Dr. Shapira's Chicago Headache Blog

Osteopathic manipulation and Chiropractic manipulation both treat headaches by changing input into the trigeminal nerve much like neuromuscular dentistry does. The article states: " Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache." The pathology in the neck is addressed to reduce pain (nociceptive) input into the trigeminal nucleus caudalis. The easiest and most direct method of reducing nociceptive input into the trigeminal nerve is a diagnostic orthotic followed by definitive long term treatment. The beauty of neuromuscular dentistry is that correcting the stomatognathic/ trigeminal system leads to auto correction of many neck problems.

The reason that NUCCA and A/O (atlas orthogonal) chiropractic is so effective when used in conjunction with a neuromuscular orthotic is that the chiropractic and/or osteopathic adjustments hold when the underlying masticatory pathology is adressed.



J Am Osteopath Assoc. 2007 Nov;107(10 Suppl 6):ES10-6.
Diagnosing and managing migraine headache.
Mueller LL.

University Headache Center, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, 42 E Laurel Rd, University Doctors Pavilion, Ste 1700, Stratford, NJ 08084-1354, USA. SOMPhysicians@umdnj.edu
Comment in:

J Am Osteopath Assoc. 2008 Apr;108(4):191; author reply 191, 214.
Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. Although tension-type headaches are the most common kind of headache, patients with this type of headache rarely seek treatment unless occurrence is daily. Migraine, which affects more than 30 million people in the United States, is the most common headache diagnosis for which patients seek treatment. Migraine is a chronic, often inherited condition involving brain hypersensitivity and a lowered threshold for trigeminal-vascular activation. Intermittent debilitating attacks are characterized by autonomic, gastrointestinal, and neurologic symptoms. Migraine results in a marked decrease in a patient's quality of life, as measured by physical, mental, and social health-related instruments. Accurate assessment of a patient's disability will guide physicians in prescribing appropriate modes of therapy. However, migraine remains underdiagnosed, and patients with migraine remain undertreated. A comprehensive treatment approach to migraine may include nonpharmacologic measures, as well as abortive and prophylactic medications. Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.

PMID: 17986672 [PubMed - indexed for MEDLINE]

Labels: A/O, atlas orthogonal, atypical migraine, cluster headache treatment, Migraines, neuromuscualr dentistry, NUCCA, nucleus caudalis, spenopalatine block TMJ, TMD, trigeminal nerve

Slightly rewritten from an LVI forum post explaining to new neuromuscular dentists the importance of body posture and a few of the ways t can be addressed.

I had the supreme honor of studying with Janet Travell and watched her magically turn long legs into short legs and vice-versa. A trick I picked up from her 30 years ago was to correct the standing leg posture, have the patient walk and correct it again. I use paper towels as temporary orthotics in the shoe. I have the patient take short walks and the readjust the foot orthotic (paper towel). It is done easily by feeling the top of he hips with your finger tips and getting them at eye level (patients love having their doc on his knees) after several adjustments it will stabilize.

I take most of my bites standing so I will do this before taking bite or adj. The bite is essential but is not just a record of upper jaw to lower jaw, but rather a way to capture 3 dimensional body mechanics and jaw relatin simultaneously.

I teach the patient how to do this at home. They need a full length mirror and two marker spots on the top of the hip bone. They stand 4-5 feet back from the mirror and hang a black plumb line in the middle of the mirror and can self adj.their orthotics. Initially they will do this several times a day. I Rx they just buy several diffent Dr Scholl pads an self adj frequently. Sometimes the lift will switch sides more than once while the spine staightens itself.

The second trick is to also check the hip height in the sitting position. We use tushy orthotics to even height of hips sitting. It is crucial to know if the high side changes from sitting to standing because it corkscrews the spine and wreaks havoc on the bite. These are the patients whose Atlas is never stable. We send them for Atlas orthogonal adjustment with a leg correction, We have the leg length checked standing before they leave because it may need a change in the orthotic and we check the sitting orthotic because they are sitting in the car going from one office to the other. We frequently have them keep an aqualizer in their mouth or a coton roll as well so we get a/o aj without having it affected by the bite. It would be a whole lot easier if we could just cut the head off and just deal with the bite.

The patient does the same proceedure with the plumb line but sits on a hard flat chair. The patients keep their tushy orthotics in their car, desk chair, couch etc. For long term correction of structural hip deficiecy I have had patients, usually women have them made from bike pants that the pads are adjusted and "tummy control"

If a patient has a structurally short hip on one side sitting and leg length discrepancy on the other we are guaranteeing long term problems and dental failures in the mouth.

It is vital patients do their ascending correction 24/7 or it is the same effect of our orthotics not being left in. Corrections must be continuous.

When I have a patient and we do the pen test (I use cotton rolls easier to adj to improve results) we show them arm strength and balance with the correction then without. I then correct leg length with something under shoe and repeat the test. They get the same results. We then do a double correction to increae strength and balance more and the we blow them away because they lose strength and balance regardless if we take away the shoe lift or the bite correction. They now completely understand ascending/descending concepts.

Now all we have to worry abut is the AP position of spine from hips to head including pelvic tilt and hip rotation and balancing pecs and rhomboids and the effects on jaw relation.

Labels: A/O, neuromuscular dentistry, NUCCA, posture, TMD, TMJ