Cluster Headaches and Trigeminal Autonomic Cephalgias, TMJ Disorders and Neurostimulation

AMAZING MIGRAINE, HEADACHE AND TMJ TESTIMONIALS   (links below)
Various stimulators can be used for treating migraines and cluster headaches. A 50-70% reduction in Trigeminal Headaches was seen by  stimulation of the Deep Brain, the Sphenopalatine Ganglion and with occipital stimulation.  The Trigeminal-Autonomic reflex is key to understanding these types of headaches.
Neuromuscular Dentistry also utilizes stimulation of the Trigeminal Nervous System to create muscle relaxation as well as central effects.  Neuromuscular Dentistry reestablishes a healthy homeostasis within the Trigeminal Nervous System by the use of a diagnostic neuromuscular orthotic.  This treatment allows patients to maintain a healthy neurological state and healthy condition of trigeminaly innervated muscles.  In addition, postural correction also occur which reduce occipital headaches.

The use of neuromuscular dentistry and SPG Blocks or Sphenopalatine Ganglion Blocks can give remarkable long lasting relief.

Permanent correction will prove to curative for a significant number of patients but should only be considered after suitable trial period.  There are many patient videos on Reddit attesting to the amazing effects of neuromuscular Dentistry and SPG Blocks.  Combination of these techniques gives patients multiple pathways to a better quality of life.

I have practiced neuromuscular dentistry since 1980 and learned from Barney Jankelson , the genius who created the field.  I currently practice Neuromuscular Dentistry in Chicago in my two offices in Highland Park and Gurnee.  Treatment of TMJ disorders will frequently also eliminate Migraines, cluster headaches and many other chronic pain conditions.

The Highland Park office website is www.ThinkBetterlife.com

The Highland Park office is www.DelanyDentalCare.com

THE FOLLOWING REDDITS HAVE PATIENT TESTIMONIALS

https://www.reddit.com/r/NeuroMuscularDent/

https://www.reddit.com/r/SPGBlocks/

PubMed Abstract:

Headache. 2017 Feb;57(2):327-335. doi: 10.1111/head.12874. Epub 2016 Aug 4.

Cluster headache and other TACs: Pathophysiology and neurostimulation options.

Láinez MJ1,2, Guillamón E1.

Author information

Abstract

BACKGROUND:

The trigeminal autonomic cephalalgias (TACs) are highly disabling primary headache disorders. There are several issues that remain unresolved in the understanding of the pathophysiology of the TACs, although activation of the trigeminal-autonomic reflex and ipsilateral hypothalamic activation both play a central role. The discovery of the central role of the hypothalamus led to its use as a therapeutic target. After the good results obtained with hypothalamic stimulation, other peripheral neuromodulation targets were tried in the management of refractory cluster headache (CH) and other TACs.

METHODS:

This review is a summary both of CH pathophysiology and of efficacy of the different neuromodulation techniques.

RESULTS:

In chronic cluster headache (CCH) patients, hypothalamic deep brain stimulation (DBS) produced a decrease in attack frequency of more than 50% in 60% of patients. Occipital nerve stimulation (ONS) also elicited favorable outcomes with a reduction of more than 50% of attacks in around 70% of patients with medically intractable CCH. Stimulation of the sphenopalatine ganglion (SPG) with a miniaturized implanted stimulator produced a clinically significant improvement in 68% of patients (acute, preventive, or both). Vagus nerve stimulation (VNS) with a portable device used in conjunction with standard of care in CH patients resulted in a reduction in the number of attacks. DBS and ONS have been used successfully in some cases of other TACs, including hemicrania continua (HC) and short-lasting unilateral headache attacks (SUNHA).

CONCLUSIONS:

DBS has good results, but it is a more invasive technique and can generate serious adverse events. ONS has good results, but frequent and not serious adverse events. SPG stimulation (SPGS) is also efficacious in the acute and prophylactic treatment of refractory cluster headache. At this moment, ONS and SPG stimulation techniques are recommended as first line therapy in refractory cluster patients. New recent non-invasive approaches such as the non-invasive vagal nerve stimulator (nVNS) have shown efficacy in a few trials and could be an interesting alternative in the management of CH, but require more testing and positive randomized controlled trials.

© 2016 American Headache Society.

KEYWORDS:

hypothalamus; migraine pathophysiology; neuromodulation; trigeminal autonomic cephalalgia

Why Headaches Hurt and Why Neuromuscular Dentistry Is Extremely Effective In Treating A Wide Variety Of Headaches and Migraine.

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.

Chronic Daily Headache: Neurological Sciences Study Showed 17 of 20 Patients Required Neurmuscular Orthotic

A neuromuscular orthotic is used to correct occlusal discrepancies that can cause chronic daily headaches, migraines and tension-type headaches.The current study (abstract below) showed that 85% of patients with chronic daily headache has significant discrepancies between their occlusion and their ideal neuromuscular position.

The majority of dentists treating TMJ disorders and chronic head and neck pain are lost when it comes to establishing the neuromuscular position. The neuromuscular rest position and occlusion can only be determined after uilizing ultra-low frequency TENS to relax muscles and deprogram the occlusion.

I prefer the term Diagnostin Neuromuscular Orthotic because even though Neuromuscular Dentistry is extremely effective it is imprortant to establish success prior to long term restoration. The diagnostic orthotic is used to find this three dimensional relaxed position.

I see chronic headache and TMJ disorder patients on a long distance basis. The first series of appointments are to establish improved posture and a functionally correted Diagnostic Neuromuscular Orthotic.

I will have my out of town patients arrive on Sunday and then see them Monday AM for diagnostic evaluation, radiographs, impressions and examination. I then deliver the Diagnostic Orthotic Monday afternoon. It is adjusted Tuesday AM and PM and on Wednesday morning. This protocol allows me to send patients home after a short series of appointments with a functionally corrected neuromuscular diagnostic orthotic. I frequently will also do trigger point injections, SPG blocks and other physical therapy modalities.

I insist I receive a complete history and conduct a phone interview prior to giving the patient an appointment. This is essntial to be able to rapidly help patients get relief from chronic daily headaches, migraines and head and neck pain.

Neurol Sci. 2011 May;32 Suppl 1:S161-4.

Chronic daily headache: suggestion for the neuromuscular oral therapy.

Didier H, Marchetti C, Borromeo G, Tullo V, D'amico D, Bussone G, Santoro F.

Source

Fondazione IRCCS Cà Granda, Dipartimento di Scienze Chirurgiche Ricostruttive e Diagnostiche Sezione di Odontostomatologia, Università degli Studi di Milano, Via della Commenda 10, 10122 Milan, Italy.

Abstract

Tweny patients (M: 4, F: 16, mean age 37 ± 11 years) with diagnosis of chronic daily headache (CDH), after drug withdrawal, were under electromyography, kinesiography and masticatory muscle deprogramming by TENS to identify the physiological rest position of the mandible. Our purpose was to clarify a possible role of the neuromuscular stomatognathic system. Examinations showed that 17 patients needed a neuromuscular orthosis, an occlusal device, to provisionally correct the detected discrepancies of jaw position. Of those, the 10 patients who showed an occlusal sagittal discrepancy higher than 2 mm and/or a lateral deviation higher than 0.4 mm, associated with more than three parafunctional activities, had a meaningful decrease on frequency/intensity of migraine crisis and/or of days of headache. VAS pain score during crisis decreased from 9.0 ± 0.9 to 4.9 ± 2.7; frequency of crisis were from 20.7 ± 5.2 to 9.5 ± 7.7. Baseline pain were from 5.3 ± 1.2 to 3.0 ± 1.3. Satisfying clinical results can be reached combining behavioural education and neuromuscular orthosis. This can be very helpful in patients who show significant discrepancy of jaw position that only TENS deprogramming can reveal and kinesiography can detect with such accuracy.

PMID:

21533736

[PubMed - indexed for MEDLINE]