CHICAGO MIGRAINE CURE: Treatment and Prevention of Migraine Headaches

Migraines can be avoided, eliminated and cured with a combination of treatments designed to reduce noxious input into the Trigeminal nervous system.  It is universally accepted that migraines are mediated by the trigeminal input to the brain in conjunction with the trigeminal nerve control of blood flow to the anterior two thirds of the meninges of the brain.

There has long been a controversy whether migraine was a vascular headache or a neurogenic headache or a combination of the two.  Ther has never been a question over mediation of migraine by the trigeminal nerves.

Noxious input from the trigeminal nerve can be eliminated.  There is actually an appliance that has been FDA approved as a migraine preventive, the NTI -TSS appliance.  NTI-TSS stands for Nociceptive trigeminal inhibition tension suppression system.  It uses noxious input into the trigeminal nervous system to suppress bruxism.  The original appliance was Dr Peter Neff's  appliance that the NTI  concept was taken from.   There are many problems and risks associated with the NTI but there is a place for it in patients with migraines that occur in the night or upon awakening and who do not have sleep disordered berthing including apneas, hypopneas, RERAs, UARS, and/or snoring.

Patients with these problems should have their nocturnal breathing corrected which can often cure these same migraines.  The TAP appliance actually treats the breathing and simultaneously creates the same effect as the NTI simultaneously.

CURING MIGRAINES goes beyond the NTI and sleep disordered breathing to idealizing the cranial cervical physiology.  Neuromuscular Dentistry as part of a comprehensive program can cure many migraines by removing the noxious input to the CNS from the trigeminal nerve.  Correction of posture is important to eliminate myofascial pain and trigger points that also cause headaches.

Upper cervical spinal problems can also create migraines but the combination of neuromuscular dental orthotics and atlas orthoganol correction creates long term stability.

The first step is always diagnosis and trial reversible treatment.  A diagnostic neuromuscular orthotic shold always be the first step in neuromuscular treatment and prevention of migraines. Correction of upper cervical probles is easier when the orthotic is worn and adjustments hold better.  It is important to understand that changes to orthotic and upper cervical areas must be balanced carefully to achieve homeostasis.

Curing migraines depends on maintaining this homeostasis.  There are migraine triggers that are chemical in nature that must be controlled by diet and avoidance.  Many patients find that over time these migraine triggers have less effect.

There are no migraine cures that work for everyone but neuromuscular dentistry offers many patients near miraculous results.  The combination of neuromuscular dentistry with upper cervicsal stabilization is even more powerful.  SphenoPalatine Ganglion Blocks can be used on more difficult cases to turn off and prevent migraines.  These were discussed in a popular book "Miracles on Park Avenue".  In my office we teach patients to self administer SPG blocks with cotton tipped swabs and lidocaine delivery.   Learn more about treatment of headaches and migraines at
www.thinkbetterlife.com.

Migraines and Vomiting for 15 Years. Neuromuscular Dentistry and SPG Blocks May Resolve Symptoms.

Anne: I've been getting migraine headaches for the past 15 or so years. I always have terrible nausea and vomiting. I have tried many many different things with no luck. I had a migraine yesterday where I vomited non-stop for 12+ hours. The migraines are typically on the right side behind my eye but this time I also noticed pain in my upper jaw.

Dr Shapira response:

Dear Anne,

A diagnostic neuromuscular orthotic can often give dramtic results in lowering the frequency and severity of migraine attacks (and associated nausea) and is especially helpful with tension-type headaches and referred muscle headaches. The muscular headaches are frequently the trigger for the migraines. The nausea is a secondary autonomic effect. The trigeminal nerve (or dentists nerve) is involved in almost all migraines and other types of headache. It is also associate with autonomic symptoms. An SPG block can sometimes offer amazing relief. There is an out of print book "Miracles on Park Avenue" that discusses some of the benefits of SPG blocks.

An Spenopalatine Ganglion Block can be done at the first sign of a headache and prevent a full attack. I usually teach my patients this easy technique.

I do see long distance patients, but I like a complete history and phone interview before scheduling. I usually will have patients come in Sunday and I see them Monday AM and PM, Tuesday AM and PM and Wednesday morning for their first set of appointments. Call my office if you would like me to see you at 847-623-5530.

A neuromuscular work-up will usually show the problems and allow for correction but their may be other factors besides the jaws, jaw muscles, jaw joints, posture and trigeminal nerves. Allergies or chemical triggers can still serve as headache triggers.

SEVERE HEADACHES, MIGRAINES, FACIAL PAIN or TMD RELIEF : DR SHAPIRA CAN ARRANGE THREE DAY EVALUATION AND TREATMENT APPOINTMENT IN HIS OFFICE.

DON'T KNOW WHERE TO GO FOR PAIN RELIEF?

I frequently receive requests for referrals from across the country for patients with severe pain problems. While I usually try to find a Neuromuscular Dentist close to where you live some patients need more a very experienced practioner. I have been treating chronic pain for over 34 years since graduating dental school. While in school I was a pain patient and often experienced severe headaches and facial pain that even excessive doses of Fiorinal #3 did not touch.

Some patients who have been in severe pain want relief as soon as possible and I understand wanting to experience relief as soon as possible. A "JUMP START" appointment in my office is possible. My team can arrange a 3 day visit where we start with diagnostics on the first morning and deliver a neuromuscular orthotic in the afternoon. We can utilize SPG blocks, trigger point injections and other modalities to achieve rapid results.

I work with Dr Mark Freund who can arrange for an Atlas Axis evaluation and do Atlas-Orthogonol adjustments, if indicated.

Prior to making an appointment I require that patients submit an extensive history as well as fill out some forms.

I like patients to give me a complete history of their pain, what age it started, any history of trauma and/or surgical proceedures as well as a list of previous treatments, length of treatment and success of treatment. I will personally review this information before you are accepted as a patient. I see a maximum of two patients/month for "JUMP START" treatment due to time and scheduling constraints.

My team will arrange for a convenient hotel near the office. This is the same hotel I use for doctors and their teams when I give course. My patients fly in Sunday I meet with them at 8 AM and do an exam followed by a neuromuscular work-up. This takes approximately 4 hours. I then customize a Diagnostic Neuromuscular Orthotic in the afternoon.

I clearly want all patients to understand that there are no guarantees of success.

If we are successful in eliminating or relieving your pain and dysfunction significantly and you believe that you are substantially improved we will schedule ongoing visits as needed. The Diagnostic Orthotic is for initial treatment, healing and short-term stabilization. Long term stabilization is frequently required and can take many different forms. These alternatives will be discussed but may take many forms such as long-term orthotics, orthodontics, reconstruction, surgery. Each patient is unique so your treatment will be customized for you.

MYOFASCIAL EXAMINATION LEADS TO DIAGNOSIS AND SUCCESSFUL TREATMENT OF MIGRAINE HEADACHE

A new article in the Journal of Musculoskeletal Pain by Michael Sorrell, MD of Tufts University showed excellent results in treating Migraine utilizing trigger point injections and physical therapy with supervised home stretching. The examination of the myofascial trigger points is a step rarely done in working up migraine patients,The majority of patients had received previous diagnosis of migraine and had undergone unsuccessful drug treatment. These patients were unaware that their pain could be referred from muscles until the examination of the muscles revealed the referred pain.

The examination did not include all of the the masticatory muscles but did include masseter and temporalis muscles,the sternocleidomastoid muscle,the trapezius muscle, the corrugater supercilius, the semispinalis, splenius cevicus and capitus muscles, as well as the suboccipitalis and levator scapulae muscles. If muscle palpation examination reproduced the headache the patients were included in the trial.

This study only included patients with chronic migraine and migraine without aura whose pain could be reproduced from muscle examination. A subgroup of 11 patients with Migraine with aura (5 of 11 patients migraine symptoms reproduced on examination) was also included in the study. Those patients did remarkably well with 68% mean improvement in those receiving physical therapy and home stretching compared to 5% improvement in the group not utilizing physical medicine. Over 88% of the study group reported over 50% improvment.

This is an important article primarily because it is from a neurology group treating migraines. It is well known that tension type headaches respond to physical medicine and treatment of myofascial trigger point. Migraines are usually very responsive to physical medicine as well. The field of Neuromuscular Dentistry actively focuses on the elimination trigger through use of TENS, TP injections, Spray and Stretch and other techniques as well. More importantly use of neuromuscular trigger points prevents the formation of new trigger points.

The examination in the above article ignored many of the masticatory muscles known to creat migraine like symptoms.

There is also an important concept of myofascial triggers serving as a trigger for migraines. Removal of these triggers can eliminate future migraines.

I have frequently seen migraine patients achieve complete relief thru a combination of a neuromuscular diagnostic orthotic and physical medicine modalities. I have seen other patient who have greatly reduced frequency of migraine but when a migraine does occur medication is still necessary due to severity. This is common with hormonal headaches and migraines. I will have a patient with severe diaily migraines that are eliminated but the patient qwill still have a tension type headache or migraine at ovulation or prior to Menses.

These are patients who I believe we have relieved the myofascial components of their pain but the hormonal triggers remain. The headaches that are then present are less severe. Other patients may only get the aura when presented with triggers but no pain. I do believe that evaluation and elimination of myofascial triggers is important for all migraine patients but in some patients the myofacial trigger points are a secondary result of the migraine pain rather that a primary cause of migraine. It is still important to eliminate these secondary trigger points so the do not increase and become a primary problem.