Dr. Shapira's Chicago Headache Blog

A recent article in Current Opinions in Neurology reviewed Migraine treatments. While it mentioned the use of medications such as Botox (onabotulinum toxin type A), triptans , Topiramate, gabapentin, petasites and tizanidine and a new nasal form of dihydroergotamine it also discussed risk factors associated with Temporo-mandibular (TMJ, TMD) disorders, sleep apnea and treatments like occipital nerve stimulators.

These are important aspects of Neuromuscular Dentistry which utilizes ultra-low frequency TENS to stimulate the Cranial Nerves V, VII and XI. This would create effects on occipital nerves as well. The use of Botox on cranial muscles shows that they are responsible for… Read Full Post

A mechanism for retro-orbital pain and TMD is presented in this anatomical dissection of the the temporal branch of the zygomatic nerve passing through an accessory canal in the sphenozygomatic suture. This anatomical placement of the nerve would allow temporal muscle tension to cause nerve irritation and retro-orbital pain. Utilization of a diagnostic neuromuscular orthotic could differentiate retro-orbital pain that is best treated by neuromuscular dentistry.

Surg Radiol Anat. 2002 May;24(2):113-6. Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve. Akita K, Shimokawa T, Tsunoda A, Sato T.

Unit of… Read Full Post

A recent post of mine discussed the relationship between osteopathic (chiropractic) manipulation and TMD. That study showed that similar results were obtained with both types of treatment. A major consideration in treating headaches is the position of the head and neck. Neuromuscular dentistry tends to encourage healing or correction of abnormal head posture. This can have an enormous effect of the jaw muscles and jaw joints but also on the Atla-occipital joint and the Atlas-axis joint and surrounding tissues. These tissues (such as rectus capitus posterior minor) can create tension on the dura mater of the brain that can cause not just migraines, tension-type headaches, chronic daily… Read Full Post

An article (PubMed abstract below) in Janury "CRANIO journal" by Dr Wes Shankland dicusses patients with anterior throat pain. These patients have frequently seen numerous physicians and had multiple digagnostic tests and frequently ineffective treatment. There are five syndromes that frequently cause this type of problems. The five disorders are, Ernest syndrome, Eagle's syndrome, carotid artery syndrome, hyoid bone syndrome and superior pharyngeal constrictor syndrome.

Ernest syndrome and Ernst Syndrome are caused by calcification of stylohyoid or stylomandibular ligaments that is frequently diagnosed by panoramic radiographs and palpation of the ligaments. There are… Read Full Post

There was an excellent article in Practical Pain Management by Edwin A Ernst III DMD on Temporal Tendinitis. Common pain reference sites (according to the article) for this condition include: Painful TM Joints (Temporomandibular joint or TMJ), Ear Pain and/or stuffiness in the ear, retro-orbital pain sometimes radiating to occiput and /or shoulder, upper and lower aching teeth, pain in or around the eye, pain in the lateral temple area, and occasionally pain in the area of the stylomandibular ligament. These pains are frequently accompanied by prodromal symptoms similar to migraine of Nausea, vomiting, photophobia and visual disturbances.

This can be extremely intense pain and is… Read Full Post

The Sphenopalatine ganglion block can be used to prevent and/or relieve headaches and Migraines. I have used it for many years in my office as an adjunct for treating headaches and migraines in patients. While it is not effective for all patients there is a subgroup that remarkable relief from pain and a second group that can stop a migraine before it becomes full blown.

The real beauty of SPG blocks is that they are simple and safe and I teach patients how to use them at home when they need them. The block is done with a Q-tip with lidocaine. The q-tip is gently place in the nostril until the lidocaine soaked cotton tip is adjacent to the SPG. This is left in place for 20-30… Read Full Post

Transformed Migraine (common Migraine) usually has a history of beginning as episodic migraine attacks which increse in frequency. This occurs over aperiod of months to years and the Transformed Migraine (TM) occur frequently, often daily and are a combination of vascular and Tension-type Headaches. The TM can very from mild to moderate severity with epsodes of increased severity. These headaches usually begin in teen years or early 20's. Transformed Migraine attacks are frequently accompanied by nauseau, phonophobia (sensitivity to noise), photophobia (sensitivity to light) which lessen over time. A large porportion of patients are women with 90% of whom have a history of migraine… Read Full Post

Ruby: Headache in right temple. Throbbing in teeth and tm joint. Neck pain. Had a splint put in 10 days ago. Went for Pt, massage, chiro and today pain management dr who I didn't like much and jumped to wanting to do a nerve block. Just trying to find the right person to treat me. Chronic grinder, had crowns put on all uppers and didn't make night guard fast enough. Tmj dentist only does splints and says jaw position is 80% better. Help! Haven't been able to work in almost 2 weeks.

Dr Shapira Reponse: Dear Ruby,

I am sorry to learn of your ordeal.

Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a… Read Full Post

David: I have had continous Headaches for 3-4 months now. sides and back of head mainly. Earache and eye ache as well

Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.

An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial… Read Full Post

I recently received a e-mail from a patient with the following complaint:

intense jaw pain on left side, swollen jaw and cheek, no dental issues per dentist and endodontist...tmj or trigeminal neuralgia?

The question TMJ or Trigeminal Neuralgia is very limited. 95% of all pain that patients experience is muscle pain. Many patients have severe or even excruciating pain but their TM Joints are normal. These are neuromuscular problems and may have many contributing factors. Trigeminal Neuralgia is rarely the cause of pain and when it is there is usually very specific triggers. The pain usually comes and goes going from normal to intense pain after stimulating trigger.