What is a Migraine?
A migraine is a severe headache, which lasts anywhere from two hours to two days. Other symptoms usually develop along with the headache. The most common are sensitivity to light and sound, dizziness, nausea/vomiting and disturbances of vision.
Over 23 million people suffer from migraines. Women are much more likely to experience chronic migraines – over 75% of the patients treated for migraines are women. The genesis of these headaches is traced to a biochemical substance called serotonin, which is stored in the blood platelets produced naturally in the body. When serotonin is released, the blood vessels narrow, or constrict. As the serotonin is expelled by the natural processes of the body, its level in the brain is depleted, causing the blood vessels to expand, or dilate. This change in blood vessel size causes a reaction in the surrounding nerves, which we see as migraines. Migraines come in two typical types, the common migraine and classic migraine.
The common migraine takes longer to develop and may give indicators of its impending arrival such as fatigue, food cravings, yawning, depression, irritability and anxiousness. In most cases, the pain of a common migraine usually focuses on one side of the head.
The classic migraine develops in four distinct stages - prodrome, aura, headache and post-headache. During the first stage, prodrome, the person may feel fatigued and cranky, and could experience decreased concentration or even depression. Prodrome commonly occurs about 24 hours prior to the aura stage. During the aura stage, the migraine sufferer will notice a distinct change in their vision. A slowly expanding area of blindness may cover up to one half of the field of vision of each eye. The namesake of this stage, the aura, is a sparkling edge that surrounds the area of blindness. Along with the aura, flashing lights, colors or zig-zags of light may appear, or the headache sufferer may experience a burning or tingling sensation and/or muscle weakness on one side of the body. The next stage is the headache itself, which is characterized by a severe throbbing pain that is often intensified by bright light or noise and may be accompanied by nausea and vomiting. The final stage is post-headache, which is identified by heavy feelings of exhaustion and fatigue. One or both sides of the head may be affected by the classic migraine.
Less common types of migraines are:
- Hemiplegic migraine - involves muscle weakness or partial paralysis lasting less than an hour.
- Ophthalmoplegic migraine - which causes temporary eye inconveniences such as droopy eyelids and changes to the pupils, lasting from several days to multiple weeks.
- Basilar artery migraine – resulting in neurological spasms lasting for about six to eight hours.
- Status migraine - which indicates a severe migraine attack lasting longer than 24 hours.
Causes
Serotonin release can be triggered by a number of factors. Some are stress-related or emotional (anger, depression, shock, excitement or changes in routine), food-related (chocolate, cheese, red wine or fried foods are common culprits), or sensory-related (intense bright lights, strong odors or loud noises). In addition, it is not uncommon for migraines to be medication-related (common causes include nitroglycerin, lithium and some anti-hypertensive, anti-inflammatory and broncho-dilating drugs). Hormonal changes such as typical menstrual periods, hormone treatments or birth control pills can also cause migraines. Migraines also have a strong line of inheritance – they tend to run in families.Symptoms
Typical symptoms of a migraine may include:- Throbbing or dull aching pain on one or both sides of the head
- Nausea
- Vomiting
- Diarrhea
- Changes in vision, including blurriness or blind spots, zig-zags of light or light flashes
- Sensitivity to light, noise and odors
- Tiredness
- Confusion
- Nasal congestion
- Abrupt changes in body temperature
- Stiff or tender neck
- Anxiousness or restlessness
- Lightheadedness or dizziness
- Tender scalp
- Cold hands and feet
Treatment Options
Diagnosis
There are no tests available to definitively diagnose migraines. Your doctor will make a determination of their likelihood based on a physical examination and a thorough medical history, including triggers, symptoms and family history.Treatment
The key to treating migraines is actually preventing attacks (prophylactic or preventive therapy) and then alleviating them when they occur (abortive therapy). Prophylactic therapy includes:- Eliminating as many known triggers as possible, such as chocolate or red wine.
- Improving the person's overall health by exercising, biofeedback, relaxation techniques, adequate rest and stress reduction.
- Taking medications to prevent the onset of an attack.
The most commonly prescribed preventive drugs are beta blockers such as:
- Propranolol hydrochloride (Inderal)
- Nadolol (Corgard)
- Timolol maleate (Blocadren)
- Atenolol (Tenormin)
- Metoprolol tartrate (Lopressor, Toprol-XL)
Beta blockers have an indirect effect on serotonin, preventing dilation of the blood vessels and decreasing overstimulating impulses from the brain.
Other preventive medications include calcium channel blockers, such as:
- Verapamil and diltiazem hydrochloride (Cardizem)
- Antidepressants (Elavil)
- Aspirin
- Antiserotonin agents
Once the migraine has begun to develop, there are two methods of abortive therapy to reduce the pain: non-drug and drug-based methods. The non-drug methods include:
- Lying in a dark quiet room with a cold compress on the forehead.
- Massage or acupuncture
- Using visualization techniques to direct blood flow away from the head.
- Putting pressure on the temples.
The drug-based treatment includes medicines such as:
- Aspirin
- Acetaminophen (Datril, Panadol, Tylenol)
- Ibuprofen (Advil, Medipren, Motrin, Nuprin)
- Naproxen (Naprosyn)
- Naproxen sodium (Anaprox)
- Diflunisal (Dolobid)
- Ketorolac (Toradol)
- Sumatriptan (Imitrex)
- Ergotamine tartrate (Ergostat)
One of the biggest contributors to migraines is a poor alignment of the bite, called malocclusion. The Neuromuscular approach to combating migraines is to correct the bite so that drugs are not needed any longer. Once the bite is corrected, it remains corrected....unlike taking prescription drugs that wear out in a few short hours.
Through a scientific approach of measuring the electrical activity of the muscles of the jaw (Electromyography, called EMG), similar to measuring the electrical activity of the heart through EKG, the proper bite relation is diagnosed. This evaluation is the crucial first step to a course of treatment. If malocclusion (poor bite relation) is a primary cause of your migraines, we can help you win your battle with headaches!
Worn or Chipped Teeth
As we age, some natural wear and tear on the teeth often assumed to be "normal". However, this isn't the case. Our diets have changed radically in the last few decades, and with the number of soft and processed foods we consume today, there is no real reason for our teeth to show excessive wear. Most cases of heavy wear we see in dental patients today is the result of an improper bite.
When the jaw is at rest in the proper position, the teeth are designed to be slightly apart. A space of approximately 1/8 inch between the upper and lower teeth is typical, and is called "freeway space". The only time the teeth should touch is during swallowing, which happens between 2000 and 3000 times a day. The lower jaw is by nature loose, and needs to be stabilized by bringing the teeth together to allow for swallowing. While we are chewing, no matter how fast we chew, the teeth will not actually come in contact with each other. The muscles of the jaw know precisely when to open just before the teeth touch. This is what causes a hard particle in your food to startle you!
The only real cause of severe tooth wear is para-function. Para-function is the action of teeth against teeth to clench or grind. This large amount of force generated by clenching or grinding often happens during sleep - mostly during the Rapid Eye Movement (REM) part of the sleep cycle. This unconscious activity is many times stronger than the highest voluntary clench. In many cases, this clenching and grinding is due to a lack of harmony between the position where the teeth come together best for chewing (Habitual occlusion) and the position where the jaws relate to each other when all the muscles of the jaws, head and neck are at their ideal relaxed, unstrained position (Neuro Muscular occlusion).
It is necessary to treat the underlying cause of this disharmony when restoring the worn or chipped teeth with crowns or other methods. If the root problem is not addressed, the new restorations will eventually become worn or chipped as well. In addition, if the restorations are made with metal, the force of the muscles could actually destroy the bone that is holds the teeth in place over time. This can cause receding gums and loose or missing teeth.
Facial, Neck, Shoulder or Back Pain
The muscles of our bodies work together to produce all types of movement. In many cases, when specific muscles are overworked, they will depend on other muscles of the body to assist them with their tasks. This is known as muscle recruitment. The muscles of the head and neck all have a part in the turning of the head, chewing, talking, and breathing. If the jaw muscles are over-contracted, it will place additional strain on the muscles that support your head, shoulders and back. This recruitment of other muscles results in a lack of balance, which can cause pain. While a neuromuscular dentist does not treat these symptoms specifically, it is possible for overworked muscles to get relief with the help of one of these trained professionals.
How is it possible for your teeth to cause muscle aches and pain? As we age, many people discover that their teeth have been ground down and diminished in size, lost due to accident or dental disease, or reshaped by trauma or decay. When the integrity of your teeth has been compromised, your jaw is not able to rest in a naturally relaxed position. This causes tension in the muscles in the jaw, and may result in a seemingly unrelated pain that you may be experiencing. By restoring your proper bite, your dentist can return the jaw to its natural position, therefore alleviating the pain. Patients with seemingly unsolvable head, neck and back pain have often sought treatment from physicians, chiropractors and neurologists without success, only to have finally found relief with neuromuscular dentistry.
Vertigo / Dizziness / Meniere's Disease and TMD
Many health professionals call TMD "the great impostor". A great many symptoms that seem completely unrelated to your bite can be caused by TMD. One of these symptoms is vertigo. If you have experienced an unbalanced, dizzying sensation where your surroundings seeming to be moving, that's "vertigo". When we look into the mechanism of balance, we can see the connection between poor jaw alignment and vertigo.
The brain integrates information from three sources when calculating your body's balance. Most of the information (60%) comes from your inner ears – what we call the vestibular system. The other 40% comes from what you see – your visual information, and the "proprioception" information from stretch receptors of muscles and joints, or what you feel.
There is a structure in each of our inner ears called a labyrinth. It consists of three half-circles in three planes – called the superior, horizontal and posterior. These bony canals contain inner sacs filled with fluid, where sensation is generated by the movement of this fluid against minute hair-like organs. Each canal is oriented in such a way that the fluid (which is called endolymph) moves when we bob the head up and down, turn the head side to side or tilt head side to side over the shoulders.
The information from these highly sensitive organs in our inner ears has to integrate with the stimuli from what we see (vision) and what we sense in our muscles and joints (proprioception). This gives us balance. This explains why you feel slightly off-kilter when you get off an amusement park ride that moves quickly in many directions. The endolymph within the semi-circular canals of your inner ear is still moving, which gives you the feeling of movement, but your visual cues and muscle spindles tell you that you are standing still. This discrepancy of messages into your brain is the reason for the dizziness and occasional nausea one might experience.
These delicate balance organs of the inner ear are housed in the petrous portion of the temporal bone. The glenoid fossa, which is the "socket" of the TMJ, is also part of the temporal bone. Many people do not realize how close this bone is to the inner ear. When the jaw bone (mandible) is poorly aligned to the upper jaw, which is part of the skull, excessive pressures to the joint result. The pressure is transmitted to the most flexible part of the structure - the socket. This pressure can disrupt the natural movement of the temporal bone just enough to force the balance organ housed inside to be moved out of position as well. If one of these balance organs is knocked out of alignment even slightly, then this discrepancy leads to vertigo. Returning the jaw alignment to the proper position often leads to a correction of this misalignment of the balance organs, relieving the vertigo.
People who suffer from Meniere's Disease possess an functional abnormality of the inner ear. The disorder usually affects only one ear and is a common cause of hearing loss. It is named after French physician Prosper Meniere, who first identified the syndrome in 1861. Sufferers of Meniere's Disease can experience a variety of symptoms, including vertigo or severe dizziness, tinnitus or a roaring sound in the ears, fluctuating hearing loss, and the sensation of pressure or pain in the affected ear. Physicians believe that there is no cure for Meniere's Disease.
However, it should be noted that every one of the symptoms of Meniere's Disease is commonly found with TMD. Tinnitus, pain or pressure in the ears and dizziness are all common symptoms of both Meniere's Disease and TMD. Sometimes, when all of these symptoms occur together, then the label from 1861 is given to the condition with no hope of a treatment that would return the patient to normal health. However, there have been several cases of what appears to be Meniere's Disease that have been completely resolved through alignment of the jaw using neuromuscular treatment. If you have received this diagnosis, please get a second opinion from a specialist in TMD treatment. You may be able to experience relief through the neuromuscular dentist's knowledge of the workings of the inner ear.
Clicking or grating sounds in the jaw
When healthy, the temporo mandibular joint functions quietly. The jaw moves smoothly, and does not pull to one side (deviation) or make abrupt changes in speed and/or direction (deflection).
The glenoid fossa (also called the socket) is the part of the temporal bone that also houses the opening to the ear, the hearing mechanisms and the balancing organ. It is connected to the condyle (the rounded head of the mandible that joins with the fossa) by ligaments that bind the two bones together.
There is a disc of cartilage between these two bones, which acts as a bearing. Because this disc has no blood supply, it is nourished by a slick synovial fluid which allows smooth movement. The back of the disc is fastened to the back of the joint with a soft band of tissue that has a blood and nerve supply. The front part of the disc is connected to a small muscle (called the lateral pterygoid muscle) that pulls the disc forward during opening of the jaw. Ligaments hold the disc to the head of the condyle.
In the case of trauma to this ligament, usually due to injury or chronic clenching, the disc can slip out from between the two bones. This dislocation is usually toward the front.
When the jaw opens to a certain angle, the band of tissue holding it to the back of the joint causes the disc move to the top of the condyle, causing a clicking or popping noise. In certain cases, the disc remains in front of the condyle, resulting in the inability of the jaw to open widely. This is called a closed lock of the TM joint. When the jaw closes, the disc will slip out - usually without much noise. This causes soft tissue to lie between the bones instead of the disc. This tissue has an active blood supply, which can cause inflammation. If the soft tissue is torn or pierced, there is bone to bone contact during jaw function. The joint surfaces will roughen with continued contact, causing a grinding noise. Arthritis of the TM joint can result, leading to destruction of the bony surfaces.
Because the TM joints are in use every time we eat, speak and swallow, arthritis of TM joints has a major impact on the quality of life.
Although it may seem insignificant, the clicking and popping of TM joints may lead to irreversible damage to the jaw. It is best to correct the problem as soon as possible to retain full function of the jaw.
TMJ Pain
TMJ is a common acronym for the temporo mandibular joint. This joint is in front of the entrance to the ear, and connects the lower jaw (mandible) to the temporal bone of the skull (cranium). The temporal bone also houses the organs of hearing and balance.
The most common cause of pain at the TM joints is an inflammation of the ligaments that hold the temporal and mandibular bones together, forming a capsule around the joint. This condition, called capsulitis, is caused by strain to the joint from clenching or grinding the jaws while in deep sleep. The underlying cause of the grinding and clenching is malocclusion, a disharmony of the bite.
Other causes of pain in TM joints are due to internal derangement - a tearing of the ligament that acts as the tether for the articular disc between the two bones. This disc is designed to act as a bearing between the surfaces of the bones when they move. When the disc is not resting in the proper position, at some point during opening of the jaw the disc will pop into place, causing a clicking noise. If this dislocation remains uncorrected, it can lead to the destruction of the joint surfaces and result in arthritis of the joint. This can also be a source of TMJ pain.
Healthy TM joint. Quiet joints, smooth movements.
Dislocated disc causing popping/clicking noise.
Damaged joint causing grinding noise.
Tingling / numbness in fingers and arms
Up to a third of TMD patients have the sensation of prickling, tingling, or creeping skin of the fingers that has no apparent cause. This is referred to as paresthesia of the fingers. In many cases, patients experience a reduced grip strength. Most paresthesia sufferers do not realize neuromuscular dentistry can help!
In the practice of neuromuscular dentistry, we consider and correct the position of the lower jaw (mandible) to the upper jaw (maxilla), which is part of the skull. One of the six dimensions we examine in the position is "roll". The others are vertical, anterior/posterior, lateral, pitch and yaw. Roll is the position of the mandible as viewed from the front, where one side of the mandible is higher or lower than the other.
When the bite is higher, or "rolled", on one side, the shoulder will be lower on the opposite side to the roll. This happens because the "rolled" high bite triggers a compensatory shoulder tilt due to feedback from the balance organ - the semicircular canals and utricle and saccule otoliths in the inner ear. The tilt helps keep our bodies in balance. Imagine a child's stacking blocks. When one block is placed off center, the next one has to be offset in another direction to keep it from falling off the pile. Our body posture has to work in a similar manner to keep our bodies in balance.
A group of nerves called the brachial plexus exit at C4, 5, 6 levels, as shown in the diagram below. They travel between the anterior and middle scalene muscles, and later progress between the collarbone and first rib and down the arm.
A shoulder compensation for a tilted bite causes spasms of the scalene muscles and compression of the brachial plexus and vessels where they emerge from between the scalenes. The pinching of this nerve causes paresthesia of the fingers. It may also occur on the opposite side due to the stretching of the scalene muscles through which the brachial structures pass.
Compensation of posture often does not stop at this level. As shown in the photo below, a resulting pelvic tilt could cause symptoms in the hips or knees. Symptoms of an improper bite may be experienced a significant distance from the mandible. As unlikely as it may seem, a poor bite has a considerable impact on a person's posture.
Ear symptoms: Tinnitus (ringing), congestion, muffled sounds or stuffiness
Many people find themselves here when they're searching for a solution to their nagging ear pain. There are many causes of ear pain and often the origins aren't as simple as one would think. We hope this information can help you discover more about what may be causing your ear pain.
(Middle ear)
Unless there has been trauma to the ear or the surrounding area, ear pain, ear congestion or ear aches are usually the result of blockages or infections. Redness and swelling of the outer ear could indicate an infection of the region that will require the attention of your doctor. Ear canals can become blocked by ear wax and cause pain. In most cases, over the counter remedies to remove excess ear wax are helpful. Ear pain can also result from an infected ear canal, which most people know as "swimmer's ear". Most cases of swimmer's ear can be treated by keeping the ear dry and applying a few drops of alcohol and white vinegar mixture. If this common cure does not resolve the issue, seek a physician's help.Infections of the middle ear are more common in children than in adults. The path of these infections is usually the Eustachian tube, which requires antibiotic therapy to treat successfully. Allergies, colds or the flu can also lead to inflammation of the Eustachian tube, preventing the equalization of pressure to the ears and causing pain.
A salivary gland in front of the ear called the parotid gland can form "stones" in the parotid duct, which can lead to a blockage of the salivary flow, causing pain in the ear area. If the salivary flow is blocked, it often causes infection and pain. Often an ENT specialist will be needed to treat this condition.
In the skull behind the ear we find bony structures called mastoid air cells. If the mastoid air cells become infected, ear pain can be present. Due to the poor blood supply in this area, an infection of the mastoid air cells is difficult to treat. It often needs the attention of a physician for antibiotics, and in some cases, surgery may be required to resolve the issue.
But the most commonly misdiagnosed cause of ear pain occurs when a patient suffers from TMJ disorder or TMD. We often see patients who have had multiple courses of different antibiotics from their family physicians or ENT specialists before being referred to us for a TMD evaluation. Many of these individuals have suffered with months or even years of ear pain before discovering that the root of the problem was never actually in their ear at all.
TMD is often called the "great impostor". The symptoms of this condition present in so many different ways that the treating doctor can be easily classify them into several different diagnoses. If the ear pain you have been experiencing has not been resolved after a thorough examination of the ear and/or treatment by an ear, nose and throat specialist, the problem could very well lie with TMD.
Tinnitus
Ringing and roaring noises in the ears may arise from several causes. Loud noise, clogging of the external auditory canal with ear wax, inflammation of the ear drum, or an overdose of medications such as aspirin are all possible sources of tinnitus. However, a large number of cases can be traced back to TMD. The delicate balance of muscles and ligaments within the ear can be disrupted by TMD, causing tinnitus.
Ear Pain
When most patients experience an ear ache that generates from the inside, they assume that it is an ear infection and visit their primary physician or ENT specialist. If the examination is normal, the source of the ear pain could be TMD. Poor alignment of the jaw can lead to spasm of the delicate muscles of the ear, leading to pain. In this case, a TMD evaluation is preferable to prescribing an antibiotic as a shot gun treatment for a phantom ear infection.
Stuffiness of the ear / Ear congestion
The Eustachian tube is a membrane-lined tube that connects the middle ear space to the back of the nose. It serves to ventilate the middle ear, enabling the pressure inside the ear to remain at near normal ambient air pressure. If the Eustachian tube did not exist, the middle ear cavity would simply be an isolated air pocket inside the head, vulnerable to every change in air pressure. This would cause a continuous parade of problems with the ears. The secondary responsibility of the Eustachian tube is to drain accumulated secretions, infection, or debris from the middle ear space. A group of small muscles located in the back of the throat and palate facilitate the opening and closing of the tube. Swallowing and yawning causes the contraction of these muscles, and helps control the function of the Eustachian tube.The Eustachian tube is usually closed, which helps prevent contamination of the middle ear by the normal secretions found in the back of the nose. When the tube is always open it is called a patulous Eustachian tube. This rare condition causes chronic ear infections. A more typical problem results when the Eustachian tube fails to regulate pressure effectively on a consistent basis. Partial or complete blockage of the Eustachian tube can cause popping, clicking, and ear fullness. As the function of the Eustachian tube becomes less effective, air pressure in the middle ear falls, and the ear can feel uncomfortably full and sounds become muffled. Over time a vacuum is created, which can cause fluid to be drawn into the middle ear space. If the fluid becomes infected, an ear infection develops.
Ears can feel stuffy and congested when the Eustachian tube is blocked. This is very common when infection, swelling and inflammation are present. It can also occur when the tiny muscle that controls the opening is in spasm. When jaw alignment is poor, the muscles of mastication and their associated posture muscles have work hard to compensate. This constant compensation can lead to muscle spasms. By using the techniques of neuromuscular dentistry, correcting the jaw alignment often leads to the resolution of ear symptoms from this cause.