Saturday, June 27, 2015

CHRONIC DAILY HEADACHES (CDH): MAYO CLINIC CONSIDERS CDH THE MOST DISABLING OF HEADACHES TMJ Treatment May be the Answer


CHRONIC DAILY HEADACHES (CDH):  MAYO CLINIC CONSIDERS CDH THE MOST DISABLING OF HEADACHES

How your headaches are defined may prevent you from having effective treatment.

Living with headaches is a fact of life for many headache survivors.  According to Mayo Clinic  “chronic daily headaches occur 15 days or more a month, for at least three months. True (primary) chronic daily headaches aren't caused by another condition.”  This definition will artificially separate similar headaches into different diagnostic groupings.

Chronic daily headache is not a specific type of headache but rather a disabling pattern of headache occurrence.

Johns Hopkins describes Chronic Daily Headache as “A patient who has headaches as many days as not — at least 15 days a month — is said to have chronic daily headache (CDH). CDH is not a specific type of headache, but rather a descriptive term applied to any number of headache types. The two most common types of primary headache are Migraine and Tension-Type Headache.  Rebound headache or medication overuse headache is a frequent occurrence in patients with CDH.  The treatment actually becomes the disease.

The typical treatment offered by headache specialists and neurologists is a prescription medication.  When the first is not effective the patient is often taken thru a series of single medication trial followed by trials of multiple medications.  This is similar to what happens to patients who utilize OTC medications moving from drug to drug often mixing prescription and non-prescription medications.

Tension-type headaches are the most common type headache but they are often dismissed as being relatively mild and tolerable.  These headaches often progress to Rebound headaches and/or migraine.  Tension-type headaches should be considered to be muscle contraction headaches.  According to Cleveland Clinic “They used to be commonly referred to as muscle contraction headaches or stress headaches, but these old terms have been abandoned.”

90 – 95% of all headaches are actually partially or completely muscle contraction headaches.  There are Vascular/ Neurogenic components to all headaches as well. 

According to the NHLBI of the NIH patients who receive a diagnosis of TMJ have a 60-90% chance of experiencing satisfactory resolution of symptoms but patients diagnosed with other types of headaches will probably be condemmed to live in pain.

 or muscle contraction headaches are considered episodic if they occur less than 15 days/month and chronic if they occur more than 15 days/month.  They may las for 30 minutes to several hours or continue for days at a time.  Because they are a type of headache referred from muscles they tend to have slow onset and are achy in nature.  Patients often describe them as a taut band, pressure headaches, and usually they are bilateral and generalized in location.   What is important to understand is that Tension –Type headaches can be part of a ongoing process that triggers migraines and other more severe headaches.  Tension headaches can be as severe or even more severe than migraine headaches. Tension-Type headaches are considered a Primary headache but referred headaches from the neck muscles  (cervical headaches or cervicalgia) and/or the TMJ  (Tempormandibular Joints) and masticatory muscles are considered secondary headaches..   


These secondary headaches are examples of muscle contraction headache as are headaches related to trigger points and taut bands in Fibromyalgia and Myofascial Pain and Dysfunction. 

According to John Hopkins the following is a list of causes of tension-type headaches.  If you read the list it is almost like saying a normal life is the cause of headaches.  What all of these have in common is that they all provoke muscle contractions secondary to stress.

·        “Inadequate rest
·       Poor posture
·       Emotional or mental stress, including depression
Tension-type headaches can be triggered by some type of environmental or internal stress. This stress may be known (overt) or unknown (covert) to the patient and their family. The most common sources of stress include family, social relationships, friends, work, and school. Examples of stressors include:
·       Having problems at home
·       Having a new child
·       Having no close friends
·       Returning to school or training; preparing for tests or exams
·       Going on a vacation
·       Starting a new job
·       Losing a job
·       Being overweight
·       Deadlines at work
·       Competing in sports or other activities
·       Being a perfectionist
·       Not getting enough sleep
·       Being over-extended; involved in too many activities/organizations”


According to the National Heart Lung and Blood Institute of the National Institute of Health TMD Disorders :
TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints.

TMD remains to be classified in the larger context of other muscle and joint disorders or in the category of pain disorders (NIH Technology Assessment Conference, 1996). About half of all cases are attributed to conditions linked to the muscles of mastication”  and “Pain linked to the TMJ and/or muscles of mastication constitutes the essential criterion for case assignment. It often qualifies as “aching”, “throbbing”, “tiring” and exhausting.

These are the same symptoms found in tension headaches and both are associated with similar proportions of female to male patients.  These disorders are also associated with sleep disturbances that tie them to a wide variety of other disorders.

The National Institute of Health and PubMed.gov provide the largest database in the world of headache publications.  These publications universally agree that regardless of the type of headache a patient has almost 100% are caused or mediated by the Trigeminal Nervous system.  The Trigeminal Nerve is often called the Dentist’s Nerve because it innervated the teeth,the periodontal ligament and gums, the jaw muscles, the jaw joints and many associated structures.    The Trigeminal Nerve also controls the blood flow to the anterior two thirds of the meninges of the brain.

Why do TMJ patients do better than other headache patients?  Only dentistry treats headaches by changing input to the brain.  While migraines are often thought to be caused by chemical imbalances within the brain only dentistry attempts to correct these chemical inbalances by eliminating noxious input to the Trigeminal Nervous System.

Neuromuscular Dentistry is probably the single most effective method of controlling noxious (nociceptive) input to the brain.











Monday, June 15, 2015

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


Originally printed Highland Park Landmark
By Alan P. Henry
"Highland Park dentist Dr. Ira Shapira has a message for anyone suffering from TMJ disorders including migraines or for those looking for a way to deal with issues related to sleep apnea and snoring, including but not limited to ADD and ADHD.
“I want people out there who have problems and feel like there is no hope to know there is hope,” he said.
Dr. Shapira, a resident of Highland Park for 34 years and practicing dentist for almost four decades, has just opened an office at 3500 Western Ave. in Highland Park. Unlike his general dental practice in Gurnee, this office serves as a resource for people suffering chronic pain.
“I love changing people’s lives,” he said. “You have someone who has chronic pain, when you take away their headaches and their face pain, to me this is the most rewarding part of anything I do.”
Dr. Shapira’s approaches to headache treatment are not unique, but neither are they universal. Most doctors treating headaches are physicians or neurologists, he said, and if after tests they see no obvious issues involving the brain or tumors, they typically “make the assumption that it is a chemical problem” and turn to drugs to treat the problem.
But according to Dr. Shapira, the origin of most headaches is the trigeminal nerve, a nerve that is responsible for sensation in the face and motor functions such as biting and chewing, and it is from that direction that treatment is best directed.
He founded www.Ihateheadaches.org, an online resource designed to help people find ways to combat chronic neurological pain. The site, which includes a blog written by Dr. Shapira, can be used to find a doctor and also as an educational tool where a person can discover all they need to know about the kind of headache they may have.
“Many people in pain and desperate for an end to their headaches will look to CAT Scans, powerful medication and more to help them. Very few will look to a dentist who is able to find a solution through neuromuscular science,” writes Dr. Shapira. “Our site is designed to assist you in taking the first steps of pursuing neuromuscular eduction, diagnosis and treatment.”
Dr. Shapira was initially inspired to take on the treatment of issues related to sleep apnea and snoring by way of an experience his son Billy had when he was five.
After observing a limited attention span, excessive tiredness and unusual behavior in Billy, Dr. Shapira took his son to pediatricians, ENTs and allergy doctors, who said he had ADHD. “Basically, they told us he couldn’t start kindergarten and they wanted to put him on ritalin for life,” he said.
But Dr. Shapira also took Billy to the sleep center at Rush, where a sleep test showed he had severe sleep apnea — his heart stopped beating 60 times an hour when he was sleeping. “We took his tonsils and adenoids out when he was five and widened his mouth orthodontically, so the same kid who couldn’t start school because he had ADHD ended up graduating college magna cum laude with double majors and double minors,” said Dr. Shapira. “Turns out his drug of choice was oxygen. He needed to breath. Because he couldn’t breath, he had disturbed sleep. Back then we didn't know it, but now we know now that disruptive sleep can give you exactly the same symptoms of ADHD.”
Seeing the positive changes in his son after his airways were opened, Dr. Shapira turned his attention to the field, and the relief proper treatment can give.
“There are airway issues that start young and go all the way through life,” said Dr. Shapira. “If I can help make somebody’s quality of life better, that is huge.”
Currently, he said, as many as 80 percent of children have “underdeveloped jaws” which means they run the risk of having problematic airways. “If you have a child that is snoring, that is not normal,” he said.
Dr. Shapira now has child patients as young as two for whom he makes appliances that can be worn at night. “We can grow them bigger airways,” he said.
Dr. Shapira founded www.IHateCPAP.com, a one stop source for information about sleep apnea. Severe sleep apnea affects more than 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness. Most people with mild sleep apnea are aware that they snore and feel overtired or fatigued but are unaware of potentially serious medical problems which may exist, he said.
Dr. Shapira, DDS, D,ABDSM, D,AAPM, FICCMO is a Diplomat of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a Fellow and current Secretary of the International College of CranioMandibular Orthopedics, and a former Assistant Professor at Rush Medical School, where he researched effect of jaw position on sleep apnea.
He has written a chapter on anti-aging dentistry in an anti-aging medicine textbook; is Dental Section Editor of Sleep and Health Journal; has lectured in the US and abroad on TMJ disorders, sleep apnea, dental sleep medicine and anti-aging medicine, and has several patents on stem cell collection from developing wisdom teeth and currently are awaiting NIH funding of a study at UIC and Baylor.
He recently started Sleep Well Illinois, a company that promotes universal sleep screening in physician offices, and just became the Chair of the Alliance of TMD organizations for a two year term.
His Highland Park office is Chicagoland Dental Sleep Medicine and the Website is www.ThinkBetterLife.com"