Precision Personalized Medical Treatment for Headaches and Migraines: SomatoSensory and Autonomic Nervous Systems

Prevention and Elimination of  all types of headaches including tension headaches, muscle tension headaches, sinus headaches, cluster headaches, migraines and other autonomic cephalgias require careful but deliberate application of a combination of autonomic and somato-sensory approaches to idealization of neural input

Measurement is essential for precision medical treatment! "If it is measured it is a fact otherwise it is an opinion" Barney Jankelson father of the field of precision neuromuscular medical / physiological approach to treatment of dental occlusion and treatment of Trigeminal disorders and TMJ Disorders.

In general treatment for headaches and migraines is far from personalized or precision but rather consists of trial and error treatment with pharmaceuticals. Many neurologists use a "chinese menu approach" of one from column A and 2 from column B" When this is not successful they up the dosage.

100% of Headaches and Migraines are Trigeminally innervated either partially or predominantly. There is only one precision approach to the Trigeminal Nervous System that concentrates on reducing nociception and that is Neuromuscular Dentistry.

The fastest connection in the trigeminal nervous system, the brain or anywhere in the body is the Proprioceptive Mesencephalic Nucleus of the Trigeminal Nerve. This incredibly important area is the only place in the nervous system that has direct electrical conduction of impulses between neurons rather that the more common and slower acting chemical neurotransmitters found in other nerve connections. Only precise personalized precision adjusts of neuromuscular dentistry accurately adjust this crucial and unique area of the brain.

The brain is very complex and there are different chemical neurotransmitters that transmit impulses across neuro-junctions. Much of the pharmaceutical attack on headache symptoms concentrate on altering these neurotransmitters such as serotonin, Norepinephrine, CGRP, Substance P, Acetyl Choline, glutamate (most prevalent and usually excitatory 90% of the time), aspartate, γ-aminobutyric acid (GABA) which is the second most prevalent. Gamma-Aminobutyric Acid, or GABA, which is inhibitory at more than 90% of the synapses that do not use glutamate.

Learn more about the Personalized Precision Medicine Approach to correcting nociptive input into the trigeminal nervous system that is a major cause of all headaches, migraines and autonomic cephalgias at http://www.sphenopalatineganglionblocks.com

Elimination of headaches is different than correction of the nociceptive input into the CNS due to neuroplasticity and previous muscle splinting, taut bands, triggerpoints and other myofascial issues from chronic muscle over-adaptation. Correcting long standing problems requires directly addressing myofascial trigger points and taut bands with ULF-TENS, trigger point injections, spray and stretch, myofascial trigger point therapy, myofascial release and other techniques as well as correcting postural issues throughout the body. Trigger Point Injections as espoused by Dr Janet Travell and David Simons MD is perhaps one of the single most personalized precision types of treatment for headaches, myofascial pain and Fibromyalgia as opposed to the dangerous approach of pharmaceuticals used in a shotgun fashion. There is a place for medications in all these disorders but it should be secondary or tetiarry not primary.

The autonomic nervous system is also a major area of concern and perhaps the best approach is to avoid all psychoactive drugs with their widespread side effects and instead alter the incoming messages into the autonomic nervous system with Sphenopalatine Ganglion (SPG) Blocks which can turn off the Sympathetic Fight or Flight response and allow the Parasympathetic system to predominate with its Feed and Breed or Eat and Digest functions.

Neuromuscular Dentistry was the first to utilize electrical Stimulation of the Sphenopalatine Ganglion and has over a fifty years safety record with remarkable results for patients.  This is due to the position of the Sphenpopalatine Ganglion (also known as Pterygopalatine Ganglion, Meckels ganglion, nasal ganglion and Sluder's ganglion) on the Maxillary branch of the Trigeminal nerve.  While the primary purpose of the Myomonitor or ULF-TENS invented by Dr Barney Jankelson was to relax the Trigeminal musculature and use that to create a neuromuscular occlusion there was also incidental stimulation of the facial nerve and both sympathetic and parasympathetic fibers of the autonomic nervous system.  The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head but it also has sympathetic  fibers from the cervical chain that feeds into it.  Both of these autonomic fibers run though the same trigeminal nerves along side of the somato-sensory fibers.

Neuromuscular Dentistry has an incredible effect on resolving and preventing all types of headaches including tension headaches, muscle tension headaches, sinus headaches, cluster headaches, migraines and other autonomic cephalgias due to this unique combination of autonomic and somatosensory approaches.  Starting treatment with a Diagnostic Neuromuscular Orthotic is the ultimate in precision personalized medicine.

Personalized Precision Medicine is also ideally approached in the autonomic nervous system when patients can self administer SPG Blocks, the same technique used by DR Milton Reder in the best selling book about his practice "Miracles on Park Avenue" which discussed the miraculous "cures" that were obtained with this amazing block first discovered and reported by Dr Sluder in 1908.

This link is video stories of  patients who have had SPG Blocks:
https://www.reddit.com/r/SPGBlocks/

This link is stories of patients treated with Neuromuscular Dentistry
https://www.reddit.com/r/NeuroMuscularDent/

Dr Shapira practices Neuromuscular Dentistry in Highland Park, IL a suburb of Chicago.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
http://www.ThinkBetterLife.com
http://www.DelanyDentalCare.com
http://www.IHateCPAP.com
http://www.iHateHeadaches.org
http://www.SleepandHealth.com
http://www.SphenopalatineGanglionBlocks.com

Self Administer SphenoPalatine Ganglion (SPG) Blocks: Improve Your Quality of Life!

SPG Blocks were featured in the book "Miracles on Park Avenue" but it is often difficult to find doctors who utilize these blocks.  It is even more difficult to find doctors who teach patients to Self-Administer these blocks.  There is a link below to SPG Block referral forms.

Learn More about these blocks at www.sphenopalatineganglionblocks.com

See Videos of patient stories at: https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg
and at
https://www.reddit.com/r/SPGBlocks/

Self administration is typically done with cotton-tipped nasal catheters and 2% lidocaine.  The cost of self administration after initial visit is less than $1.00 per bilateral administration.  The real savings are decreased drug use and associated side effects, less physician visits saving driving and waiting time, decreasing or eliminating visits to the ER,  increases in quality of life, interpersonal relations etc.

In addition to relieving pain resetting the autonomic nervous system to turn off sympathetic overload which can help turn off anxiety, PTSD, depression and panic attacks.  This may be useful for patients suffering CRPS.

Patients frequently come to my office to learn this technique.  If you have a referral from your physician there is a better chance of being reimbursed by your insurance company.

Patients can learn the procedure in a single visit and we frequently see long distance patients who come in just to learn Self-Administration of the amazing block.

Referral information can be found at:  https://thinkbetterlife.com/referrals/

I have been teaching physicians and dentists to do this procedure for many years.  Most recent courses were in Scottsdale and in Buenos Aires.  I am teaching my next course in Seattle in August 2017 at the Myotronics 50th Anniversary meeting.

The SPG Block is amazing as a stand alone procedure but we routinely utilize it as a part of neuromuscular treatment protocol designed to correct balance and homeostasis to the craniomandibular-cervical complex and to control the trigeminal nervous system where all headaches and migraines originate.

The referral for also has referral information for Diagnostic Neuromuscular Orthotic, Neuromuscular Dentistry, Trigger Point Injections, Occipital Nerve Blocks, ULF-TENS and many other treatments.

Chicago Migraine Management: Amazing Migraine Relief With SPG Block

Management of migraine is often difficult and the side effects of treatment regimens can sometimes be as bad or worse than the initial problems.

SPG Blocks is a radically different type of migraine treatment that can be a game changer for many patients. The side effects of SPG Blocks include a feeling of relaxation and well being, lower BP, increased libido and increased parasympathetic / reduced sympathetic activity.

Contrary to many current algorithms for deciding which treatment to utilize for Migraine, Autonomic Cephalgias and Chronic Headache Sphenopalatine Ganglion Blocks should always  be considered a first line approach to treatment due to high efficacy and minimal negative side effects.  A very high quality of life can be achieved when these blocks are effective, though like all treatments they do not work for everyone.  It is important to remember that the method of delivering an SPG Block is important as it can determine how successful the block is.

A new article in Current Pain Management (abstract below) discusses Sphenopalatine Ganglion Blocks in treating Migraine, Facial Pain and various neuralgias.

The article states “SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias.”

The degree and duration of relief varied with the method of delivery of the SPG Block. Dr Shapira has been utilizing Sphenopalatine Ganglion Blocks for over 30 years and utilizes many different methods of delivery, He teaches course in delivery of SPG Blocks and has recently lectured in Buenos Aires and Scottsdale and is next lecturing in Seattle.

It is important for many reasons to have multiple methods of delivering these blocks. The most effective method appears to be via Suprazygomatic injection route followed by the intra-oral injection route.

In spite of high success with injection techniques Dr Shapira generally promotes the cotton tipped nasal catheter approach. While it may be less effective initially than injections because it is easy to self administer at home. The cost afte initial appointments is under $1.00 per bilateral block. The biggest savings to the patient are in travel time, aggravation and avoiding delay in treatment, ie increased time suffering.

The advantage to self administration is that patients finally are in control of their pain treatment. They can utilize blocks multiple times on the same day if desired.

There are several commercial devices for delivering SPG Blocks as well. The Sphenocath is my preferred device in patients where cotton tipped nasal catheters are not possible to utilize. These all require 20 minutes in the supine position for best results. The Sphenocath device adds considerable costs BUT the same device can be used repeatedly by a patient at home.

The Allevio and TX360 devices are also available. None of the commercial devices are marketed for home use.

Medications for treating Chronic migraine, Daily headaches, facial pain and autonomic cephalgias are very expensive, beset with many annoying and often dangerous side effects and frequently not effective.

These videos are patient who has success with SPG Blocks:

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

The SPG Block is probably the safest treatment modality for many of these chronic headache problems.

Neuromuscular Dentistry is also extremely effective in eliminating the underlying causes of these same disorders and can be easily utilized in combination with SPG Blocks.
www.ThinkBetterLife.com

PUB-MED ABSTRACT BELOW
Curr Pain Headache Rep. 2017 Jun;21(6):27. doi: 10.1007/s11916-017-0626-8.
Sphenopalatine Ganglion Block in the Management of Chronic Headaches.

Mojica J1, Mo B1, Ng A2.
Author information
Abstract
PURPOSE OF REVIEW:
Sphenopalatine ganglion (SPG) block has been used by clinicians in the treatment of a variety of headache disorders, facial pain syndromes, and other facial neuralgias. The sensory and autonomic fibers that travel through the SPG provided the scientific rationale for symptoms associated with these head and neck syndromes. Yet, despite the elucidation of this pathogenic target, the optimal method to block its pain-producing properties has not been determined. Clinicians have developed various invasive and non-invasive techniques, each of which has shown variable rates of success. We examined the available studies of sphenopalatine ganglion blockade and its efficacy in the treatment of cluster headaches, migraines, and other trigeminal autonomic cephalalgias.
RECENT FINDINGS:
Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents. Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.
KEYWORDS:
Cluster headache; Hemicrania continua; Migraine headache; Paroxysmal hemicrania; Sphenopalatine ganglion block; Trigeminal autonomic cephalalgias

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

Lake Forest TMJ, Headaches, Migraines and Neuromuscular Approach To Definitive Personalized Treatment

The relationship of TMJ Disorders to Headaches and Migraines are well documented in both medical and dental literature.  The primary connection is via the Trigeminal Nerve.  The Trigeminal Nerve is often called the "Dentists Nerve" but the Trigeminal nerve is also at the center of each and every headache and migraine treated by physicians and neurologists.  The science behind this connection is two-fold.  The Trigeminal nerve also controls the blood flow to the anterior two thirds of the meninges of the brain.

Sinus headaches are usually treated by ENT's or Otolaryngologists but the Trigeminal Nerve is also front and center in both acute and chronic sinus pain.  Multiple studies have shown that most diagnosis of sinus infections causing pain are in fact incorrect.  

There are many documented cases of complete relief of all of these disorders with eliminated with Neuromuscular Dental Orthotics especially when combined with treatment of Myofascial Pain Disorders (MPD).  There are over 100 Chicago patient Testimonials at: 

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

WWW.ThinkBetterLife.com is the website of my new office dedicated to treatment of both TMJ Disorders, Sleep Disorders including Snoring & Sleep Apnea and chronic headaches and migraines.

The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) has published a report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" that should be read by every patient with TMJ disorders, Morning Headaches, Chronic Daily Headaches, Sleep Apnea, Snoring and migraines.

 https://www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf

Sphenopalatine Ganglion Blocks are an amazing adjunct for treating chronic pain disorders.  It works via the autonomic nervous system and turns off the "Fight or Flight" reflex that is implicated in tension headaches, chronic anxiety and panic attacks.  www.sphenopalatineganglionblocks.com

Severe Vertigo, TMJ and Treatment with Neuromuscular Dentistry: Video Testimonial.

Claress had a severe episode of Vertigo that the medical specialists were unable to treat.  She had undergone CAT Scans and MRI's.

Dr Shapira had previously treated her husband who credits him with his current quality of life.  Claress cam in to Dr Shapira who utilized ULF-TENS (ultra-low frequency TENS) and a diagnostic neuromuscular orthotic to stabilize her jaw and Claress saw her Vertigo disappear.  Dr Shapira utilized Computerized Mandibular Scans with the Kinesiograph so he could measure in 3 dimensions the corrections Claress required.

Watch Claress's Testimonial on Youtube:  https://www.youtube.com/watch?v=cLwX6xXLc0I&t=2s

The Trigeminal Nerve is key to successful neuromuscular dental treatment in the treatment of TMJ disorders, chronic daily headaches, migraines, eustacian tube disorders and of course vertigo.

Visit www.ThinkBetterLife.com to learn more about problems treated in his Highland Park office.

Visit Dr Shapira's youtube channel for over 100 patient testimonials.

TMJ Lake Forest: Neuromuscular Dentistry has a Physiologic Approach to Treating TMJ Disorders

Treatment of TMJ Disorders, Headaches, Migraines and Sleep Disorder are focus in new practice serving Lake Forest and Highland Park TMJ patients.

  Dr  Shapira  created www.IHateHeadaches.org website to bring the Physiologic Approach to treating TMJ Disorders with Neuromuscular Dentistry to a wider audience and has over 10,000 unique visitors on a monthly basis.

Diagnosis and Treatment of TMJ disorders requires a wide variety of skills that most general dentists don’t acquire. The treatment of TMJ disorders is far more advanced than just the mechanical approach of mouth guard and bite adjustments. In fact, many patients get worse because invasive treatment is done at the beginning of treatment.

Drastic Improvements in the Quality of a Patient’s Life require the ability to utilize a wide range of treatment modalities and diagnostic modalities.

His new office is dedicated to treatment of TMJ disorders, Chronic headaches / migraines and sleep disorders including snoring and sleep apnea.  WWW.ThinkBetterLife.com

Dr Shapira has been a leader in the field TMJ treatment and research for many years and is the current Chair of the Alliance of TMD Organizations. He served for many as a an Assistant Professor at Rush Medical School and is a Diplomate of the Academy of Pain Management.

Patient Testimonials Videos on TMJ, Migraines, Trigeminal Neuralgia Sleep Apnea and Snoring https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

He has practised Physiological Neuromuscular Dentistry and trained with Barney Jankelson the Father of Neuromuscular Dentistry. Dr Shapira has served as a Fellow and Regent of ICCMO: The International College of CranioMandibular Orthopedics and is their representative to the TMD Alliance.

He has lectured extensively on Sleep and TMJ disorders and is scheduled to lecture in Buenos Aires, Argentina in 2017 on Sphenopalatine Ganglion Blocks. He previously lectured on the “Common Development Aspects of TMJ Disorders, Sleep Apnea, Headaches, Migraines and ADD (ADHD) in Buenos Aires.

Dr Shapira’s paper on Neuromuscular Dentistry was written for the American Equilibration Society and has been republished by ICCMO and was presented at an SOT research meeting.

The Myofascial Pain and Dysfunction components of TMJ disorders are vital to understanding how to achieve the best results. Dr Shapira trained with Dr Janet Travell and has taught courses in treating MPD and TMJ.

Dr Shapira has been published in Cranio Journal, The Journal of CranioMandibular Practice and has a chapter in a textbook of Anti-Aging Medicine dealing with anti-aging aspects of dental treatment. He currently does editorial reviews of new articles submited to Cranio prior to acceptance for publication.