This is a post that was originally posted in Sleep and Health Journal. I thought the information on the mechanics, physiologic and neurologic understanding of how neuromuscular dentistry not only treats headaches but actually works prophylactically to prevent or eliminate many headaches and migraines.
The trigeminal nerve is almost universally implicated in all headaches and migraines whether they are vascular, muscular or hormonal in origin. Diagnostic evaluation and treatment of headaches utilizing a Diagnostic Neuromuscular Orthotic can lead to life changing results. The 12 Cranial Nerves are responsible for about 80% of all neural input into the brain and around 70% of that input comes from the Trigeminal Nerve. The Trigeminal Nerve accounts for about half of total nervous system brain input.
The sensations of pain felt with headaches and migraines are carried via pain fibers (nociceptive) of the Trigeminal Nerve. The trigeminal nerve innervates the teeth, jaw muscles, jaw joints (TMJ, TemporomMandibular Joint), the tensor of the ear drum, the tensor of the soft palate that opens and closes the eustacian tubes, the lining of the maxillary and frontal sinuses and most importantly the periodontal ligaments the most awesome feedback mechanism found anywhere n the human body. There are at least 27 different nerve endings capable of transmitting messages thru the trigeminal nerve to the brain.
Trigeminally innervated muscles are required for verbal communication, biting, chewing, swallowing, breathing and posture. The trigeminal Nerve is often called “The Dentists Nerve” because it innervates all of the structures of the mouth.
There are three branches of the trigeminal nerve that divide at the trigeminal ganglion.
The first is the ophthalmic nerve carries sensory input from the upper eyelid, the conjunctiva and cornea, the nose and nasal and frontal sinus mucosa as well as from the forehead and scalp. Most important is the innervations to the meninges (dura) and blood vessels of the brain.
The second is the Maxillary division (nerve) of the Trigeminal Nerve carries sensory information from the lower eyelid, the upper lip, the nares, the cheeks, all of the maxillary teeth and mucosa (gums), the hard and soft palate and upper areas of the pharynx and the maxillary and ethmoid sinuses. Most important again is additional innervations to different areas of the meninges.
The third division of the Trigeminal Nerve is the Mandibular Nerve that carries sensory input from the lower lip, mandibular (lower jaw) teeth and gums, parts of the ear and again important branches to the meninges of the brain.
The proprioceptive input carries information about jaw position, touch, temperature and pain. The lingual branch of the mandibular nerve gives partial innervation to the tongue.
The motor fibers of the trigeminal nerve also pass thru the mandibular division of the trigeminal nerve and control eight muscles including four that provide for jaw movement:
Masseter Muscle
Temporalis Muscle
Medial Pterygoid Muscle
Lateral Pterygoid Muscle
An additional four trigeminally innervated muscle are:
Tensor Veli Palatini that controls the soft palate and opens and closes the Eustachian tube.
Tensor Veli Tympani that controls the tautness of the ear drum.
Mylohyoid Muscle
Anterior Digastric muscle, which are used for mouth opening jaw muscles.
It is importance of the trigeminal nerve that allows almost miraculous resolution of many headaches and migraines when a diagnostic neuromuscular orthotic is carefully adjusted to decrease nociceptive input to the trigeminal nervous system.
It is essential to initially utilize a reversible neuromuscular orthotic prior to making major permanent occlusal changes. This allows the patient to go through a period of trial therapy to evaluate improvement (or lack of improvement) and to allow postural corrections to occur.
The use of Sphenopalatine Ganglion Blocks in association with the orthotic allows the trained neuromuscular dentist to directly address neural input associated with trigeminal autonomic headaches such as cluster headaches, SUNCT and Paroxysmal Hemicrania. See my previous post:
Saturday, December 3, 2011
TRIGEMINAL AUTONOMIC CEPHALGIAS, Chronic Headaches Related To Trigeminal Nerve Respond well to Neuromuscular Dentistry & Sphenopalatine Ganglion Block
The following paragraph is from the website of the:
National Institute of Neurological Disorders and Stroke (NINDS) of the NIH
Why Headaches Hurt:
Information about touch, pain, temperature, and vibration in the head and neck is sent to the brain by the trigeminal nerve, one of 12 pairs of cranial nerves that start at the base of the brain.
The nerve has three branches that conduct sensations from the scalp, the blood vessels inside and outside of the skull, the lining around the brain (the meninges), and the face, mouth, neck, ears, eyes, and throat.
Brain tissue itself lacks pain-sensitive nerves and does not feel pain. Headaches occur when pain-sensitive nerve endings called nociceptors react to headache triggers (such as stress, certain foods or odors, or use of medicines) and send messages through the trigeminal nerve to the thalamus, the brain's "relay station" for pain sensation from all over the body. The thalamus controls the body's sensitivity to light and noise and sends messages to parts of the brain that manage awareness of pain and emotional response to it. Other parts of the brain may also be part of the process, causing nausea, vomiting, diarrhea, trouble concentrating, and other neurological symptoms.
