CHRONIC DAILY HEADACHES (CDH): MAYO CLINIC CONSIDERS CDH THE MOST DISABLING OF HEADACHES TMJ Treatment May be the Answer

CHRONIC DAILY HEADACHES (CDH):  MAYO CLINIC CONSIDERS CDH THE MOST DISABLING OF HEADACHES

How your headaches are defined may prevent you from having effective treatment.

Living with headaches is a fact of life for many headache survivors.  According to Mayo Clinic  “chronic daily headaches occur 15 days or more a month, for at least three months. True (primary) chronic daily headaches aren't caused by another condition.”  This definition will artificially separate similar headaches into different diagnostic groupings.

Chronic daily headache is not a specific type of headache but rather a disabling pattern of headache occurrence.

Johns Hopkins describes Chronic Daily Headache as “A patient who has headaches as many days as not — at least 15 days a month — is said to have chronic daily headache (CDH). CDH is not a specific type of headache, but rather a descriptive term applied to any number of headache types. The two most common types of primary headache are Migraine and Tension-Type Headache.  Rebound headache or medication overuse headache is a frequent occurrence in patients with CDH.  The treatment actually becomes the disease.

The typical treatment offered by headache specialists and neurologists is a prescription medication.  When the first is not effective the patient is often taken thru a series of single medication trial followed by trials of multiple medications.  This is similar to what happens to patients who utilize OTC medications moving from drug to drug often mixing prescription and non-prescription medications.

Tension-type headaches are the most common type headache but they are often dismissed as being relatively mild and tolerable.  These headaches often progress to Rebound headaches and/or migraine.  Tension-type headaches should be considered to be muscle contraction headaches.  According to Cleveland Clinic “They used to be commonly referred to as muscle contraction headaches or stress headaches, but these old terms have been abandoned.”

90 – 95% of all headaches are actually partially or completely muscle contraction headaches.  There are Vascular/ Neurogenic components to all headaches as well. 

According to the NHLBI of the NIH patients who receive a diagnosis of TMJ have a 60-90% chance of experiencing satisfactory resolution of symptoms but patients diagnosed with other types of headaches will probably be condemmed to live in pain.

 or muscle contraction headaches are considered episodic if they occur less than 15 days/month and chronic if they occur more than 15 days/month.  They may las for 30 minutes to several hours or continue for days at a time.  Because they are a type of headache referred from muscles they tend to have slow onset and are achy in nature.  Patients often describe them as a taut band, pressure headaches, and usually they are bilateral and generalized in location.   What is important to understand is that Tension –Type headaches can be part of a ongoing process that triggers migraines and other more severe headaches.  Tension headaches can be as severe or even more severe than migraine headaches. Tension-Type headaches are considered a Primary headache but referred headaches from the neck muscles  (cervical headaches or cervicalgia) and/or the TMJ  (Tempormandibular Joints) and masticatory muscles are considered secondary headaches..   

These secondary headaches are examples of muscle contraction headache as are headaches related to trigger points and taut bands in Fibromyalgia and Myofascial Pain and Dysfunction. 

According to John Hopkins the following is a list of causes of tension-type headaches.  If you read the list it is almost like saying a normal life is the cause of headaches.  What all of these have in common is that they all provoke muscle contractions secondary to stress.

·        “Inadequate rest

·       Poor posture

·       Emotional or mental stress, including depression

Tension-type headaches can be triggered by some type of environmental or internal stress. This stress may be known (overt) or unknown (covert) to the patient and their family. The most common sources of stress include family, social relationships, friends, work, and school. Examples of stressors include:

·       Having problems at home

·       Having a new child

·       Having no close friends

·       Returning to school or training; preparing for tests or exams

·       Going on a vacation

·       Starting a new job

·       Losing a job

·       Being overweight

·       Deadlines at work

·       Competing in sports or other activities

·       Being a perfectionist

·       Not getting enough sleep

·       Being over-extended; involved in too many activities/organizations”

According to the National Heart Lung and Blood Institute of the National Institute of Health TMD Disorders :

“TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints.

TMD remains to be classified in the larger context of other muscle and joint disorders or in the category of pain disorders (NIH Technology Assessment Conference, 1996). About half of all cases are attributed to conditions linked to the muscles of mastication”  and “Pain linked to the TMJ and/or muscles of mastication constitutes the essential criterion for case assignment. It often qualifies as “aching”, “throbbing”, “tiring” and exhausting.

These are the same symptoms found in tension headaches and both are associated with similar proportions of female to male patients.  These disorders are also associated with sleep disturbances that tie them to a wide variety of other disorders.

The National Institute of Health and PubMed.gov provide the largest database in the world of headache publications.  These publications universally agree that regardless of the type of headache a patient has almost 100% are caused or mediated by the Trigeminal Nervous system.  The Trigeminal Nerve is often called the Dentist’s Nerve because it innervated the teeth,the periodontal ligament and gums, the jaw muscles, the jaw joints and many associated structures.    The Trigeminal Nerve also controls the blood flow to the anterior two thirds of the meninges of the brain.

Why do TMJ patients do better than other headache patients?  Only dentistry treats headaches by changing input to the brain.  While migraines are often thought to be caused by chemical imbalances within the brain only dentistry attempts to correct these chemical inbalances by eliminating noxious input to the Trigeminal Nervous System.

Neuromuscular Dentistry is probably the single most effective method of controlling noxious (nociceptive) input to the brain.

TMJ Treatment, Sleep Apnea Treatment, ADHD Prevention and Improving People's Lives: A Message of Hope

Originally printed Highland Park Landmark

By Alan P. Henry

"Highland Park dentist Dr. Ira Shapira has a message for anyone suffering from TMJ disorders including migraines or for those looking for a way to deal with issues related to sleep apnea and snoring, including but not limited to ADD and ADHD.

“I want people out there who have problems and feel like there is no hope to know there is hope,” he said.

Dr. Shapira, a resident of Highland Park for 34 years and practicing dentist for almost four decades, has just opened an office at 3500 Western Ave. in Highland Park. Unlike his general dental practice in Gurnee, this office serves as a resource for people suffering chronic pain.

“I love changing people’s lives,” he said. “You have someone who has chronic pain, when you take away their headaches and their face pain, to me this is the most rewarding part of anything I do.”

Dr. Shapira’s approaches to headache treatment are not unique, but neither are they universal. Most doctors treating headaches are physicians or neurologists, he said, and if after tests they see no obvious issues involving the brain or tumors, they typically “make the assumption that it is a chemical problem” and turn to drugs to treat the problem.

But according to Dr. Shapira, the origin of most headaches is the trigeminal nerve, a nerve that is responsible for sensation in the face and motor functions such as biting and chewing, and it is from that direction that treatment is best directed.

He founded www.Ihateheadaches.org, an online resource designed to help people find ways to combat chronic neurological pain. The site, which includes a blog written by Dr. Shapira, can be used to find a doctor and also as an educational tool where a person can discover all they need to know about the kind of headache they may have.

“Many people in pain and desperate for an end to their headaches will look to CAT Scans, powerful medication and more to help them. Very few will look to a dentist who is able to find a solution through neuromuscular science,” writes Dr. Shapira. “Our site is designed to assist you in taking the first steps of pursuing neuromuscular eduction, diagnosis and treatment.”

Dr. Shapira was initially inspired to take on the treatment of issues related to sleep apnea and snoring by way of an experience his son Billy had when he was five.

After observing a limited attention span, excessive tiredness and unusual behavior in Billy, Dr. Shapira took his son to pediatricians, ENTs and allergy doctors, who said he had ADHD. “Basically, they told us he couldn’t start kindergarten and they wanted to put him on ritalin for life,” he said.

But Dr. Shapira also took Billy to the sleep center at Rush, where a sleep test showed he had severe sleep apnea — his heart stopped beating 60 times an hour when he was sleeping. “We took his tonsils and adenoids out when he was five and widened his mouth orthodontically, so the same kid who couldn’t start school because he had ADHD ended up graduating college magna cum laude with double majors and double minors,” said Dr. Shapira. “Turns out his drug of choice was oxygen. He needed to breath. Because he couldn’t breath, he had disturbed sleep. Back then we didn't know it, but now we know now that disruptive sleep can give you exactly the same symptoms of ADHD.”

Seeing the positive changes in his son after his airways were opened, Dr. Shapira turned his attention to the field, and the relief proper treatment can give.

“There are airway issues that start young and go all the way through life,” said Dr. Shapira. “If I can help make somebody’s quality of life better, that is huge.”

Currently, he said, as many as 80 percent of children have “underdeveloped jaws” which means they run the risk of having problematic airways. “If you have a child that is snoring, that is not normal,” he said.

Dr. Shapira now has child patients as young as two for whom he makes appliances that can be worn at night. “We can grow them bigger airways,” he said.

Dr. Shapira founded www.IHateCPAP.com, a one stop source for information about sleep apnea. Severe sleep apnea affects more than 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness. Most people with mild sleep apnea are aware that they snore and feel overtired or fatigued but are unaware of potentially serious medical problems which may exist, he said.

Dr. Shapira, DDS, D,ABDSM, D,AAPM, FICCMO is a Diplomat of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a Fellow and current Secretary of the International College of CranioMandibular Orthopedics, and a former Assistant Professor at Rush Medical School, where he researched effect of jaw position on sleep apnea.

He has written a chapter on anti-aging dentistry in an anti-aging medicine textbook; is Dental Section Editor of Sleep and Health Journal; has lectured in the US and abroad on TMJ disorders, sleep apnea, dental sleep medicine and anti-aging medicine, and has several patents on stem cell collection from developing wisdom teeth and currently are awaiting NIH funding of a study at UIC and Baylor.

He recently started Sleep Well Illinois, a company that promotes universal sleep screening in physician offices, and just became the Chair of the Alliance of TMD organizations for a two year term.

His Highland Park office is Chicagoland Dental Sleep Medicine and the Website is www.ThinkBetterLife.com"

Severe Daily Headaches: Find Headache Hope Through Neuromuscular Dentistry & Correction of Trigeminal Nervous System Input

Lisa is suffering from severe daily headaches and contacted Dr Shapira thru www.IHateHeadaches.org for help.
Dr Shapira sees Midwest and long distance patients in his Illinois offices.

Lisa:     I have headaches (which are more like ear/face /aches) every day. I have had this for years.
I went to an ENT. My CT scan shows a deviated septum with a bony spur and a small cyst.
The doctor said this was not causing the headaches and that it was not sinus related.

My GP said I have TMJ combined with tension headaches. I was prescribed Imitrex which relieves my stress and helps lesson the headache pain (but it is still there).

I cannot remember the last time I didn't have some sort of pain in the ears, face, head. I was told by the ENT to see a neurologist to rule out migraines (since light and sound does aggravate my symptoms).

Dr Shapira Response: Dear Lisa,

When the CT can doesn't show an organic problem the neurologist will treat you with medications. It does not matter what they call the headache; migraine, tension headache etc they will treat you with meds and not address the underlying problems.

I would suggest seeing a neuromuscular dentist and having a diagnostic neuromuscular orthotic. This is a reversible treatment but successfully alleviates or redures 50-100% of pain in 90% of patients. (approx)
All of the types of headaches are primarily disorders of the Trigeminal Nervous System. The Trigeminal Nerve, also called the Dentist's Nerve is key to causing and eliminating headaches. Neuromuscular dentistry and diagnostic orthotics change brain chemistry by changing neural input to the brain.

I frequently see long distance patients in Chicago area if you do not find answers but I am sending you a link to find an ICCMO Neuromuscular Dentist.

I usually find that we can eliminate most pain in just a few visits for the majority of patients.
See some of the vide testimonials http://thinkbetterlife.com/patient-testimonials/

There are 26 ICCMO members in California, each has there own level of knowledge but have shown a commitment to the science and art of neuromuscular dentistry by belong to and attending ICCMO meetings.
http://occlusiontmjauthority.com/find-a-tmj-dentist-2/

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations

www.ThinkBetterLife

• 
  

ARE MY HEADACHES CAUSED BY TMJ? BOTOX: Diagnosing TMD (TMJ) Disorders with BOTOX

Are my headaches caused by TMJ?  

Headache Relief from BOTOX Injections is Diagnostic of a TMJ/TMD Disorder.

Edited from article in www.ThinkBetterLife.com

Patients frequently want to know whether their migraines or chronic daily headaches are caused by TMJ disorders.   This depends on how you differentiate  TMJ and/or  TMD disorders from headaches and migraines if the pain symptoms are identical.   The TMJ (Jaw Joint) is the TemporoMandibular Joint, TMD stands for TemporoMandibular Disorder.  The term TMJ often creates confusion in medical profesions, especially dentists who believe that TemporoMandibular Joints have to be clicking or poppping for a patient to be diagnosed with a TMJ disorder.  Diagnosing TMD or TemporoMandibular Dysfuction Syndrome requires examining  the entire complex of muscles, joints, teeth, habits, nervous system and understanding the complex underlying physiology of the entire system.

I have seen patients whose headaches are very easy to treat but they never had complete evaluation becaause they were told their headaches were not TMJ or TMD because there were no joint sounds or locking.  Patients can be critically deprived of proper treatment due to lack of apprpriate diagnosis.

TMD or TemporoMadibular Dysfunction includes the TMJoint, The joint capsule,  the muscles, the teeth, the periodontal ligaments,  the sinus linings, the tongue and its connections to the hyoid bone and associated muscles and ligaments, The posterior cervical muscles, the upper cervical spine including the atlas and axis vertebrae,the airway, the ears and most importantly the Trigeminal  Nervous System.

I will explain what the connection of TMJ to Headaches initially and at the end of this article how TMD treatment with a Diagnostic Neuromuscular Orthotic is an essential component in the diagnosis and treatment of all headache patients.

All headache specialists agree that the Trigeminal Nervous System is involved in almost 100% of all headaches. Specifically, two components of the Trigeminal Nerve are of critical importance to headache patients. The first is the Tigeminalvascular System which is the critical nervous component of all Migraine and Vascular Headaches as well as all autonomic Cephalgias. It controls the blood flow to the anterior two thirds of the brain thru the meninges or dura of the brain.

Most migraine preventive and treatment medications address the TrigeminoVascular System and the Trigeminal-Cervico Complex.

The second Trigeminal component is the Trigemino- Cervico Complex which is connected to almost all types of headaches including tension headaches, cervicogenic headaches and chronic daily headaches and more importantly is responsible for CENTRAL SENSITIZATION. Central Sensitization is the key connection that connects headaches and Fibromyalgia and other chronic pain syndromes.  

“The nociceptive (painful input) inflow from the meninges to the spinal cord is relayed in brainstem neurones of the trigemino-cervical complex (TCC). Two important mechanisms of pain transmission are the convergence of nociceptive trigeminal and cervical afferents and sensitization of trigemino-cervical neurones. ” (Schmerz. 2004 Oct;18(5):404-10.)

The same article also stated “These mechanisms have clinical correlates such as hyperalgesia, allodynia, spread and referral of pain to trigeminal or cervical dermatomes."  Trigemino-cervical complex neurones act as "integrative relay neurones between peripheral and central pain mechanisms. The understanding of these mechanisms has implications for the understanding of the clinical phenomenology in primary headache syndromes and the development of therapeutical options.”

The Central Nervous System thru the Trigeminal nerves causes referred pain and hyperalgesia, an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves.

Dermatones are actually road maps of where different nerves go, understanding where nerves come from and go to is essential in diagnosing what processes are causing pain.

Peripheral treatment of Migraine, Tension Headache, Chronic Daily Headache and Chronic Migraine with Botox is currently in vogue and should be considered an important diagnostic procedure as well as a treatment procedure. When Botox is administered to Trigeminally innervated muscles and gives substantial relief it should be considered diagnostic proof of a TMD problem.  This is especially true in patients diagnosed with fibromyalgia,  MPD or Myofascial Pain and Dysfunction problems.  

While there is nothing wrong with injecting Botulinum Toxin every three months into headache and migraine patients if it relieves their symptoms and improves their quality of life it is ridiculous to ignore the underlying causes necessitating use of BOTOX.  Our bodies are not designed or evolved to require BOTOX injections but need them due to failure to achieve healthy homeostasis of physiologic systems.

Relief of Migraine and other headaches by BOTOX should be considered proof of the existence of a TMD disorder.  

The Trigeminal Nerve is often called the Dentist’s Nerve, it innervates all of the pulpal tissue of the teeth as well as the periodontal ligaments (PDL). The PDL has at least 29 known nerve receptors and is the largest input to the proprioceptive system of the human body. The Trigeminal dwarfs input from the middle ear especially after impulses are amplified inthe Reticular Activating System of the brain.  

The trigeminal nerve also innervates the Jaw Joints or TMJoints, the joint capsules and the retrodiscal lamina of the TMJoints where most primary TMJ pain originates. Referred pain to the TMJoint can come from Trigeminally innervated masticatory muscles including the masseter muscles, the temporalis muscles, the medial pterygoid muscles the lateral pterygoid muscles, the diagatric muscles and the very specialized muscles that tense the ear drum (Tensor Veli Tympani) and the muscle that opens and closes the eustacian tubes the Tensor Veli Palatini.

Referred pain to the TMJoint area can also be referred fron neck and shoulder musculature via the Trigemino-Cervical Complex.  The upper cervical musculature should always be considered as an intimate component of the masticatory system and be evaluated in TMJ and/or TMD patients.

The tongue is also partially innervated by the Trigeminal Nerve and an extremely important function of the Trigeminal Nerve is to maintain a patent airway. The National Heart Lung and Blood Institute (NHLBI) of the NIH wrote an incredibly important report “The Cardiovascular and Sleep Related Consequences of TemporoMandibular Disorders” It emphasizes the effects of airway on a wide variety of problems. Sleep Apnea is a TMD problem or Jaw Problem, the most important function of our jaws, teeth tongue and muscles is to maintain an airway, essential for life.

Forward head posture is implicated in almost all chronic head and neck problems and is actually largely a response to diminished airway. A more accurate description would be a forward neck posture with excessive rotation at Atlas-Axis-Occipital Joints. This airway head position connection is the link to all chiropractic patients and TMD patients. As long as forward head posture is uncorrected adverse mechanical forces will be affecting the spine and posture. Atlas Orthoganol Chiropractic and NUCCA Chiropractic address this connection concentrating on the Occipital -Atlas-Axis connections which they feel is the primary  key to successful treatment.

The effect of the Trigeminal nerve including TrigeminoVascular and Trigemino-Cervico Complexes is that of  variable nociceptive and proprioceptive input into our CNS or Central Nervous System. In computer language chronic pain is an I/O error or input/uotput error. In English, GARBAGE IN-GARBAGE OUT!  Too much Nociceptive input will create temporary and eventually premanent changes in brain function.  Our Brain is our computer and nociceptive and garbled input to the body creates biochemical changes in our brain, at one threshold they cause pain at a higher or more continuous level they cause chronic pain and at their worst they cause Central Sensitiztion or a meltdown of normal fuction with creation of Hyperalgesia (increased pain response) and Allodynia (inappropriate pain response). The use of Botox TOXIN is to disconnect the Trigeminal Nerve from the Trigeminal Muscles. If it improves headache it is proof of the TMD disorder.

The most Ethical approach to these problems is the use of a Neuromuscular Diagnostic Orthotic to correct physiologic function of the masticatory system, decrease trigminal nociception, to create homeostasis of the proprioceptive systems, decrease Central Sensitization, correct airway and posture and to remove adverse mechanical forces to the cervical spine and to the entire spinal structure.

When the neuromuscular diagnostic orthotic is used many patients respond extremely favorably and utilization of dangerous medications is reduced or eliminated. The frequency of physical therapy, massage therapy, chiropractic and osteopathic adjustments is reduced and the overall quality of life is improved.  This is due to the unique ability of the diagnostic orthotic to change input to the brain thru the Trigeminal Nervous System.

Patients who respond positively to treatment with a neuromuscular diagnostic orthotic can move forward with  definitive treatment or have long term removable orthotics made.  Patients can titrate the amount of time they wear removable orthotics based on their symptoms.  

The adaptability of the human body is great and the joints and muscles can adapt to less than perfect physiology and position but this results in excess nociception into the CNS and can result in Central Sensitization.   There are certain publications such as "Treating TMDs with Permanent Mandibular Repositioning: is it Medically Necessary?" by  Charles S. Greene, DDS, Ales Obrez, DMD, PhD that use adaptability as a reason not to create permanent changes in the bite for TMD.   

The conclusion is any position, no matter how awful is always correct because of adaptability.  You can change the position but not for TMD.  

The arcticle states " The continuing adaptability of the teeth, muscles and TMJs throughout life is described in terms of homeostasis, leading to the conclusion that each person current TMJ position is biologically correct. Therefore, that position does not need to be changed as part of a TMD treatment protocol. This means that irreversible treatment procedures such as equilibration, orthodontics, full mouth reconstruction and orthognathic surgery cannot be defended as being medically necessary.

Dr Greene has a long history of working with Insurance companies to deny patients legitimate coverage.  In this paper Dr Greens wants to use insurance contract medical language used to deny claims and raise it to the level of science.  

The following is a footnote in the article:  "The term “medical necessity” appears often in the medical literature in regard to treating patients with various diseases/disorders. However, it is almost never defined in an operational manner. The authors were unable to find a complete or consistent definition for this term by searching medical dictionaries, PubMed, or various internet search engines (e.g., Google, Bing, Yahoo). Instead, the main source for the above list has been certain insurance company contracts, in which they inform doctors and hospitals about what will or will not be covered. The authors have modified those statements to develop the 6-point definition presented here. 

What Doctor Greene is stating:   THE SCIENTIFIC DIAGNOSIS OF WHAT IS MEDICALLY NECESSARY SHOULD BE BASED ON WHAT INSURANCE COMPANIES COVER.

The article is correct in stating there is adaptability but nervous system adaptability (or lack) creates central sensitization.

There are many aspects to treatment of TMJ disorders and this article is meant to address just the treatment effects of diagnostic orthotics.  Diagnostic Orthotics change jaw position and joint position but long term treatment is a clinical decision made by doctors and their patients together.

Each patient is in essence a clinical study of one. This is evidenced based medicine but it is the evidence obtained by evaluating and treating a single individual. There is an enormous benefit to prospective studies involving hundreds of patients to give us evidenced based approaches to fit populations. Unfortunately, the field of TMD has so many variables that the most efficatious method to study an individual is to do a clinical study that includes all of the variable unique to this specific patient. In utilizing a Neuromuscular Diagnostic Orthotic we accomplish that goal.

The patient can discontinue the non-invasive treatment at any time but if treatment improves symptoms in a life changing way the patient can elect to make definitive changes utilizing a position that has been shown to be effective and therapeutic.

IMPROVEMENT IN QUALITY OF LIFE IS ALWAYS THE GOAL OF TREATMENT

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.

Neuromuscular Dentistry: Migraine,Chronic Daily Headache and TMJ Treatment. Find A Neuromuscular Dentist at ICCMO,The International College of CranioMandibular Orthopedics

This article is being reprinted form a press release:                    CHICAGO, IL, April 10, 2015 /24-7PressRelease/ -

ICCMO, The International College of CranioMandibular Orthopedics is the premier group representing Neuromuscular Dentistry since founded by Barney Jankelson, The father of Neuromuscular Dentistry.

"The American section of ICCMO has created a new website to help patients find Neuromuscular Dentists and to learn about treatment of headaches, migraines and TMJ disorders utilizing neuromuscular concepts to achieve a physiologically healthy bite."

 The International College of CranioMandibular Orthopedics is a society of health care professionals who are devoted to the study of the anatomy and physiology of the stomatognathic system with special emphasis on Neuromuscular occlusion, jaw function and orthopedics dysfunction (TMJ-D) with effects across the entire body. Primary functions include chewing, eating, smiling, communication and maintenance of a health airway during the day and during sleep.

ICCMO has recently created an exciting new website to help patients Find A Neuromuscular Dentist. http://occlusiontmjauthority.com

The Neuromuscular Treatment has been shown to be very effective in treating patients with a wide variety of problems including TMJ disorders, Jaw Pain, Sinus Pain, Neck Pain, Migraines, Chronic Daily Headaches, Otalgia (ear pain) and many other types of pain and postural dysfunction. To find a Neuromuscular Dentist visit http://occlusiontmjauthority.com hit the TMJ Patients tab and read each section including:
TMJ 101
How to Mange Your TMJ
Signs of TMJ
Symptoms of TMJ
Causes of TMJ
Treatment of TMJTMJ Testimonials..In Chicago http://thinkbetterlife.com/patient-testimonials/
Then go to the Find a Neuromuscular Dentist and type in your state to find Neuromuscular Dentists in your area.

An excellent description of Neuromuscular Dentistry that was written by this author and published in the ICCMO Anthology can be found at: 
http://www.sleepandhealth.com/neuromuscular-dentistry

The primary objectives of the ICCMO members from the website http://occlusiontmjauthority.com are;
"ICCMO members pledge to apply the highest level of integrity and objectivity in the care of their patients, and the organization pledges itself to the following:

To understand the physiology of jaw function
To alleviate the widespread human suffering of those persons afflicted with head and neck pain and dysfunction (TMJ-D)
To encourage study of the anatomy, physiology, biophysics and pathology of the human neuromuscular system
To develop research and educational programs that will identify and define the principles of neuromuscular dentistry
To teach interested professionals how the principles of neuromuscular dentistry are applicable to the treatment of malocclusion, dental restoration, and the various pathological conditions of headache, sleep apnea, temporomandibular dysfunction, and head and neck postural dysfunction
To encourage research and development of equipment that allows objective measurement and recording of normal function and existing pathological neuromuscular conditions of the bones, muscles, nerves, joints and ligaments of the head and neck
To sponsor educational scientific meetings that provide instruction in the application of these various neuromuscular principles to the practice of dentistry
To encourage our members in this field of scientific endeavor for the ultimate benefit of the people of the world
To promote publications of neuromuscular studies in dentistry
To actively endeavor to maintain "Freedom of Practice" for all of the College's members enabling them to practice in accordance with their professional expertise, license and the needs and desires of each patient and to protect their right to "Freedom of Practice"
Exchange of ideas, practices and research"

Dr. Bernard Jankelson is the undisputed Father of the field of Neuromuscular Dentistry and the Dental Occlusion Concepts. He also founded ICCMO in 1979 with an international group of clinicians and dental educators. ICCMO was created as a not for profit organization to provide an open forum for the free exchange of ideas, practices, and research in the field of neuromuscular dentistry. The members have always strived for a professional, noncompetitive and friendly atmosphere.

I want to disclose that as author I am both a member, Secretary and Fellow of ICCMO and had the pleasure to train with Dr J and I was sponsored by him to become a member of ICCMO. I currently treat patients in Gurnee and Highland Park, Illinois and I am the representative of ICCMO to the TMD Alliance and the current Chair of the TMD Alliance. My Highland Park office website is www.ThinkBetterLife.com

ICCMO currently has active Sections in the United States, Canada, Japan, Germany, Italy, France, Russia and South America. ICCMO has played a key role throughout these years in gaining recognition and acceptance of neuromuscular dentistry (NMD) and the computerized measurement devices used in clinical practice in the US and abroad. In addition, the ICCMO is a member of the American Alliance of TMD Organizations.

Patients who are looking for treatment of TMJ disorders, TMD, Chronic Daily Headches and Migraines are well advised to seek out a Dentist actively involved with the International College. The next ICCMO meeting is in Kyoto, Japan on April 18 and 19 2015. This author was scheduled to speak but had to cancel my trip due to family and business matters but I did have the pleasure of attending the meeting 18 months ago in Germany and deliver a lecture in the meeting in Buenos Aires, Argentina. More information about the meeting is available at: http://occlusiontmjauthority.com/shop/non-iccmo-members-18th-internat ... oto-japan/

The ICCMO.org website states "ICCMO members have proven the validity of neuromuscular dental principles and practices through programs at universities, dental organizations and governmental bodies, together with scientific publications in peer reviewed medical and dental journals.

North American ICCMO members on behalf of the College have made presentations before the ADA, USFDA and NIDCR (NIH).

Similar activities have transpired in Europe, Japan and South America. Textbooks on TMD have been authored by ICCMO members and published in the US, Japan, and Italy."

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal. Sleep and Health is a unique monthly periodical dedicated to public education about healthy sleep as a foundation for general health. GOOD HEALTH means Good SLEEP and High ALERTNESS

Sleep and Health represents a Forum of opinions, giving voice to public concerns as well as health professionals about problems in the Health Care. Over the years Sleep and Health has not shunned or avoided controversy and has been engaged in sharp public debates on important health issues. Reader's feedback was and is always important to us.

As a founding member of The American Academy of Dental Sleep Medicine (formerly the Sleep Disorder Dental Society) Dr Shapira was among the first dentists to become a Diplomate of the American Board of Dental Sleep Medicine and was also a founding and charter member of DOSA, The Dental Organization for Sleep Apnea. He is currently involved in the Dental Sleep Masters program that is promoting universal sleep screening.

Dr Shapira did research utilizing neuromuscular dentistry on the similarities in jaw position in sleep apnea and TMJ patients in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry. 
His research showed that TMJ and Sleep Apnea patients had very similar jaw postures.

Dr Shapira has maintained a general dental practice with a special emphasis on sleep and pain in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates in Highland Park. More information on Sleep, TMJ and Headache Treatment can be found on his websites.

http://www.delanydentalcare.com (Gurnee Office)

http://www.thinkbetterlife.com (Highland Park office)

http://www.ihateheadaches.org 

http://www.chicagoland.ihatecpap.com.

http://www.Sleepandhealth.com

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, President of Sleep Well Illinois, Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. He is currently working with Dr Tom Diekwisch at the University of Illinois and Baylor University to prove these stem cells can change peoples lives for the better. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

#neuromuscularDentistry, #findaneuromusculardentist

Does the Trigeminal nerve trigger migraines from smells?

A study by the Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston showed that migraines and other similar problems may be caused by the trigeminal nerve. This is another example showing how the use of neuromuscular dentistry to decrease noxious input from the trigeminal may be effective in eliminating a migraine trigger.

While this study suggests that migraines can be caused by smells from the Trigeminal Nerve I strongly believe the Trigeminal Nerve can also utilize smells to turn off migraines, tension headaches and other pains.  The Trigeminal nerve is utilized to smell menthol a common addition to many topical pain relievers.  I believe that input to the trigeminal nerve can turn headaches on or off.

The physiologic effect of neuromuscular dentistry and the use of TENS is to change the input to the trigminal nerve.  Changing of brain chemistry is the basis for many types of drugs that tray migraine, headaches and depression.  Brain chemistry can also be adjusted with neural input via implntable devices.  Neuromuscular Dentistry utilizes changes to neural inputs by adjusting and correcting physiologic function.

The article states "Trigeminal nerve fibers in nasal and oral cavities are sensitive to various environmental hazardous stimuli, which trigger many neurotoxic problems such as chronic migraine headache and trigeminal irritated disorders." These disorders would include Sinus pain and headaches, migraines tension-type headache and TMD (temporomandibular disorders)

The study was published in Biochem Biophys Res Commun. 2008 Nov 28;376(4):781-6 by Wu J, Zhang X, Nauta HJ, Lin Q, Li J, Fang L.. The authors state that " the role of JNK kinase cascade and its epigenetic modulation of histone remodeling in trigeminal ganglion (TG) neurons activated by environmental neurotoxins remains unknown". The important part is not the exact chemical pathways involved but rather the confirmation that migraines triggered by smells and chemicals are trigeminally innervated and therefore there is good reason to believe that the restoration of a healthy physiologic state to the masticatory system, bite and neurouscular function should help alleviate many or all of these migraines.



In the orbital apex, the nasociliary, frontal, lacrimal, and maxillary branches of the trigeminal nerve demonstrated intense staining upon entering the orbit. CONCLUSIONS: Sympathetic nerves enter the orbit via the first and second divisions of the trigeminal nerve and a plexus of nerves surrounding the ophthalmic artery.