foramen is an intraoral injection that is routinely used in dentistry. Oral Surgery procedures often require this block for removing wisdom teeth. Many patients who have maxillary wisdom teeth removed experience a respite from migraines often for an extended time. More often than not the migraine relief is from the block not the removal of the teeth. The block can be done just to turn off a severe headache or as a migraine preventive. It is often accompanied by temporary facial numbness and numbness of the palate.

Injection can also be done extraorally either from above the zygomatic arch or through the masseter muscle. I prefer the approach that avoids the muscle. It is a relatively easy injection and can be done in the office. It is also done by some doctors using video fluoroscopy but that gratly increases the cost. This method of injection is the most effective and fastest onset often relieving the headaches in a minute or two.

This is ideal SPG approach for headaches that would put patients in the ER, migraines or severe headaches of several days duration, and especially headaches related to anxiety, stress and worry.

There are also three devices that can deliver local anaesthetic to the nasal mucosa that overlies the Sphenopalatine Ganglion. The three devices are the TX360 nasal applicator using the MiRX protocol. Its is intended for use for Trigeminal Neuralgia, Migraines, Cluster Headaches and Tension Headaches. It is essentially a high tech double barreled squirt gun that is designed to deliver anesthetic solution over the area covering the Ganglion.

The Sphenocath and the Allevio devices are simpler to use and may deliver the anaesthetic solution in a slightly superior position. The Sphenocath is the original device and the Allevio is a copy made by the Sphenocath ‘s original manufacturer.

My preferrd method when nasal passages are large enough is to utilize hollow cotton tipped applicators that use a capillary action to continually deliver anaesthetic over a longer period of time.

The beauty of this approach is that patients can self apply the block in minutes at an extremely low cost. They can turn off the headache faster than any drugs take effect and Lidocaine or other anesthetic can be used.

Side effects are feeling relaxed, turning off fight or flight response, reduced anxiety, increased parasympathetic actiity such a digestion, feelings of warmth and comfort, increased sexual desire and responsiveness, lower blood pressure and other positive effects.

The most effective method of eliminating triggers is through a diagnostic neuromuscular orthotic that can be created to decrease noxious input to the trigeminal nervous system that causes headache. The diagnostic appliance allows evaluation of the effect in a safe and cost effective approach prior to comencine and dental, orthodontic or orthopedic interventions.

The combination or SPG Blocks and Neuromuscular Dentistry may be the closest we will ever come to curing migraines and other trigeminal type headaches.

Drug treatments are directed at changing neurotransmitter and neuropeptide levels by drug interaction. Neuromuscular Dentistry and SPG Blocks do it by restoring homeostasis and eliminating noxious input to the trigeminal nervous system.

The noxious input causes the ultimate release of neuropeptides by the TrigeminoVascular System like CGRP or Calcitonin gene Related Peptide in the meninges in the anter two thirds of the brain which cause vascular headaches,

It also corrects input to the trigeminal cervical complex that is responsible ofr occipital headaches, while at the same time postural corrections of the head reduce excess cervical muslce activity and makes the spine, especially C1 and C@ or the Atlas and Axis more stable. The mechanics have been well explained in the Quadrant Theorem of Guzay.

My Headaches Are Destroying My Relationships and My Family

From www. IHATEHeadaches.org e-mail

Susan: I have been having severe chronic daily headaches for over 5 years. I have been diagnosed as sinus headaches, migraines, atypical migraines, TMJ, Trigeminal Neuralgia. I have had numerous CAT Scans and MRI that all appear normal. I have tried multiple medications that seem to slightly ease the pain on a temporay basis but I do not remember the last time I was pain free. My marital life is a mess and my husband doesn't understand how I can have so much pain when all the tests are normal. I am constantly yelling at the kids and the feel horribly guilty. My friends have all but cut off contact but it is probably my fault. I wish the scans could find a tumor so everyone would know the pain was real.
I'm desperate but that just seems to make the pain even worse.

Dr Shapira:
Susan, Please do not give up. I have heard many stories similar to yours. First, because all of the tests have been negative for disease there is excellent hope for significant improvement.. I suggest you seek out a Neuromuscular Dentist who also understands chronic Myofascial Pain and the use of Trigger Point Injections, Sphenopalatine Ganglion Blocks, Spray and stretch techniques.

Susan, it is important to understand that eliminating your pain is not a cure. You have been forever changed by the hell you have been experiencing. The only real cure would be a do-over on the last five years of your life. The goal of treatment is eliminate pain and restore quality to your life and allow you to reconnect with your husband, children, family and friends. The pain you have lived with has changed who you are forever but that may just make you appreciate your life more in the future.

The medical model for Chronic Headaches is diagnostic test and then perscription medicine. I find that patients who have symptoms you describe are easier to treat than expected. I usually spend 1-2 hours on an initial consultation with new patients. Initially we talk so I can understand who you are, how the pain is affecting you, your life and your family. The next part of the consultation is to try to eliminate some or all of the pain you are experiencing at that time.

I usually begin with trigger point deactivation of the cranial and upper body muscles. It is amazing how frequently we can elimnate all or most of the pain just by utilizing techniques described by Dr Janet Travell over 50 years ago. Dt Travell was President John F Kennedy's physician.

The majority of all pain patients experience is muscular in orgin, and turning off the pain allows us to understand the undrlying processes. At this same visit we will make a trial change of proprioception into the central nervous system from the trigeminal nerves.

We can usually eliminate most pain during the first visit the hard work is to make these changes on a long term basis. I tell my patients to set a goal of 50-80% reduction in pain initially. As treatment progresses we continually try to remove 50-80% of remaining pain. This is accomplished by utilizing a diagnostic neuromuscular orthotic to change how the muscles function and to alter trigeminal nerve proprioceptive input to the brain.  Over time there are postural changes and healing.

I often find that I "meet" my patients at the third or fourth appointment.  The patient I meet initially is the person living in pain for months or years but after a few visits I meet the real person who was lost under an avalanche of pain.  There is a great joy in watching people recover and regain their lives.

I practice Neuromuscular Dentistry and Pain Treatment as part of my Chicago area TMJ practice.

Intense Migraines: Trigeminal Neuralgia, Trigeminal Neuropathy or a simple problem best addressed through Neuromuscular Dentistry and an orthotic.

Carolyn: Intense migrane headaches with jaw, neck, shoulder, face, sinues,eye and ear pain, also numb feeling on face. I had MRI's done of my head and neck and was diagnosed with Trigeminal Neuralgia, seeked Gamma Knife, was told I wasn't a canidate and to have an MRI of my neck, had that done, nothing showed up, then was told I had Trigeminal Neuropothy. I was diagnosed with TMJ a long time ago and had a mouth piece...it didn't do much and as time went on things got worse. I am convienced that my problem is with the Tri nerves and TMJ...no doctor has caught on. I am at my wits end and need to find out what is wrong with my neck and face. Please help me in finding a doctor who could figure out my problem. Thank you!!

Dr Shapira response: Carolyn, I am sorry your life is being destroyed by what sounds like horrible pain. I would strongly suggest avoiding Gamma Knife surgery as a first line treatment.

You did not mention trying non-invasive or minimally invasive treatment such as massage therapy, chiropractic adjustment or Ice Down Therapy which can be helpful. The beauty of Neuromuscular Dentistry is that results can be rapid, amazing and life changing in just a few visits. I would suggest starting with very simple diagnostic evaluation such as spray and stretch with vapo-coolant for myofascial pain, trigger point injections SPG blocks and most importantly a diagnostic neuromuscular orthotic.

I frequently see long distance patients and we can sometimes produce amazing results in just wo to three days of intensive therapy. We do our consultation , work-up and exam the morning of the first day and deliver an orthotic that afternoon. We deactivate trigger point injections with spray and stretch techniques as described by Dr Janet Travell. The second morning we adjust the appliance and do diagnostic/treatment trigger points and blocks and adjust again that afternoon. I work closely with an Atlas orthoganol DC who can address the cervical vertebrae during your stay.

There is no "CURE" for these problems but rapid relief is possible and the orthotic lets you maintain comfort. A real "CURE" would mean you could get back the years you lost to pain, reverse the effects on your life, your relationships and your family. The best we can do is give you a brighter future.

All of the symptoms you descibed are why TMJ disorders are called "The Great Imposter"

Read "Suffer No More: Dealing With The Great Imposter" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

Contact my office if you would like to schedule a 3 day series of appointments for rapid evaluation and treatment or I will try to find you a knowledgable doctor in your area.

Shooting pains in the head and face. Is Trigeminal Neuralgia the Cause? Why did MVD brain surgery not help?

Melanie: I have had root canals, anti seizure meds I could not tolerate, and on 12/30/10 I had MVD brain surgery. I still have pain and shocks in my facial area, teeth, ears and the back of my head (cannot lay down). Am currently seeing a doctor that is giving me occipital nerve block injections. Just saw the doctor at Duke who did the MVD surgery and he admitted that his surgery did not fix the problem and they don't have anything else to offer me. I am seeing an oral surgeon in Vinton, VA on 3/28 for a TMJ consultation, but I went to UNC-Chapel Hill school of dentistry last year for an evaluation and was told that my TMJ is not causing the neuralgia and shocks. I am so light sensitive I cannot go outside or watch TV. I cannot talk on the phone without getting shocked so please do not call me. I cannot chew without causing an increase in shocks. Sometimes by the evening hours I cannot talk but have to write notes to communicate with my husband. I have had neck problems fo r years, treated by chiropractic. In fact the shocks started after a rather aggressive chiropractic neck adjustment (in June 2010).

Dr Shapira Response: Dear Melanie,

I am sorry you are having to bear so much pain. I know it is not easy. Are the occipital nerve blocks helping? The fact that the Microvascular decompression did not help probably means it was not the source of the problem.

Have you tried a spenopalatine ganglion block? The SPG block can be done as an injection or through the nose. It addresses the autonomic potion of the trigeminal nerve. The nasal block can be easily and painlessly self administered on a daily basis for 20 minutes (one or more times a day) and can give miraculous results for some patients.

It is unlikely that you will find an oral surgeon who understands neuromuscular (NMD) dentistry. I have seen incredible results with NMD but it can be a problem depending on where your trigger locations are. You may not have a "TMJ" problem but have problem with masticatory system and trigeminal nerves. CRPS (chronic regional pain syndrome) is also a possibility.

Do you have a specific trigger area or spots that can be identified? It is also possible that a medially displce disk can be pressing on the trigeminal nerve. This could be addressed surgically.

How long ago did this problem begin? Did the Chiropractic adjustment exacerbate or start the problem? If it really stated immediately after chiro adj you might want to consider having a stellate ganglion block.

I usually try to avoid surgical procedures initially as frequently surgery can make problems more severe. Did the severity change following surgery, for better or worse or was the pain just unchanged?

Facial Pain and Headache: Incidence of Facial Pain

A recent article in the Journal Pain looked at incidence of facial pain in the Netherlands. The authors wanted to " The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH)"

Trigeminal Neuralgia and Cluster Headaches were the most common types and both increased with age. This study found that facial pain was rare but more common than expected prior to the study. The trigeminal nerve is frequently a culprit in many types of pain disorders. Many, but not all patients with trigeminal neuralgia diagnosis will respond positively to neuromuscular treatment.

My take on this is a little different because I frequently see patients who complain of sinus pain, tooth pain eye pain while pointing to painful areas. Thsi study would have ignored thos findings. Over the years I frequently see patients that have been given a diagnosis of a disorder neuromuscular dentistry can't treat yet they get better with an orthotic. This does not mean the orthotic can treat those conditions and often just points out a misdiagnosis. I have had patients diagnosed with MS whose symptoms disappeared with my treatment. That does not mean I treated the MS, it may just mean that the diagnosis was incorrect.

There is no harm in a second or third opinion.

Pain. 2009 Dec 15;147(1-3):122-7. Epub 2009 Sep 26.
Incidence of facial pain in the general population.
Koopman JS, Dieleman JP, Huygen FJ, de Mos M, Martin CG, Sturkenboom MC.

Dept. of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands. skoop29@gmail.com
Facial pain has a considerable impact on quality of life. Accurate incidence estimates in the general population are scant. The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH) in the Netherlands. In the population-based Integrated Primary Care Information (IPCI) medical record database potential facial pain cases were identified from codes and narratives. Two medical doctors reviewed medical records, questionnaires from general practitioners and specialist letters using criteria of the International Association for the Study of Pain. A pain specialist arbitrated if necessary and a random sample of all cases was evaluated by a neurologist. The date of onset was defined as date of first specific symptoms. The IR was calculated per 100,000PY. Three hundred and sixty-two incident cases were ascertained. The overall IR [95% confidence interval] was 38.7 [34.9-42.9]. It was more common among women compared to men. Trigeminal neuralgia and cluster headache were the most common forms among the studied diseases. Paroxysmal hemicrania and glossopharyngeal neuralgia were among the rarer syndromes. The IR increased with age for all diseases except CH and ON, peaking in the 4th and 7th decade, respectively. Postherpetic neuralgia, CH and LoN were more common in men than women. From this we can conclude that facial pain is relatively rare, although more common than estimated previously based on hospital data.

PMID: 19783099 [PubMed - in process]