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?
Monday, March 21, 2011
Monday, March 14, 2011
Are there tmj specialists? Is neuromuscular dentistry a specialty? Are neuromuscular Dentists Headache Specialists?
The answer to all of the above is no. There is no specialty in treatmrnt of TMJ disorders (TMD). Specialties are decided by the American Dental Society and individual state laws. There are however many trained Neuromuscular Dentists who devote a major part of their practice to treating TMJ patients, chronic pain patients, headache patients etc.
Neuromuscular Dentistry is unique in that it uses biomedical instrumentation to aid in the diagnosis and treatment of TMJ disorders, TMD, Myofascial pain (MPD) and referred head and neck pain.
Should there be a TMJ or orofcial pain specialty? Absolutely not!
There are often many approaches to dealing with a chronic pain problem involving the teeth and jaws. Research has shown that different approaches can be successful. Creation of a specialty is almost certain to prevent patients from a full choice of therapeutic options. There are many educational and scientific societies dedicated to treating chronic pain. The Alliance of TMD organizations has taken a stand against specialty.
I firmly believe that neuromuscular dentistry is the best method for treating most fuctional disorders of the masticatory system including MPD, TMJ, TMD and occlusion. I will be happy to respond to specific questions on this blog why I believe it is the best approach.
I am a Fellow of ICCMO the group representing Neuromuscular Dentistry but I also go to yearly meetings of the AES or American Equilibration society. I belong to the American Academy of craniofaciall pain and have attended many meetings over the years. I also belong to IACA, the international academy of comprehensive esthetics that combines function and esthetics and I am a Diplomate of the academy of pain management.
Many of these groups overlap and share common goals and ideas and there are also major disagreements between groups as to what is the best treatment.
Almost universally they show great success in treatment.
Neuromuscular Dentistry is unique in that it uses biomedical instrumentation to aid in the diagnosis and treatment of TMJ disorders, TMD, Myofascial pain (MPD) and referred head and neck pain.
Should there be a TMJ or orofcial pain specialty? Absolutely not!
There are often many approaches to dealing with a chronic pain problem involving the teeth and jaws. Research has shown that different approaches can be successful. Creation of a specialty is almost certain to prevent patients from a full choice of therapeutic options. There are many educational and scientific societies dedicated to treating chronic pain. The Alliance of TMD organizations has taken a stand against specialty.
I firmly believe that neuromuscular dentistry is the best method for treating most fuctional disorders of the masticatory system including MPD, TMJ, TMD and occlusion. I will be happy to respond to specific questions on this blog why I believe it is the best approach.
I am a Fellow of ICCMO the group representing Neuromuscular Dentistry but I also go to yearly meetings of the AES or American Equilibration society. I belong to the American Academy of craniofaciall pain and have attended many meetings over the years. I also belong to IACA, the international academy of comprehensive esthetics that combines function and esthetics and I am a Diplomate of the academy of pain management.
Many of these groups overlap and share common goals and ideas and there are also major disagreements between groups as to what is the best treatment.
Almost universally they show great success in treatment.
Sunday, March 13, 2011
ICCMO STANDS FOR THE INTERNATIONAL COLLEGE OF CRANIO MANDIBULAR ORTHOPEDICS. ICCMO IS THE ORGANIZATION FOR NEUROMUSCULAR DENTISTRY
ICCMO, THE INTERNATIONAL COLLGE OF CRANIO MANDIBULAR ORTHOPEDICS IS THE ORGANIZATION THAT REPRESENTS THE ART AND SCIENCE OF NEUROMUSCULAR DENTISTRY. DR BARNEY JANKELSON THE FATHER OF NEUROMUSCULAR DENTISTRY IS ALSO A FOUNDER OF ICCMO.
NEUROMUSCULAR DENTISTRY UTILIZES SOPHISTICATED INSTRUMENTATION TO ASSESS AND CORRECT THE PHYSIOLOGIC POSITIONING OF THE JAWS, MUSCLES, OCCLUSION AND POSTURE TO ADDRESS CHRONIC TMJ,TMD AND MYOFASCIAL PAIN PROBLEMS IN A PHYSIOLOGIC FRAMEWORK.
NEUROMUSCULAR DENTISTRY CAN VASTLY IMPROVE RESULTS IN COSMETIC, IMPLANT AND RECONSTRUCTIVE DENTISTRY. THE BASIC THEORY OF NEUROMUCULAR DENTISTRY IS THAT IDEALING THE OCCLUSION SO THAT FUNCTION DOES NOT REQUIRE PATHOLOGIC MUSCLE DAPTATION. CREATING AN IDEAL ENVIRONMENT FOR NORAM MUSCLE FUNCTION CREATES NORMAL PHYSIOLOGIC RESPONSES AND HEALTHY MUSCLES.
THE NEUROMUSCULAR SYSTEM INVOLVES THE TEETH, JAW MUSCLES, JAW JOINTS, HEAD POSTURE, SWALLOWING VESTIBULAR FUNCTION, BREATHING, SLEEPING, PERIPHERAL NERVOUS SYSTEM AND THE CENTRAL NERVOUS SYSTEM. THE TRIGEMINAL NERVES AND TRIGEMINOVASCULAR SYSTEM ARE INTIMATELY INVOLVED NOT JUST IN TMJ DISORDERS BUT ALSO IN CHRONIC DAILY HEADACHE, TENSION-TYPE HEADACHE AND MIGRAINE.
I TREAT ALL OF THESE CONDITIONS IN MY GURNEE, IL OFFICE. I AM ALSO THE SECRETARY OF ICCMO AND THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.
NEUROMUSCULAR DENTISTRY UTILIZES SOPHISTICATED INSTRUMENTATION TO ASSESS AND CORRECT THE PHYSIOLOGIC POSITIONING OF THE JAWS, MUSCLES, OCCLUSION AND POSTURE TO ADDRESS CHRONIC TMJ,TMD AND MYOFASCIAL PAIN PROBLEMS IN A PHYSIOLOGIC FRAMEWORK.
NEUROMUSCULAR DENTISTRY CAN VASTLY IMPROVE RESULTS IN COSMETIC, IMPLANT AND RECONSTRUCTIVE DENTISTRY. THE BASIC THEORY OF NEUROMUCULAR DENTISTRY IS THAT IDEALING THE OCCLUSION SO THAT FUNCTION DOES NOT REQUIRE PATHOLOGIC MUSCLE DAPTATION. CREATING AN IDEAL ENVIRONMENT FOR NORAM MUSCLE FUNCTION CREATES NORMAL PHYSIOLOGIC RESPONSES AND HEALTHY MUSCLES.
THE NEUROMUSCULAR SYSTEM INVOLVES THE TEETH, JAW MUSCLES, JAW JOINTS, HEAD POSTURE, SWALLOWING VESTIBULAR FUNCTION, BREATHING, SLEEPING, PERIPHERAL NERVOUS SYSTEM AND THE CENTRAL NERVOUS SYSTEM. THE TRIGEMINAL NERVES AND TRIGEMINOVASCULAR SYSTEM ARE INTIMATELY INVOLVED NOT JUST IN TMJ DISORDERS BUT ALSO IN CHRONIC DAILY HEADACHE, TENSION-TYPE HEADACHE AND MIGRAINE.
I TREAT ALL OF THESE CONDITIONS IN MY GURNEE, IL OFFICE. I AM ALSO THE SECRETARY OF ICCMO AND THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.
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]
Thursday, March 10, 2011
ICCMO: NEUROMUSCULAR DENTISTRY tREATMENT OF TMJ DISORDERS, HEADACHES AND MIGRAINES
ICCMO IS AN ACRONYM THAT STANDS FOR THE INTERNATIONAL COLLEGE OF CRANIOMANDIBULAR ORTHOPEDICS. WHEN LOOKING FOR A NEUROMUSCULAR DENTIST IT IS VITAL TO FIND A MEMBER OF ICCMO IF AT ALL POSSIBLE. WHILE THERE ARE OTHER GROUPS AND COURSES THAT BOTH TEACH AND UTILIZE NEUROMUSCULAR DENTISTRY TECHNIQUES ONLY ICCMO IS DEDICATED TO THE ADVANCEMENT OF NEUROMUSCULAR DENTISTRY AND THE RELATED PHYSIOLOGIC AND ANATOMIC RELATIONS TO THE WHOLE BODY.
BARNEY JANKELSOM THE FATHER OF NEUROMUSCULAR DENTISTRY FOUNDED ICCMO AS AN EDUCATIONAL GROUP DEDICATED TO THE ADVANCEMENT OF NEUROMUSCULAR DENTAL SCIENCE. iT WAS MY HONOR TO BE HIS STUDENT AND HE SPONSORED MY MEMBERSHIP TO ICCMO. I BECAME A FELLOW OF ICCMO AND I AM THE CURRENT SECRETARY OF ICCMO AS WELL AS THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.
ICCMO IS THE RECOGNIZED LEADER AND VOICE OF NEUROMUSCULAR DENTISTRY. iF HEADACHES, MIGRAINES, TMJ, TMD OR POSTURAL ISSUES ARE IMPORTANT ISSUES THAT YOU LOOKING TO HAVE TREATED I STRONGLY SUGGEST YOU FIND YOURSELF AN ICCMO NEUROMUSCULAR DENTIST WHO IS ACTIVE IN THE ORGANIZATION. BEWARE OF DOCTORS WHO ARE NOT NEUROMUSCULAR BURT MERELY PAY DUES TO ICCMO.
BARNEY JANKELSOM THE FATHER OF NEUROMUSCULAR DENTISTRY FOUNDED ICCMO AS AN EDUCATIONAL GROUP DEDICATED TO THE ADVANCEMENT OF NEUROMUSCULAR DENTAL SCIENCE. iT WAS MY HONOR TO BE HIS STUDENT AND HE SPONSORED MY MEMBERSHIP TO ICCMO. I BECAME A FELLOW OF ICCMO AND I AM THE CURRENT SECRETARY OF ICCMO AS WELL AS THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.
ICCMO IS THE RECOGNIZED LEADER AND VOICE OF NEUROMUSCULAR DENTISTRY. iF HEADACHES, MIGRAINES, TMJ, TMD OR POSTURAL ISSUES ARE IMPORTANT ISSUES THAT YOU LOOKING TO HAVE TREATED I STRONGLY SUGGEST YOU FIND YOURSELF AN ICCMO NEUROMUSCULAR DENTIST WHO IS ACTIVE IN THE ORGANIZATION. BEWARE OF DOCTORS WHO ARE NOT NEUROMUSCULAR BURT MERELY PAY DUES TO ICCMO.
Monday, March 7, 2011
CHRONIC DAILY HEADACHES AND MIGRAINE ASSOCIATED WITH TMD ACCORDING TO NEW ARTICLE IN CLINICAL JOURNAL OF PAIN.
THIS NEW ARTICLE SHOWS THAT ALL TYPES OF HEADACHES ARE ASSOCIATED WITH TMD . THE ABSTRACT OF "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." IS REPRINTED BELOW. WHILE IT IS GENERALLY ACCEPTED THAT TENSION HEADACHES, EPISODIC TENSION-TYPE HEADACHES ARE COMMONLY CAUSED BY SORE MUSCLES IN TMD PATIENTS IT IS ACTUALLY THE CHRONIC NATURE OF TMD THAT IS SO DANGEROUS.
CHRONIC PAIN CAN CAUSE CENTRAL SENSITIZATION. THIS CAN LEAD PROBLEMS LIKE ALLODYNIA, AND HYPERALGESIA BUT THE CENTRAL SENSITIZATION IS NOT NECESSARILLY PERMANENT . UNTREATED IT IS ALSO MAY RESULT IN COMPLEX REGIONAL PAIN SYNDROME. TMD WHEN UNTREATED FREQUENTLY BECOMES CHRONIC. THERE ARE SOME RESEARCHERS WHO BELIEVE THAT TMD PROBLEMS ARE MENTAL NOT MEDICAL AND "EXPERTS" SOMETIMES PRESCRIBE BIOSOCIAL THERAPY OR PSYCHOTHERAPY BUT IGNORE THE UNDERLYING PHYSICAL CAUSES AND TRIGGERS . MANY PATIENTS WITH CHRONIC PAIN DO HAVE DEPRESSION AND OTHER PSYCHOLOGICAL DISABILITIES BUT THEY ARE USUALLY CAUSED BY PATIENTS LIVING WITH PAIN.
IT CAN BE VERY DIFFICULT TO FIND PRACTITIONERS WHO SEE THAT HEADACHES, TMD, AND OTHER PROBLEMS ARE REAL DISORDERS. MANY PATIENTS FEEL THAT THEIR DOCTORS DON'T BELIEVE THEM OR UNDERSTAND THE SEVERITY OF THEIR PROBLEMS.
I FREQUENTLY SEE PATIENTS WHO RESPOND TO VERY SIMPLE TECHNIQUES ADDRESSED AT RELIEVING PAIN FROM MASTICATORY MUSCLES. THE PATIENTS ARE QUITE OPEN AND TELL ME THAT THEY WERE TOLD THAT THEY DID NOT HAVE TMJ BECAUSE THEY DID NOT HAVE CLICKING OR LOCKING.
MANY PATIENTS HAVE MASTICATORY DISORDERS AND MUSCLE PAIN THAT REPSONDS BEAUTIFULLY TO A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS.
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]
CHRONIC PAIN CAN CAUSE CENTRAL SENSITIZATION. THIS CAN LEAD PROBLEMS LIKE ALLODYNIA, AND HYPERALGESIA BUT THE CENTRAL SENSITIZATION IS NOT NECESSARILLY PERMANENT . UNTREATED IT IS ALSO MAY RESULT IN COMPLEX REGIONAL PAIN SYNDROME. TMD WHEN UNTREATED FREQUENTLY BECOMES CHRONIC. THERE ARE SOME RESEARCHERS WHO BELIEVE THAT TMD PROBLEMS ARE MENTAL NOT MEDICAL AND "EXPERTS" SOMETIMES PRESCRIBE BIOSOCIAL THERAPY OR PSYCHOTHERAPY BUT IGNORE THE UNDERLYING PHYSICAL CAUSES AND TRIGGERS . MANY PATIENTS WITH CHRONIC PAIN DO HAVE DEPRESSION AND OTHER PSYCHOLOGICAL DISABILITIES BUT THEY ARE USUALLY CAUSED BY PATIENTS LIVING WITH PAIN.
IT CAN BE VERY DIFFICULT TO FIND PRACTITIONERS WHO SEE THAT HEADACHES, TMD, AND OTHER PROBLEMS ARE REAL DISORDERS. MANY PATIENTS FEEL THAT THEIR DOCTORS DON'T BELIEVE THEM OR UNDERSTAND THE SEVERITY OF THEIR PROBLEMS.
I FREQUENTLY SEE PATIENTS WHO RESPOND TO VERY SIMPLE TECHNIQUES ADDRESSED AT RELIEVING PAIN FROM MASTICATORY MUSCLES. THE PATIENTS ARE QUITE OPEN AND TELL ME THAT THEY WERE TOLD THAT THEY DID NOT HAVE TMJ BECAUSE THEY DID NOT HAVE CLICKING OR LOCKING.
MANY PATIENTS HAVE MASTICATORY DISORDERS AND MUSCLE PAIN THAT REPSONDS BEAUTIFULLY TO A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS.
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]
NORMA:
I have had headaches everyday for over two years. Took migraine medications, no help, chiro,no goo, needles in neck for pain, no good,ct scans, nose,ear and throat doctor no help, had a stress test on heart noblockage,I had been taking thyroid medication for ten years and they took me off of it and checked later and said ok but now my thryoid test can back a litle low so taking snythroid 25mg. Also not eating gluten products right no to see if that helps but my neck is hurting so bad and shoulders but I had a shoulder surgery in N0v 2010 but haven;t exercised it like I should but had headaches all the time before the surgery. I haven;t had a allergy test done yet. I am so depressed and cry alot because the headaches are everyday and I can;t enjoy life with my grandchildren. It takes so much away from quality of life. I have had dry eyes for the past month and still red. I am in bad shape.
DR SHAPIRA RESPONSE:DEAR NORMA,
I AM SORRY TO HEAR HOW SEVERE YOUR HEADACHES ARE. NEUROMUSCULAR DENTISTRY MAY BE THE ANSWER YOU ARE LOOKING FOR. I HAVE FORWARDED YOU THE NAMES OF 2 TOP PRACTITIONERS IN YOUR AREA.
YOU DID NOT TELL ME ABOUT YOUR HISTORY PRIOR TO THE STAR OF YOUR HEADACHES WHICH CAN HELP IN UNDERSTANDING YOUR HEADACHES. HAS A DOCTOR USED VAPOCOOLANT SPRAY AND STRETCH. YOU SAID YOU HAD NEEDLES IN YOUR NECK, WAS THAT TRIGGER POINT INJECTIONS TO TRY AND RELIEVE YOUR PAIN OR WAS IT ACCUOUNCTURE? I FIND I CAN RELIEVE MOST PATIENTS PAIN WHILE IN MY OFFICE. SOMETIMES DIAGNOSTIC BLOCKS CAN BE HELPFUL IN UNDERSTANDING WHERE THE HEADACHES ARE ARISING.
YOU SAID THAT CHIROPRACTIC TREATMENT DID NOT HELP BUT DID YOU SEE A NUCCA OR A/O CHIROPRACTER.
THE FACT THAT CAT SCANS ARE NORMAL ARE GOOD. MOST PAIN IS REFERRED FROM MUSCLES. IT SOUNDS IKE THEY HAVE RULED OUT ORGANIC DISEASE.
I CAN ARRANGE TO SEE YOU AT MY ILLINOIS OFFICE IF YOU PREFER. I CAN ONLY HANDLE 1 LONG RANGE PATIENT /WEEK. THIS WEEK I HAVE A PHYSICIAN FROM DENVER BUT NEXT WEEK IS AVAIABLE.
OUT OF TOWN PATIENTS ARE USUALLY SEEN FOR 4 CONSEQUTIVE DAYS AT INITIAL VISIT SEQUENCE.. MON- THUR.
I have had headaches everyday for over two years. Took migraine medications, no help, chiro,no goo, needles in neck for pain, no good,ct scans, nose,ear and throat doctor no help, had a stress test on heart noblockage,I had been taking thyroid medication for ten years and they took me off of it and checked later and said ok but now my thryoid test can back a litle low so taking snythroid 25mg. Also not eating gluten products right no to see if that helps but my neck is hurting so bad and shoulders but I had a shoulder surgery in N0v 2010 but haven;t exercised it like I should but had headaches all the time before the surgery. I haven;t had a allergy test done yet. I am so depressed and cry alot because the headaches are everyday and I can;t enjoy life with my grandchildren. It takes so much away from quality of life. I have had dry eyes for the past month and still red. I am in bad shape.
DR SHAPIRA RESPONSE:DEAR NORMA,
I AM SORRY TO HEAR HOW SEVERE YOUR HEADACHES ARE. NEUROMUSCULAR DENTISTRY MAY BE THE ANSWER YOU ARE LOOKING FOR. I HAVE FORWARDED YOU THE NAMES OF 2 TOP PRACTITIONERS IN YOUR AREA.
YOU DID NOT TELL ME ABOUT YOUR HISTORY PRIOR TO THE STAR OF YOUR HEADACHES WHICH CAN HELP IN UNDERSTANDING YOUR HEADACHES. HAS A DOCTOR USED VAPOCOOLANT SPRAY AND STRETCH. YOU SAID YOU HAD NEEDLES IN YOUR NECK, WAS THAT TRIGGER POINT INJECTIONS TO TRY AND RELIEVE YOUR PAIN OR WAS IT ACCUOUNCTURE? I FIND I CAN RELIEVE MOST PATIENTS PAIN WHILE IN MY OFFICE. SOMETIMES DIAGNOSTIC BLOCKS CAN BE HELPFUL IN UNDERSTANDING WHERE THE HEADACHES ARE ARISING.
YOU SAID THAT CHIROPRACTIC TREATMENT DID NOT HELP BUT DID YOU SEE A NUCCA OR A/O CHIROPRACTER.
THE FACT THAT CAT SCANS ARE NORMAL ARE GOOD. MOST PAIN IS REFERRED FROM MUSCLES. IT SOUNDS IKE THEY HAVE RULED OUT ORGANIC DISEASE.
I CAN ARRANGE TO SEE YOU AT MY ILLINOIS OFFICE IF YOU PREFER. I CAN ONLY HANDLE 1 LONG RANGE PATIENT /WEEK. THIS WEEK I HAVE A PHYSICIAN FROM DENVER BUT NEXT WEEK IS AVAIABLE.
OUT OF TOWN PATIENTS ARE USUALLY SEEN FOR 4 CONSEQUTIVE DAYS AT INITIAL VISIT SEQUENCE.. MON- THUR.
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.
Subscribe to:
Posts (Atom)