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..

Facial Pain, Normal Sinus CT scans, Headache, Migraine and TMD

An older study in the Laryngescope is on 104 patients with facial pain who had normal CT scans. Twenty nine of the patients had previous unsuccessful sinus surgery. The patients were approximately 80% women, TMJ disorders are usually (80%) found in female patients.

The study showed " Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis." It is essential that organic neurologic causes are ruled out but the 100 remaining patients had headaches of undetermined causes. Facial pain and sinus pain are a alert for MPD (myofascial pain) and TMD (temporomandibular pain). Treatment of patients with chronic headaches, migraines sinus and/or facial pain is frequently done without a neuromuscular dental evaluation even though NMD has extremely high success rates.

The Trigeminal nerve innervates the sinus cavities. It is often called the Dentist's nerve because the trigeminal nerve primarily goes to the teeth, jaw muscles, jaw joints, periodontal ligaments and is responsible in full or part for most headaches. It also controls blood flow to the anterior 2/3 of the brain thru the meninges.

Correction of underlying neuromuscular problems often allows drug free effective treatment. When CT scans are normal patients with sinus pain and facial pain should always be evaluated by a neuromuscular dentist. Neurologists should evaluate all patients with organic brain disorders but functional treatment is preferred to heavy drug therapy for the majority of patients.

Frequently Chiropracters and dentists can get miraculous results by working together especially NUCCA and A/O (Atlas Orthogonal) chiropracters. The Dentists can correct nociceptive trigeminal nerve input while the chiropracters correct cervical and head posture. Long term correction of those problems usually requires correction of descending conditions associated with improper jaw function.



Laryngoscope. 2004 Nov;114(11):1992-6.
Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.
Paulson EP, Graham SM.

Department of Otolaryngology--Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1093, USA.
Abstract
OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings.

STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board.

METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey.

RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749).

CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.

PMID: 15510029 [PubMed - indexed for MEDLINE]

Sphenopalatine block and tinnitus,swallowing problems and other disorders

I just had a patient in the office who we did a spenopaltine block on 1 week ago with major relief of shoulder pain (I was not treating) and reduction of tinnitus and droopy eyelids that we were sleeping. My patients chief complaint is swallowing problems that were better almost immediately after the SPG block

I have seen patients with severe insomnia sleep well without medications, other patients who have had relief from restless leg and other diverse conditions.

I usually do SPG blocks for sinus pain and pressure, migraine prevention or treating cluster headaches. However, when patients have "wierd" symptoms it is nice to have the SPG block as a possible treatment.

The Sphenopalatine ganglion is an autnomic nervous center and if we see only temporary relief frow symptoms it is possible to send patients to a neurologist for a stellate ganglion block for longer lasting relief.

TMJ Disorders can adversely affect the entire family.

TMJ disorders rarely only affect the patient but family friends and colleagues a well. Well there are many symptoms that are discussed it is actually the sum of these symptoms that changes patients personalities. A young mother who has dealth with severe pain uring the day has much less patience with her children and will often be short with them for no reason. She will then feel guilty about this which only exacerbates her symptoms.

A major aspect of sleep disorders if frequently excessive tiredness. This may be due to disturbed sleep from grinding but is frequently associated with upper airway resistance syndrome that is common in TMJ disorders and can lead to fibromyalgia symptoms. Disturbed sleep from any cause can lead to a wide variety of chronic pain conditions. Patients are often not aware of how poor their sleep really is. Many times they just never feel rested. This can be a strain on marriages when there is no longer energy for warm relationships and patients become mere autonoms going thru the motions of a normal life.

Headaches and Migraines associated with TMJ disorders can be overwhelming. Most physicians immediately treat the symptoms with powerful medications without considering that a true neuromuscular problem is at the root of these headaches. Correction of the underlying problem can let symptoms melt away like ice on a hot sumer day.

Children with TMJ disorders are more likely to snore and have ADHD which can be an extra stress on a parent already struggling and feeling like she is failing her family. Loss of social networks is common with any chronic pain condition because pateints are just to tired and beg off parties, dinners and other activities that would actually be therapeutic.