My Headaches Are Destroying My Relationships and My Family

From www. IHATEHeadaches.org e-mail

Susan: I have been having severe chronic daily headaches for over 5 years. I have been diagnosed as sinus headaches, migraines, atypical migraines, TMJ, Trigeminal Neuralgia. I have had numerous CAT Scans and MRI that all appear normal. I have tried multiple medications that seem to slightly ease the pain on a temporay basis but I do not remember the last time I was pain free. My marital life is a mess and my husband doesn't understand how I can have so much pain when all the tests are normal. I am constantly yelling at the kids and the feel horribly guilty. My friends have all but cut off contact but it is probably my fault. I wish the scans could find a tumor so everyone would know the pain was real.
I'm desperate but that just seems to make the pain even worse.

Dr Shapira:
Susan, Please do not give up. I have heard many stories similar to yours. First, because all of the tests have been negative for disease there is excellent hope for significant improvement.. I suggest you seek out a Neuromuscular Dentist who also understands chronic Myofascial Pain and the use of Trigger Point Injections, Sphenopalatine Ganglion Blocks, Spray and stretch techniques.

Susan, it is important to understand that eliminating your pain is not a cure. You have been forever changed by the hell you have been experiencing. The only real cure would be a do-over on the last five years of your life. The goal of treatment is eliminate pain and restore quality to your life and allow you to reconnect with your husband, children, family and friends. The pain you have lived with has changed who you are forever but that may just make you appreciate your life more in the future.

The medical model for Chronic Headaches is diagnostic test and then perscription medicine. I find that patients who have symptoms you describe are easier to treat than expected. I usually spend 1-2 hours on an initial consultation with new patients. Initially we talk so I can understand who you are, how the pain is affecting you, your life and your family. The next part of the consultation is to try to eliminate some or all of the pain you are experiencing at that time.

I usually begin with trigger point deactivation of the cranial and upper body muscles. It is amazing how frequently we can elimnate all or most of the pain just by utilizing techniques described by Dr Janet Travell over 50 years ago. Dt Travell was President John F Kennedy's physician.

The majority of all pain patients experience is muscular in orgin, and turning off the pain allows us to understand the undrlying processes. At this same visit we will make a trial change of proprioception into the central nervous system from the trigeminal nerves.

We can usually eliminate most pain during the first visit the hard work is to make these changes on a long term basis. I tell my patients to set a goal of 50-80% reduction in pain initially. As treatment progresses we continually try to remove 50-80% of remaining pain. This is accomplished by utilizing a diagnostic neuromuscular orthotic to change how the muscles function and to alter trigeminal nerve proprioceptive input to the brain.  Over time there are postural changes and healing.

I often find that I "meet" my patients at the third or fourth appointment.  The patient I meet initially is the person living in pain for months or years but after a few visits I meet the real person who was lost under an avalanche of pain.  There is a great joy in watching people recover and regain their lives.

I practice Neuromuscular Dentistry and Pain Treatment as part of my Chicago area TMJ practice.

Are Trigger Point Injections More Effective Than Botox In Treating TMD (TMJ) Myofascial Pain

A recent study in Pain. 2011 Apr 21 looked at botulinum toxin type A for treatment of persistent myofascial TMD pain. Saline was used as the placebo-control in this double blind study. The crossover study examined 21 patients Myofascial TMD with inadequate pain control.

The study was done to evaluate the effectiveness of botulinum toxin type A for treatment of persistent myofascial TMD pain but actually showed that Saline is normally considered an excellent placebo because there are no direct biological changes associated with saline. There was statistically no advantage to botulinum toxin type A over saline.

I hypothesize that the improvement in pain showed in the study with saline was a direct result of the injection, not what was injected. Dry needling has also been shown to be very effective treatment for myofascial trigger points associated with TMD. I utilize both dry needling and lidocaine injections for treating MPD. Treatment of myofascial trigger points is an extremely effective treatment for TMD pain.

Trigger Point Injections and Dry Needling remain on of the most effective treatments for myofascial TMD.


Pain. 2011 Apr 21. [Epub ahead of print]
Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain: a randomized, controlled, double-blind multicenter study.
Ernberg M, Hedenberg-Magnusson B, List T, Svensson P.
Source

Unit of Clinical Oral Physiology, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE 141 04 Huddinge, Sweden.
Abstract

Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P=.163), but there was a significant time effect (P<.001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1month and by 23 (30%) after 3months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1month and 7 after 3months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3months after saline injection (P<.05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain. Botulinum toxin type A is not an effective adjunct to conventional treatment in persistent myofascial temporomandibular disorders.

Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

PMID:
21514731
[PubMed - as supplied by publisher]

WHY IS NEUROMUSCULAR DENTISTRY SO SUCCESSFUL IN TREATING TMJ (TMD) DISORDERS AND HEADACHES. THE PRESENCE OF MYOFASCIAL PAIN IS THE LINK

TREATMENT OF TMD, TMJ DISORDERS, TENSION-TYPE HEADACHE AND MIGRAINE HAVE WIDE AREAS OF OVERLAP. THIS OVERLAP IS IN SYMPTOMS AND CAUSES BUT MYOFASCIAL TRIGGER POINTS ARE A MAJOR SOURCE OF PAIN.

NEUROMUSCULAR DENTISTRY IS VERY SUCCESSFUL AT TREATING TMJ, TMD AND MYOFASCIAL PAIN DISORDERS OF THE HEAD AND NECK. PATIENTS WHO DO NOT WANT LONG TERM DRUG THERAPY SHOULD CONSIDER THE NEUROMUSCULAR DENTISTRY APPROACH TO IMPROVING THE HEALTH OF THE MASTICATORY SYSTEM, RELIEVING CHRONIC MUSCLE PAIN AND MYOFASCIAL TRIGGER POINTS AND PREVENTING CENTRAL SENSITIZATION.

THE LITERATURE STRONGLY SUPPORTS THE ROLE OF MUSCLES IN CHRONIC PAIN. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS AN IDEAL FIRST STEP FOR LONG TERM TREATMENT OF TMJ (TMD) DISORDERS AND HEADACHES. NEUROMUSCULAR DENTISTS FREQUENTLY WORK IN CONJUNCTION WITH PHYSICAL THERAPISTS, CHIROPRACTERS, OSTEOPATHS AND MASSAGE THERAPISTS.

IMPROVING THE QULITY OF LIFE OF PATIENTS ARISING FROM MUSCULAR DISORDERS AND IDEALIZING HOMEOSTASIS ARE BASIC TO NEUROMUSCULAR DENTAL TREATMENT.

There are 576 scientific articles that come up on a PubMed search using key terms of Myofascial Pain and TMJ. 221 PubMed articles come up searching Myofascial pain and Headache, and 61 articles when searching Myofascial Pain and Migraine. There are another 80 articles that come up searching Myofascial Pain and Tension-type Headaches.

Myofascial Pain is a constant in these searches. Myofascial pain results from repetitive overuse syndromes and is commonly considered a major component of TMD.
Neuromuscular Dentistry is directed toward treating myofascial pain, muscle spasm and other muscular disorders of the masticatory system.

An article "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." published in Feb 2011 Clinical Journal of Pain (abstract below) found that " TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved."

Central facillitation is central to many theories on why some patients get chronic headaches and migraines. Another article, "Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache." in the Feb 2011 Journal of Headache Pain (abstract below) confirms that tension type headaches in children are associated with myofascial pain.

The article states that "TrPs (myofascial trigger points) were identified with palpation and considered active when local and referred pains reproduce headache pain attacks." and that "The total number of TrPs was significantly greater in children with CTTH (chronic tension type headache) as compared to healthy children"

More significantly it stated "Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack.

THIS MEANS THAT TRIGGER POINTS CAUSE TENSION TYPE HEADACHES IN CHILDREN, THE MORE TRIGGER POINTS THAT WERE PRESENT THE LONGER THE HEADACHES LASTED.

The study found a similar association with neck pain and trigger points " Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children."

Another 2011 article "The relationship of temporomandibular disorders with headaches: a retrospective analysis." (abstract below)found that "The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach."

THIS MEANS THAT HEADACHES, ESPECIALLY TENSION-TYPE HEADACHES ARE FREQUENTLY CAUSED ASSOCIATED WITH TMD OR TMJ DISORDERS.

ANOTHER STUDY FROM DECEMBER 2010 JOURNAL PAIN "Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain." SHOWED CORRELATIONS OF HEADACHE FREQUENCY TO TMD.

THEY CONCLUDED THAT "these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches."

THIS MEANS THAT THE CENTRAL SENSITIZATION FOUND IN HEADACHES, MIGRAINES AND FIBROMYALGIA ARE POSSIBLY DUE TO TMD.

THE ARTICLE "Pure tension-type headache versus tension-type headache in the migraineur." FROM Curr Pain Headache Rep. 2010 Dec;14(6):465-9. STATES THAT IT CAN BE DIFFICULT TO DIFFERENTIATE MIGRAINE, TENSION TYPE HEADACHES AND SYMPTOMS OF TMD ESPECIALLY IN THE CASE OF CHRONIC PAIN.








Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.

Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.

*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract

OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.

METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.

RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.

DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.

PMID: 21368664 [PubMed - as supplied by publisher]

J Headache Pain. 2011 Feb 27. [Epub ahead of print]
Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain, cesar.fernandez@urjc.es.
Abstract

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

PMID: 21359873 [PubMed - as supplied by publisher]

Agri. 2011 Jan;23(1):13-7.
The relationship of temporomandibular disorders with headaches: a retrospective analysis.

Cakır Özkan N, Ozkan F.

Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Abstract

Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.

PMID: 21341147 [PubMed - in process]

Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.

Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.

University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

PMID: 21196079 [PubMed - as supplied by publisher]

Curr Pain Headache Rep. 2010 Dec;14(6):465-9.
Pure tension-type headache versus tension-type headache in the migraineur.

Blumenfeld A, Schim J, Brower J.

The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract

Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.

PMID: 20878271 [PubMed - indexed for MEDLINE]

Continuous headache with earache and eye ache.

David: I have had continous Headaches for 3-4 months now. sides and back of head mainly. Earache and eye ache as well

Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.

An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial pain. If stretch and spray gives relief of the headache, earache and eye ache you will confirm the muscular component.

Because almost all Tension Type Headaches are influences by the Trigeminal Nervous system you will probably do well by tring a Diagnostic Neuromuscular Orthotic as a non-invasive safe diagnostic and treatment entity. If yo get complete relief you will confirm that the headache is muscular and trigeminally modulated.

Occasionally trigger point injections are needed to break-up long standing muscle issues.

Headaches since June, Back of head that last 1 1/2 days and end with throwing up.

Rachel: I have on going headaches since June. They are in the back area of the head and I usually have them for 1 day and half. Most of the time I end up throwing up

Dr Shapira response: Dear Rachel,

I assume that you have visited you physician to discuss your headaches due to the dramatic change. If nothing is found medically occipital headaches are frequently helped by a neuromuscular orthotic. Symptoms that you describe can also be caused by Atlas/Axis problems and you might want to consider seeing an Atlas Orthogonal or NUCCA chiropracter..

If the pain is primarily muscle ait may be easy to relieve utilizing Travell vapocoolant spray and stretch. Does the pain go away immediately after vomiting? When you vomit it causes instant but temporary release of closing jaw muscles.

It is always important to consider organic disease when a new type of headache occurs. Never assume that there is not an undrlying disease process. Neuromuscular Dentistry is probably one of the safest and most effective treatments for chronic headaches and migraines but when a new type of headache occurs it is important to rule out other medical causes.

Objective diagnosis is the key, you do not want to become a drug guinea pig diagnosed by serial drug experiments.

Trigger point injections are an essential part of TMD, Migraine and Headache treatment for many patients

The importance of this study though extremely limited is that it explains why understanding Myofascial Pain and Dysfunction is essential when chronic pain problems including neck pain, headache and TMD disorders. In this study a single injection in the trapezius muscle (shoulder) gave significant reduction in pain in the masseter region along with reduction in EMG values.

There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.

Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.

Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.

Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.

PMID: 8121703 [PubMed - indexed for MEDLINE]

Trigger points and referred pain

Dr. Shapira, Thank you for taking the time to answer my question. This answer is one that has help me know what is definately going on in my head and given me a posible remedy to my misery. THANK YOU!!!

The sore spots are from tender muscles and trigger points that cause the headaches.

Neuromuscular dentistry can frequently correct the problem that causes both the headaches and the muscle pain.