Headache Treatment and Neuromuscular Dentistry: I Hate Headaches LLC Creates A New Website Offering Hope To Millions Of Headache Sufferers

    GURNEE, IL, December 01, 2009 /24-7PressRelease/ -- It has been estimated that as many as 30-48 million Americans have chronic headache or migraine. Approximately one in six Americans suffer from headaches. They are divided into two groups Primary and Secondary Headaches. The Primary group accounts for more than 90% of all headaches and include tension headaches or muscular contraction headaches, vascular or migraine headaches, and cluster headaches.

It is these primary headaches sufferers that neuromuscular dentistry can help. Recent studies in Cephalgia estimate that a large percentage of these patients have overlapping disorders and that treatment of the patients TMD disorder can have positive effects on eliminating the problems. A study in Cephalalgia. (2008 Aug;28(8):832-41) "Are headache and temporomandibular disorders related? A blinded study." found the prevelance of TMD (temporomandibular dysfunction) in the headache population was 56.1%. The patients with combined migraine and tension-type headaches had a higher prevelance of TMD. They also found that over 40% of patients had psychosocial dysfunction caused by TMD and that there was moderate to severe depression by over 50% of patients.

A second paper published in Cranio (2009 Apr;27(2):101-8) "Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment." by Dr Barry Cooper "concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition." The article stated "Evidence for a cause and effect relationship was strong." meaning that there is excellent evidence of a cause and effect relationship between TMD and headache.

The article also reported clinically significant reduction or resolution of tension-type headaches. The new website http://www.ihateheadaches.org concentrates on how neuromuscular dentistry can be used to reduce or eliminate tension-type headaches and migraines. A recent article on Neuromuscular Dentistry in the American Equilibration Society publication "Contact" was reprinted in Sleep and Health Journal and can be found at http://www.sleepandhealth.com/neuromuscular-dentistry The article describes neuromuscular dentistry and TMJ disorders in an understandable fashion.

Two articles published in Cranio by Shimshak et al showed that there was a 200-300% increase in medical costs in all medical field in patients carrying a diagnosis of a TMJ disorder. This should be considered especially important as we try to control expansion of medical costs. A study in Cephalgia (2009 Apr 30.) "Application of ICHD-II criteria for headaches in a TMJ and orofacial pain clinic." found that ". In 502 temporomandibular disorder and orofacial pain patients, 246 patients (49%) were diagnosed with tension-type headache (TTH), followed by migraine without aura (14.5%), probable migraine (12.9%), migraine with aura (7%), probable TTH (4.8%) and cluster headache (0.2%). " It also found that "Of the headache patients, 81.1% presented with masseter muscle pain and 47.8% with temporal muscle pain." They concluded by suggesting that these muscle pains " may be an inducing factor of primary headache."

The Trigeminal nerve is what TMJ,TMD, tension-type headaches (previously chronic daily headaches) and migraines have in common. The trigeminal nerve is implicated in most migraines because it controls the blood flow to the anterior two-thirds of the brain thru the meninges. The Trigeminal nerve is also called the Dentists nerve because it supplies nerves to the jaws, jaw joints, jaw muscles, the tongue, the lining of the sinuses (ie sinus pain or headache), the tensor of the eardrum and the muscle that controls the soft palate and eustacian tube. TMJ disorders are sometimes called The Great Imposter (http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor) because they mimic so many problems.

A new article in Medical Hypothesis (Med Hypotheses. 2009 Sep 16) "Migraine, neuropathic pain and nociceptive pain: Towards a unifying concept." presents the case for a unifying theory of the three commonest pain syndromes affecting humans, migraine, neuropathic pain and nociceptive pain. They address the issue that the two theories of migraine pain, central mediation vs periferal and suggest they share the same pathophysiology. This is exactly what neuromuscular dentistry proponents have taught for years.

The authors conclude "At the end, we suggest that fundamentally all the three pain syndromes referred to in the article share a common pathophysiological mechanism, namely peripheral pain perception, peripheral sensitization at dorsal root ganglion or its intracranial counterpart (like trigeminal ganglion) and central sensitization at the spinal cord (dorsal horn for somatic pain), brain stem nuclei and thalamus before final pain perception at the sensory cortical matrix." The problems of TMJ disorders (TMD) are often related to central sensitization of the trigeminal nerve secondary to nociception (painful impulses received by the brain) from peripheral problems.

Neuromuscular dentistry can effect over 50% of the nervous input to the brain in a positive way to reduce nociceptive input from peripheral nerves and thereby prevent both the neuropathic pain and central sensitization. There is a second theory that migraines are caused primarily thru vascular rather than neurogenic means. This would also be explained by the Medical Hypothesis article"Migraine, neuropathic pain and nociceptive pain" as the trigeminal nerve controls the blood flow to the brain and both central and periferal influences could cause pathological blood flow leading to migraine or other intracranial vascular disorders. Neuromuscular dentistry would still be suited to treating the vascular headaches thru correction of trigeminal nerve regulation.

The National Heart Lung and Blood Institute released a report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" that discusses the relation of TMJ problems to sleep apnea but also discusses the central sensitization as well as the importance of the jaws for breathing and swallowing control. The report states that "Nearly 12% of the general population, primarily women, exhibits symptoms of TMD. These subjects are characterized by pain, restricted range of mandibular motion, altered jaw relationships including retrognathia, and the impact of pain on jaw motor function." The report estimates that TMD is "estimated to affect about 12% of the general population, representing more than 34 million Americans." All dental literature shows that women make up the majority of patients seeking treatment. These symptoms are most common during the reproductive years. An interesting finding by Shimshak was that there was a 200-300% increase in medical usage but this did not include obstetrics. This may be do to lower birth rates among women with chronic pain problems. The report also stated "TM disorders are considered a serious health problem because many individuals lose their ability to hold regular jobs and to function productively even within
the context of a household environment."

There is a large overlap between TMJ symptoms and symptoms associated with sleep apnea. Morning headaches in particular are nearly always related to either sleep disorders or TMJ disorders. Sleep bruxism and sleep clenching are considered to be sleep disorders primarily that negatively effect the TM Joint and trigeminal nerve controlled muscles.

Patients who have sleep apnea are usually prescribed CPAP treatment. Unfortunately the majority of patients do not tolerate CPAP. Patients who do not tolerate CPAP (see http://www.ihatecpap.com/oral_appliance.html) often find help treating their sleep apnea with oral appliances. Their are many similarities between sleep apnea appliances and neuromuscular orthotics used to treat TMJ disorders. Sleep apnea and TMJ disorders are very closely related and patients with chronic headaches, especially morning headaches should have their sleep evaluated.

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com 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. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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