Dr. Shapira's Chicago Headache Blog

A recent study in Pain. 2011 Apr 21 looked at botulinum toxin type A for treatment of persistent myofascial TMD pain. Saline was used as the placebo-control in this double blind study. The crossover study examined 21 patients Myofascial TMD with inadequate pain control.

The study was done to evaluate the effectiveness of botulinum toxin type A for treatment of persistent myofascial TMD pain but actually showed that Saline is normally considered an excellent placebo because there are no direct biological changes associated with saline. There was statistically no advantage to botulinum toxin type A over saline.

I hypothesize that the improvement in pain showed in the study… Read Full Post

Tell us about your headaches... Stephanie I've been suffering from headaches since I was an early teen. It was around the age of 17 that they began to worsen. I noticed when I would stand up or sit down quickly, I would get these excruciatingly, sharp pains in one area in my head- generally, the right side. It feels almost like someone is using a crowbar to pry open my skull. Now my headaches have progressed as I have gotten older. Now when I start getting those headaches the excruciating pain comes out of nowhere. I'll be walking across the room and I get the "crowbar" feeling- very intense, very brief. But I'll still have a constant, underlying headache with bursts of pain. I've… Read Full Post

PATIENTS LIVING WITH TMJ DISORDERS, CHIROPRACTIC DISORDERS, HEADACHES AND MIGRAINES are alll suffering from the same underlying disorders. It is well recognized that it is impossible to achieve long term successful treatment without addressing both the dental, TMJ and Trigeminal components in conjunction with with the Chiropractic aspects of care.

Atlas Orthoganal Chiropractic or NUCCA chiropractic focus on the first two vertebrae. Both are excellent techniques but I usually prefer working with A/O chiropracters as they take a more universal approach to care. Many NUCCA chiropracters think that they can correct everything even though research at the prestegious Las Vegas Institue… Read Full Post

I have found that trigger point injections are extremely effective in reducing tension-type headaches and frequently can completely eliminate them when combined with a neuromuscular orthotic. This current study from the Archives of Physical Medicine and Rehabilitation shows high-power ultrasound as effective as trigger point injections in treating the Trapezius muscle.

The Trapezius muscle is a large easily treated muscle that can cause referred headache pain. Trigger point injections took less therapy sessions but there was equal effectiveness to both treatments. When treating headaches many of the muscles that cause tension-type headaches are not good candidates for high-power… Read Full Post

DANGERS OF WISDOM TOOTH REMOVAL: PARESTHESIA & TMJ DAMAGE ARE THE PRIMARY CONCERNS OF WHEN REMOVING MANDIBULAR THIRD MOLARS

THIS IS A REPRINT OF A SLEEP AND HEALTH JOURNAL BLOG. I THINK IT IS IMPORTANT TO UNDERSTAND THAT THERE MAY BE A RELATION BETWEEN CHRONIC HEADACHES, MIGRAINES AND TMJ DISORDERS AND REMOVAL OF WISDOM TEETH. I BELIEVE THERE IS A BETTER ALTERNATIVE.

The removal of mandibular third molars frequently results in associated morbidities, the most concern is about paresthesia or permanent numbness from nerve damage. I have also frequently seen patients with TMJ disorders (TMD) such as joint locking, clicking or pain after removal of wisdom teeth. Chronic… Read Full Post

I have been a strong advocate of utilizing sphenopalatine ganglion blocks to treat cluster headaches, acute and chronic daily migraines, sinus headaches and chronic daily headaches. The following Pub Med abstract is a case report on utilizing lidocaine (an extremely safe drug) to do SPG blocks for cluster headaches.

The Ptsosis (wikipedia...Ptosis (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid ) as well as the pain responded to the block. It is important to note that SPG… Read Full Post

Patients missing one or more permanent molars are more prone to headaches and TMJ disorders. Missing just a single first molar has been shown to double the resk of headaches, sinus pain and /TMJ disorders. When the molars are missing there can be drastic increases in headaches and TMJ disorders. Patients with loss of vertical dimension are more prone to morning headaches, sleep apnea and migraines.

Dental Implants are frerquently used to replace missing teeth when treating headaches and migraines associated with TMJ diorders.

A new article in Medical Hypothesis (see Pub Med abstract below) on Atypical Trigeminal Neuralgia discusses the pathogenisis of Central Sensitization in patients with Trigeminal Neuralgia. A percentage of patients with Trigeminal Neuralgia will have pressure on the trigeminal nerve either from blood vessels or tumors usually in the area of the foramen ovale.

Many patients who have trigeminal neuralgia have no overt cause for the disorder. When there is a tumor or blood vessel creating undue pressure on the nerve a surgiclal approach is usually corrective but the central sensitization may remain. This article postulates that time is of the essence and the longer the pain persists… Read Full Post

Patients with thyroid problems frequently also have headaches, TMJ disorders and sleep disorders. The treatment of pain disorders frequently is aided by normalization of thyroid hormone. Free T3 is the activ e form of thyroid hormone and appears to be the most important thyroid hormone when dealing with chronic pain problems.

In the midwest theree is low naturally occuring iodine in the water. Patients with low thyroid and high TSH can frequently be helped by nutritional supplements containing iodine. 1 of drop of iodine in 8 oz of water every other day may be enough iodine to allow the thyroid to function normally. Many years age the Panda bears in Washington DC were unable to… Read Full Post

The utilization of using Neuromuscular orthotics to treat or eliminate migraines, tension-type headaches and chronic sinus and facial pain is well established. The correction of postural distortion is also well documentd however the treatment of movement disorders has been primarily anectdotal.

That is beginning to change, the correction of oral and pharyngeal reflexes combined into neuromuscular orthotics allows treatment of more complex disorders.

The OSB, or Oral Systemic Balance appliances promoted by Dr Farand Robson are focused into these reflexes. The work of Brendan C Stack DDS MS, Dr John Beck MD and others in treating Parkinsons is exciting new work. The Academy… Read Full Post