Vestibular Migraine and Occipital Headaches: The Best Approach is not Medication.

Neuromuscular Dentist in Chicago, IL Accepting Patients Nationwide & Worldwide

Posted: August 20, 2020

Trigeminal Nervous System is key to 100% of headaches and migraines.

The standard medical approach considers this a migraine problem where it is frequently a posture and airway issue.

Occipital headaches are extremely common in patients with forward head posture.  Forward head posture can independently lead to symptoms identical with vestibular migraine.  

Forward head posture is also associated with TMJ or Temporomandibular Disorders (TMD).  There is also  a close association between small nasopharyngeal airways and TMJ disorders. All of the symptoms of Vestibular Migraine are commonly associated with TMJ disorders as well.

Treatment and long term corrections can be accomplished frequently by use of Neuromuscular orthotics that treat the TMD and also help correct the forwardhead posture. 

Atlas Orthoganol or NUCCA Chiropractors working with patients can help tremendously if there is a primary neck problem at the level of C1 and C2.  This is almost always the case in patients with forward head posture.  

Ideally, treatment begins with with a patient being fitted for a diagnostic neuromuscular orthotic as the first step.  Once this has been accomplished the upper cervical correction can be completed.  It is important that the neuromuscular orthotic is adjusted to the corrected head position.

Nociceptive input to the Trigeminal nervous system is reduced by careful adjustments to the diagnostic orthotic and the use of ULF-TENS to relax the muscles.  The mandible acts like a counter-balance to the head and correction of the jaw position will increase upper cervical stability.  

The Autonomic nervous system is also important in the treatment of Vestibular Migraines and Occipital Headaches.  The Sphenopalatine Ganglion (also known as Sluder's Ganglion, Meckel's Ganglion and Pterygopalatine Ganglion) is the largest Parasympathetic Ganglion of the head.  It is located in the Pterygopalatine Fossa on the Maxillary Branch of the Trigeminal Nerve where it exits the brain thru the Foramen Rotunda.

The Sphenopalatine Ganglion or SPG also contains Sympathetic Nerves from the Superior Sympathetic Cervical Chain some of which come up from the Stellate Ganglion at the bottom of the chain.  The ULF-TENS acts as a Neurotransmitter Modulation device on these nerves and can affect, improve and eliminate many symptoms  including migraine, vestibular migraine, tension headache, occipital headache and anxiety. The BNS-40 is a personal use ULF_TENS muscle stimulator that will aslo work on the Sphenopalatine Ganglion.

Sphenopalatine Ganglion Blocks are used to treat a wide variety of chronic pain related to the head, jaws, ears and sinuses. They are also effective in treating anxiety and can resolve about 1/3 of essential hypertension.

Dr Shapira has an article in  CRANIO Journal "Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper" that details this important information:

The entire article is available on Dr Shapira's website or

The link is:

The most effective method of doing SPG Blocks is Self Administration of SPG Blocks.  SASPGB can be searched for more informatio.  There are also multiple patient videos on the video links. 

There are over 200 You Tube patient testimonial videos at:

There are numerous articles on on these subjects:

Dr Shapira sees patients from across North America as well as international patients.

To contact Dr Shapira vist his primary website

This is a reprint from NEUROLOGY ADVISOR:

Occipital Headaches More Common in Patients With vs Without Vestibular Migraine

Brandon May

Brandon May


girl holding head in pain
Compared to patients with migraine without vestibular symptoms, those with vestibular migraine are more likely to experience occipital headaches.

Compared with patients with migraine without vestibular symptoms, those with vestibular migraine (VM) are more likely to experience headaches in the occipital region, according to study results published in Headache.

The study was a cross-sectional retrospective analysis of medical charts of 169 patients seen at 2 headache clinics between January 2008 and April 2014. Specifically, the investigators assessed the location of the headache in patients with migraine with VM (n=103) vs without vestibular symptoms (M group) (n=66). Questionnaires were used to obtain information about headaches for each patient. Additional secondary outcomes assessed were the association between VM and sex, age of headache onset, age of vestibular symptom onset, aura, motion sickness, other associated symptoms, and family history of headaches and motion sickness.

A significantly greater percentage of patients in the VM group vs those in the M group had a headache in the occipital region (44% vs 18%, respectively; odds ratio [OR], 3.5; 95% CI, 1.7-7.2; P <.001). The age of onset of vestibular symptoms was also significantly later than headache onset in the VM vs M group (32±12 vs 3 years, respectively; =.005). There was no significant difference between women and men in terms of the age of headache onset in the M group (18±8 vs 17±12 years, respectively; =.914). However, the age of headache onset was significantly earlier in women than men in the VM group (26±11 vs 34±14 years, respectively; =.012)

Patients in the VM group were also significantly older than those in the M group at headache onset (28±12 vs 18±9 years, respectively; P <.001) and were more likely to report motion sickness since childhood (42% vs 2%, respectively; P <.001). No difference was found between the 2 groups of patients with regard to family history of headache. A significantly greater percentage of patients with vs without vestibular symptoms reported a family history of motion sickness (30% vs 3%, respectively; OR, 13.48; 95% CI, 3.47-58.61; P <.001).

In addition, no difference was found between the groups in terms of headache frequency (=.82). Patients with vs without vestibular symptoms reported significantly less aura

(2% vs 23%, respectively; OR, 0.07; 95% CI, 0.01-0.27; P <.001) and vomiting (24% vs 41%, respectively; OR, 0.46; 95% CI, 0.24-0.92; P <.034).

Study limitations included its retrospective nature and the reliance on different types of questionnaires between the 2 clinics. Investigators noted that the study sample did not reflect the estimated percentage of patients with VM vs those with migraine without vestibular symptoms in the general population.

According to the investigators, findings from this study support work for a future “prospective study investigating whether a patient who develops migraine headache later in life, has pain localized in the back of the head, and has a history of motion sickness is more likely to suffer from vestibular migraine at a later age.”


Wattiez A-S, O’Shea SA, Eyck PT, et al. Patients with vestibular migraine are more likely to have occipital headaches than those with migraine without vestibular symptomsHeadache. Published online July 25, 2020. doi:10.1111/head.13898