Dr. Shapira's Chicago Headache Blog

It is well known that the majority of patients complaining of TMJ Disorders are women even though the anatomy of men and women tend to be very similar.  It is also know that there are estrogen receptors in the TemporoMandibular Joints (TMJ)

A recent article in Pain  discussed the fact that in general most non-cancer pain is more frequent in women as well.  I have frequently found that in premenopausal women it is easy to get near total relief of Chronic Daily Headaches and Status Migraine for up to 25-28 days a month but that it is much harder to completely eliminate pain during ovulation and around menses.

While total pain relief is not… Read Full Post

Frank: What are the costs of treatment and is it covered by insurance? I have severely ground teeth. I clench a lot but mostly during day. 61 yrs old I do TMJ massage and that slightly helps. The headaches occur 4-10 times month. Headaches are inside my ears, above ears, in mouth and jaw and seem to sometimes be in the teeth and roof of mouth. I had whiplash injury. When I have atlas aligned it helps but does not stay in alignment.

Dr Shapira response: Insurance sometimes covers part of the cost but most insurance companies are worried primarily about shareholders and profits. Several years ago Chicago HMO agreed to pay 100% of the costs even though it was specifically excluded… Read Full Post

Patrick :    What are the surgical options for treating my severe cluster headaches?

Dr Shapira response: Dear Patrick,

 am not a big advocate of surgery for cluster headaches.  Treatment of the Trigeminal Nerve  " microvascular decompression of the trigeminal nerve with section of the nervus intermedius compares very favorably to other destructive techniques without the accompanying neurologic deficits" (see below) is probably the best surgical treatment but do not expect success.  There is a significant risk of very negative outcomes.  As there is unquestionably a Trigeminal Nerve  basis in cluster headaches I would… Read Full Post

Headaches and Migraines are almost 100% caused by the Trigeminal Nervous System.  This is accepted by all specialties of medicine who deal with headache patients.

The Spenopalatine Ganglion Block, Pterygopalatine Ganglion Block or SPG Block is known to be one of the safest and most effective means of preventing and treating migraines and tension headaches.

The Spenopalatine Ganglion is the largest parasympathetic ganglia in the head.  The other ganglia are the Ciliary Ganglion, the Submandibular Ganglion and the Otic Ganglion.

The Sphenopalatine Ganglion was made famous by the best selling book, "Miracles on Park Avenue" where it was explained how SPG… Read Full Post

The Sphenopalatine Ganglion Block has been used for while over a century.  So, why does it seem like nobody has ever heard of it until recently and why is it changing now.

According to an article in the Pain Practitioner in 2004, "Sphenopalatine Ganglion Blockade: A Review and Proposed Modification of the Transnasal Technique Report of Technique" by  Robert E. Windsor, MD, and Scott Jahnke, DO  the accepted uses of "the SPG block are sphenopalatine neuralgia, trigeminal neuralgia, atypical facial pain, acute migraine, acute and chronic cluster headaches, herpes zoster involving the ophthalmic nerve and a variety of other facial neuralgias. The mechanism by which… Read Full Post

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