Migraines, Chronic Daily Headaches, TMJ, TMD and Neuromuscular Dentistry

Tell us about your headaches...: I have suffered from migraines w/and w/o aura since I was 10. I got a brain tear frontal lobe in the third grade. It's only been about the last several years that I got diagnosed with tmj. In the last 6 months it has got unbearable. I've got a permanent mouth guard for night grinding,but I still have pain and migraines help!
First Name: Lorin
Last Name: M.....

DR Shapira's response:

Lorin in Boston,  Your e-mail was rejected, I hope you find this response helpful

Night Guards work great if you only have pain at night or on awakening.  If you have day and night pain it is usually necessary to utilize a 24/7 appliance. TMJ is not a diagnosis but a Joint, the TemporoMandibular Joint.  TMD is a more correct description because it includes the Myofascial and neurogenic aspects of migraine and chronic daily headaches.  I suggest  a neuromuscular diagnostic orthotic as it allows an ongoing healing process as you adjust it for postural changes.  Spenopalatine ganglion blocks can serve to prevent migraines and you can learn to do them easily at home.  Trigger point injections or spray and stretch techniques are useful for eliminating trigger points.

It is a process to correct a lifetime problem and I like the analogy of ealing an onion, you remove one set of problems to get to the next level.

I would like to tell you that everyone who practices Neuromuscular Dentistry (NMD) can help you but NMD is only one part of a larger puzzle.  It is extremely important component of treatment because it addresses nociceptive input to the Trigeminal Nervous system that is primary in all migraine and non-migraine headaches.  Unlike drug treatment that affect the CNS like a shotgun blast NMD particularly is designed to focus on I/O errors or input/output erros into the Trigemininal nervous system.  In computer lingo the expression GARBAGE IN....GARBAGE OUT describes the effect of unfiltered nociceptive input into the central nervous system.  100% of all physicians, neurologists and pain specialists understand that all headaches and migraines are Trigeminally nerve related.  

Neuromuscular Dentistry addresses this input output error of the human computer...ie the brain.

Physicians often consider TMJ and TMD problems a subset of headaches due to their ignorance of the massive input to the CNS (central nervous system) from the Trigeminal Nervous System)

Te use of Botox to treat headaches and Migraines is directly due to effects on the masticatory system of the trigeminal nervous system...  ie a TMD or TMJ problem addressing not the entire scope of the problem but just the myofascial pain aspects.  Botox is a crutch that can be used while correcting the underlying problems.  Unfortunately there is money to be made in injecting dangerous neurotoxins and where there is money there are always willing participants.  The problem is not the use of Botox but the substitution of Botox for correction of the underlying problems.

Read:  http://www.sleepandhealth.com/neuromuscular-dentistry  for more info on neuromuscular dentistry.

I do see up to two long diatance patients  month in my Gurnee office, the first week I see you twice a day on Monday and Tuesday and half a day wednesday.

Ira L Shapira DDS, D,AAPM, D,ABDSM, FICCMO

I get headaches more when I am tired or stressed or when it is sinus season

Glendale: I get headaches more when I am tired or stressed or when it is sinus season

Dr Shaira response: These are very common statement for people with neuromuscular problems, TMJ disorders or TMD

The reason is that most headaches are primarily modulated by the trigeminal nerve. The lining of the sinuses is innervated by the trigeminal nerve so the addition of sinus irritation to and existing problem is enough to push you over the edge. Stress in general is related to TMJ disorders, myofascial pain and headache. There are different types of stress our bodies cope with.

Structural stress is all about muscles, joints, bones, habits, trauma, bite, whiplash etc. Posture is about proper or improper alignment of all these body parts. The Quadrant Theory of Guzay shows that jaw position is incredible important in determining head posture. Head posture is extremely important in treating any chronic pain patient.

Emotional or life stress includes stresses related to family, money, jobs, children , parents, friends etc.

Biochemical stress includes diet, vitamins , minerals, organic disease, aleergies hormones an so on.

When our ability to cope is less than the total of our stresses and the system tells us pain, headache, sinus pressure etc.

It is always the total of stresses exceding our ability to cope that pushes pain over the edge. When you state stress or sinus season pushes you over the edge you are correct. Correcting the underlying structural stress will also raise the threshold before you feel pain. Total stress including all types is the culprit. Lowering any of the components will improve your quality of life.

A neuromuscular diagnostic orthotic is designed to remove noxious (painful) input to the brain, allow the muscles and joints to heal and for posture to correct..

Chronic daily headaches and meds don't work. What should I do? Neuromuscular Dentistry may be the answer.

Chronic headaches without a cause are frequently related to the Trigeminal nervous system and have no specific diagnosis. When headaches are not helped by routine medical care a neuromuscular dentist may be the best answer.

Question from Tiffany: I have been having headaches everyday now for about a year and 9 months now. Had no accidents or head trama btu i have headaches everyday ..No meds work for me only excedrin for about an hours and the head aches is right back. I really dont know the cause but i would like to find out more or what could be causing this.

Dr Shapira Response.

Tiffany, chronic headaches are usually coming from head and neck musculature, especially those muscle innervated by the Trigeminal Nerve. There may or may not be any joint noise or discomfort. A thorough medical evaluation with your physician to rule out organic disease is alway in order.

I start patients with a consultation appointment and usually can relieve a significant amount of pain during the appointment. Most muscle pains can be allieviated or eliminated temporarily with vapocoolant spray and stretch techniques to confirm muscle problems.
I start treatment with a thorough head and neck exam and a neuromuscular dental work up and than a neuromuscular diagnostic orthotic. Most patients see drastic improvement in just a couple of visits. There are no magic cures and it takes time for a chronic problem to unwind completely.

Relief of 30 years of constant Headache: Brief relief may provide clue to long term relief.

KEN:I Have had headaches for 30 years going away only once when having a root canal done on an upper tooth. While everything was numbed up I had complete brain function and no headache. They are located directly behind my nose area and I feel a constant pressure.

Dr Shapira response: The anaesthetic relieved the pain probably confirming that it is from the trigeminal nerve. I would be very interested is a spenopalatine ganglion block could give more long term relief. It is a easy procedure that I have taught patients to do at home with a q-tip and anaesthetic thru the nose. There are also other diagnostic blocks that can be done to determine the cause of your headaches.

A diagnostic neuromuscular orthotic would be an excellent first step in treatment. If the headaches are eliminated or significantly relieved a permenant stabilization could be done. I have referred you to an excellent Dr who knows both of the procedures mentioned.