Dr. Katz, iHATEheadaches Blog

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Eagle Syndrome

noreply@blogger.com (Abraham A. Katz, DDS) — Mon, 14 Dec 2009 00:48:00 +0000

Everyone once and a while you come across a condition or an anatomical
oddity you learned about years ago but thought you would never see in the everyday population you treat.

Such was the case the other day. I had my hygienist take a panorex x-ray, an x-ray that shows the skeletal structures of the entire mouth, jaws and sinuses, for a new patient in our office. The individual had no symptoms at all. No neck pain, facial pain or headaches. But when I looked closely at the panorex, I saw an unusual sight. The Styloid process, a small bone
on the back of the head, adjacent to the ear lobe running down the side of the neck and which is usually about3/4 of an inch long was about three or more inches long in this case.

I asked again if he had any unusual symptoms like throat pain or facial pain but the patient said that he felt perfectly fine. I showed him the x-ray and told him how amazed I was that he felt perfectly fine. There appeared to be no other pathology. I explained to him that the extended bone might at some point cause him headaches, pain when turning his head, loss of appetite, or even a change in his voice.

I told him that a combination of symptoms such as those could be classified as Eagle Syndrome. I also told him that he was fortunate that he looked well and felt well but be aware that if he began experiencing any symptoms I described, he would be wise to see me so I could refer him to an ear nose and throat specialist.

The causes of headaches, head pain, neck and facial pain are varied. Sometimes a simple dental x-ray and a keen diagnostic eye can make the difference between years of suffering or a very quick and simple remedy.

Stress- Mind Over Matter

noreply@blogger.com (Abraham A. Katz, DDS) — Mon, 23 Nov 2009 01:32:00 +0000

Stress has been shown to be a major factor in the onset and longevity of tension headaches. We all experience occasional tension headaches. Sometimes they come infrequently but sometimes they can become chronic occurring on a daily basis. Chemical levels in the body such as serotonin and endorphins may be effected by outside stresses on the body and may be the trigger for many headaches.

Frequent episodic tension type headaches can last from hours today. They are bilateral, pressing and frequently coexist with migraines without aura.

Many years ago, I treated a middle aged women who suffered from almost daily headaches. She was also being treated by a neurologist for her headaches and I don't recall any TMJ related
symptoms that might have been contributing to her condition.
She was very high strung, nervous and asked to be sedated for her dental treatment. This occurred over twenty five years ago so I don't have her records available to me any longer but I do remember the following episode very well. I remember that she had a very unusual name with 6 or seven consonants and one vowel. A name I had much trouble pronouncing.

I completed her dental treatment under sedation and she then disappeared from my practice.
I remember that on her last visit I wished her well and hoped that she would eventually find relief from her chronic and debilitating headaches.

A few years later I was introduced to a new patient with the same unusual name as
the woman with the headaches I had seen previously. The patient was a very pleasant, neat
young woman with no dental needs other that a good cleaning.
After my initial examination, I mentioned to her that a few years back I had seen someone
with the same unusual name and out of curiosity asked if there was any relationship.
"Why Yes, she answered me, that was my mother.

I was quite surprised and my immediate question was about her mother's headaches.
"Does she still get them. Are her headaches still as debilitating as they had been."

My Mother , she answered does not get any headaches any more she's doing great and very happy. Astounded, I asked what accounted for the dramatic turn around in her mothers
health. She divorced my father she answered. She just left him.
We both broke out laughing. I was quite amazed and very happy for her mother.
It was a great lesson learned. The mind can definitely effect our bodies and health both in a positive and a negative way. Medication is not always the answer.

True story
So, for your own good health, treat your spouse well

What do teeth have to do with it?

noreply@blogger.com (Abraham A. Katz, DDS) — Wed, 04 Nov 2009 01:13:00 +0000

I had not seen Donna, who was now 50 years old, for more than six years. On examination Donna showed evidence of multiple caries and moderate periodontal disease. She had four bicuspids missing,her teeth were crooked and crowded and it was obvious from the four bicuspid extractions that she had had braces at a young age. Her main concern was that she was very dissatisfied with how her teeth looked. She could not open her mouth very wide and made a lot of noise when opening and closing her mouth but was not concerned about it..

"Do you also have shoulder pain", I asked. she told me her shoulders always hurt especially on the left side. "What about your neck?" Her neck had been hurting for as long as she could remember. ' But that's because I sit in front of a computer screen all day. "Well, how about headaches, do you get them often?" I get them a lot especially when I'm tense around my temples and over my eyes. "Do your fingers tingle too." Yes she said, but how did you know that and what does all this have to do with my teeth. "

"Good question", I answered. Maybe your symptoms are all related to your posture, work habits, level of tension and migraines. But you have certain symptoms that can also come form another source, the relationship of your upper to your lower jaw, the relationship of how your teeth come together (occlusion) and the effect the position of your teeth and jaws have on your neck, shoulder and jaw muscles.From the noise your jaws were making it sounds like you jaws (TMJoints)have taken a beating. That popping noise and grinding feeling has to do with your jaw
fitting in the groove of your skull. Like worn shock absorbers or worn brakes , your jaw has become poorly aligned and could just be the cause of your headaches , neck pain and even tingling in your hands. Just like realigning your tires and getting new brakes your car will function better and last longer.

Your teeth are not isolated a vacuum that's your mouth. Your teeth are part of a system in your body and changes in that system effects other parts of your body. From your teeth to your neck and shoulders to your ears hands and back.

Your body likes to be in balance and when one of its parts goes out of balance
it lets you know by sending you pain signals. After a while those sharp pains become low grade chronic pain and only become acute if an additional factor suddenly reminds the body that there is still an imbalance and it making you hurt. Worn and broken teeth, shifting teeth, painful jaw joints, bad bite, limit opening and closing are all things that might be causing or contributing to severe head pain.

So when I examined Donna again, I told her I was not only looking at her teeth but that I was observing signs and symptoms that might be telling me that she may have more problems than broken fillings and an unsightly smile that might need addressing.
She was definitely impressed and surprised that I was paying attention to so many thing besides just her teeth. "When I look at you, I told her, I see more than just teeth". I see someone who wants to be as healthy as she can be."

What do teeth have to do with it?

noreply@blogger.com (Abraham A. Katz, DDS) — Wed, 04 Nov 2009 01:13:00 +0000

Holistic Approach to headache relief

noreply@blogger.com (Abraham A. Katz, DDS) — Tue, 27 Oct 2009 00:26:00 +0000

Holistic medicine is defined by the Canadian Holistic Medical Association, as

"A system of health care which fosters a cooperative relationship among all those involved, leading toward optimal attainment of the physical, mental, emotional, social, and spiritual aspects of health."

There are many types of headaches and cause of headaches. There are primary causes and secondary causes, genetic causes, hormonal causes and causes due to chemical imbalance and chemical hypersensitivities. In each of these areas there are specialist who treat headaches based on their specialty. If after seeing a host of practitioners and going through many diagnostic tests and then no cause is found, the sufferer becomes apprehensive, worried, despondent and made to feel that it's all in their head.

Neuromuscular dentist understand that there are other factors that may contribute to head,neck and fascial pain. Headaches of many types are associated with the fifth cranial nerve, the Trigeminal nerve. Migraines, sinus headaches,headaches cause by Temporomandibular dysfunction (TMD) or TMJ are also associated with the same nerve the fifth cranial nerve. Treating, TMJ,the jaw joints, can help relieve or prevent a lot of pain and the associated symptoms linked to the fifth nerve.

Pnupa, a college student over a period of a year, developed symptoms that included headaches,neck, shoulder and facial pain, ringing in the ears and tingling and numbness in her hands. After seeing a host of specialist and months of test, she was told no apparent cause could be found for her symptoms. She had trouble typing and she had to cut the number of classes she could attend at school because of her hand numbness. Carpal tunnel syndrome was ruled out.

She saw a pamphlet I had in my waiting room describing TMD and it's symptoms. "That's me "she said.

Together with her physician, a physical therapist and our treatment of her TMJ with appliance therapy, her symptoms have started to subside. Her hand pain has gone from a Maximum of five out of five to a two in intensity. She is thrilled that she can spend more time typing and working at school. Best of all she happy to know it was not in her head.

Not every headache is due to jaw or bite dysfunction. But being open minded to all the possiblities and working together can make make many chronically unhappy and pain stricken people, pain free and productive again.

Dealing with stress

noreply@blogger.com (Abraham A. Katz, DDS) — Sat, 24 Oct 2009 12:27:00 +0000

How do you deal with stress? Some people get high blood pressure, some people get ulcers. Myself, I tend to clench and grind my teeth. I wasn't always aware of it.
A few years back, I was driving with my wife to a shopping mall. What's the matter she said. "Nothing, I said. Why do you ask." She told me that since we left our drive way my jaw muscles were contracting and expanding as I was grinding and clenching away. I had never realized it. She was right . I was worrying about something and was mulling it over in my mind not realizing that I was transmitting my anxiety and manifesting my tension by grinding and clenching.

Most people clench or grind occasionally but about 10% suffer from TMJ problems and those can set in suddenly. TMJ disorders can mimic migraine headaches, earaches, sinus infection and tooth aches. it can cause dizziness, ringing in the ears, and muscle pain that radiates down the neck and shoulders.

A clenched jaw can exert up to 300 pounds of pressure which can wear and crack teeth. Over time, these excessive and abnormal forces can cause degenerative changes in the jaw joint and muscles of the face, neck and shoulders.

Once Tmj problems set in, treatment can vary depending on the cause and the condition of the jaw muscles, jaw joint, bite, posture and working and sleeping habits. Treatments can include medications, anti-inflammatories, trigger point injections, physical therapy, changing working and sleeping habits, stress management and correction of a misaligned bite.

It's important that when you experience chronic headaches you see your physician to rule out other organic cause that might be causing your headaches. But many times your problem can be of dental origin and a trained dentist in the treatment of TMJ dysfunction and head and neck pain may be your avenue to pain relief.

We know how debilitating headaches can be and our goal is to relieve your pain and give you your life back.

Stand up Straight

noreply@blogger.com (Abraham A. Katz, DDS) — Thu, 22 Oct 2009 00:43:00 +0000

Have you ever been told to stand up straight?
If you look in the mirror and see that your head is in a forward position , your shoulders are rounded in a down and forward position and your VDO, vertical dimension of occlusion, the distance between your upper and lower jaw when your teeth meet is reduced, your posture may be your pain problem.
Not only does this type of posture makes you look and feel older than your are, it also the cause for many head and neck pain and severe headaches. In addition, neck and back pain tends to be worse on the side that has the most loss of VDO. Studies have also shown that an increase in the VDO significantly increased range of neck motion and decreased neck and shoulder pain.

One of the things that you can do to help straighten you up is a very simple exercise. Take a pen or pencil and hold it with one hand on each end behind your back.
Walking or standing with a pencil in that position will bring your shoulders, head straight and give you a straighter appearance. Try it for ten minutes a day. In time it will make you feel better and will become your new posture if your bite is corrected as well.

More tips soon.

Great Day

noreply@blogger.com (Abraham A. Katz, DDS) — Sun, 18 Oct 2009 11:58:00 +0000

Whenever I see someone for headache or Tmd pain, I usually temper their expectations by letting them know that the cause of their symptoms have had years to develop and resolution of their problem will probably take time to resolve.

last Thursday was a very intense and stressful day for me. I was looking forward to the day's end. Jennifer was my last scheduled patient. I had given her a lower orthotic two week ago and she was back to check the appliance and for me to make any adjustments necessary.
Jennifer had been experiencing pain for over nine months on an almost a daily basis. Pain on the side of her head, on top of her head, eye pain, head and neck pain and very tender muscles of the neck and shoulders. She could not open her mouth very wide and her jaw deviated to the right when she opened. She had seen already seen a neurologist, an ear , nose and throat specialist, who had placed tubes in her ears to treat her symptoms, and a chiropractor without resolution.

Hi jennifer. You look great how are you feeling. I was hoping that she had gotten some relief from the orthtic. Her answer was loud and clear, "I feel great". She told me she had had only one or two headaches in the past two weeks but all the soreness on her shoulder and neck were almost all gone. Sure enough, checking all the muscles that were so painful before were now almost pain free. Her whole attitude had changed . She was happy and smiled a lot. I went on to TENS her and adjust her appliance. I let her know that I was overjoyed with the initial results we'd gotten but there was a lot of work still to be done.

My team let Jennifer know how happy we all were for her. We all felt wonderful that we
had been able to finally give Jennifer the relief she'd been looking for.
A wonderful way to end a hard day.

What is that smell

noreply@blogger.com (Abraham A. Katz, DDS) — Tue, 13 Oct 2009 00:50:00 +0000

I mentioned to my wife about a week ago that I've been sniffling a lot lately in the office. My assistant also complained about some head congestion and she had gone to her doctor who recommended nasal spray for her problem.
Friday morning I came to work with a slight headache. I took some Advil and began to feel better. Then I suddenly got the aura I used to get when I had migraines years ago. Fortunately, It didn't last very long and there was no severe head pain. I was very surprised to have this type of headache return after so many years. I was happy that I felt better rather quickly and relieved because I was afraid I would not be able to work for the rest of the day.

At two o'clock Pam walked in, took a wiff, and said , "what is that smell?" It's such a heavy chemical smell. I can't sit in a dental chair if you don't get rid of that smell. I get bad headaches from chemical smells like that . Needless to say, I didn't smell anything.
We sometimes burn candles or use scented liquid in small bottles with fine sticks that absorbs the liquid and lets it evaporate to give the office a pleasant aroma. I suddenly remembered that we were using a new label and I had turned the sticks over this morning so that the half that had been in the bottle was now filling the air with its odor.

I had to laugh. I thought my headaches were returning or worse. My headache, sniffling and the slight headaches I had had the week before was coming from that new bottle of scent that was filling the air. It was Pam who opened my eyes. Sometimes the answers to puzzles are right in front of you if you take the time to ask the right questions and patiently observe the situation. Needless to say, out went the bottle. Work Monday was great . My head was clear
my nose dry.

I'm sure I'll remember this incident the next time I interview someone about their existing chronic or acute symptoms. Not everything is what it seems.
By the way my assistant is feeling better too.

I've got what Kind of Points ?

noreply@blogger.com (Abraham A. Katz, DDS) — Thu, 08 Oct 2009 00:15:00 +0000

"They're called Trigger Points, I said as I palpated the Sternocleidomastoid (SCM) muscle of the neck and got a sharp "Ouch" response from my friend who had been suffering from neck and head pain "forever". They can be the center of a lot of intense pain whose source may be far away from the immediate location of pain that you might be experiencing.

I've always been aware of muscle trigger points how they contributed to headaches and orofascial pain. But Trigger point therapy has for the most part been the treatment modality of physical therapist. I decide that I wanted to be more expertise at locating and identifying trigger points while performing my examination for head and neck pain. So I recently enrolled in the Janet G. Travell seminar series with a focus on myofacial pain and trigger point therapy at Bethesda physiocare center in Bethesda Maryland.

Trigger points as described by David Simons, MD, " is a hyper irritable spot in muscle.... with a hypersensitive and palpable nodule in a taut band." Applying pressure to these sore nodules or bands, for instance in the neck area, can then elicit pain patterns that a person might be experiencing in the TMJ region or on the head.
Dr. Simons along with Dr. Travell diagrammed referred pain patterns from trigger points from the cervical (neck) area to the head and orofacial regions. Two major muscle groups have shown significant pain patterns of referral to the head and neck region. The SCM, one of the primary controllers of position and balance of the head and the Trapezius muscle of the neck and back.
The Trapezius muscle refers pain that can extend to the side of the head, centering inn the temple and back of the eye socket and may include the angle of the jaw and lower molar teeth.

The guidelines of The American Academy of Orofacial Pain advises dentists to include examination of the neck during an initial examination to rule out neck dysfunction.

I thought this was enough of an introduction to trigger points to give my friend. There would be other opportunities for more information, so it was time to finish the neck examination and see if we would get any more "ouch" responses.
The goal by the way was not so much to get an "ouch" response but to learn and identify a problem and make the pain go away.

Not another Headache

noreply@blogger.com (Abraham A. Katz, DDS) — Wed, 07 Oct 2009 00:44:00 +0000

"Almost every morning I wake up with a headache," my neighbor was telling me "and I've had this headache all day. I've been to my doctor but he couldn't find anything wrong. And to make matters worse, I'm tired all the time. My doctor suggested I see a neurologist but I saw a neurologist a few years ago and he could find nothing either. I feel run down and my relationship with my wife is suffering, if you know what I mean." I felt a bit uneasy with this piece of information but it encouraged me to give my neighbor a bit of information that I felt could definitely help him.

It is well known across many studies that headache patients exhibit a two to eight fold risk of sleep disorders than the general population. The sleep disorder most implicated with headaches
is obstructive sleep apnea. Treatment of obstructive sleep apnea can improve and in some cases resolve headaches.

So I asked my neighbor Ed, "do you snore a lot." " Do I snore a lot? My snoring is so bad I have to sleep in the guest room. My wife can't sleep with me in bed. She says the pictures on the wall shake when I snore." I went through a list of questions with Ed and the answers he gave me convinced me that Ed probably had obstructive sleep apnea.

Ed was was sleepy all the time, sometimes falling asleep at his desk at work.
On a few occasions, he's had trouble staying awake driving home from work. He laughed when he told me how he fell asleep at a stop sign for a brief second and woke up when the police car behind him began to honk his horn. Besides the snoring, his wife also told him that when he slept he would have episodes where he would suddenly wake gasping for air. He said he had no memory of it at all. What was really concerning him now was the fact that he was developing high blood pressure and that he was forgetting things more often.

Putting all these symptoms together convinced me that part of his headache problem if not all might be due to obstructive sleep apnea. A problem that effects over 40 million Americans.
I briefly discussed how obstructed air flow can produce his symptoms and it would be wise to at least eliminate obstructive sleep apnea as a causative factor for his chronic headaches and fatigue. A simple overnight test known as a polysomnogram could give him the answer that could very well give him the relief he's been looking for all this time. I sincerely hope he follows through. Ed said he'd keep me informed.

Welcome!

noreply@blogger.com (Bonnie) — Wed, 02 Sep 2009 18:47:00 +0000

Welcome to the Viriginia neuromuscular dentistry blog for Dr. Abraham Katz. Please check back for additional posts.