TENDERNESS IN TEMPORALIS MUSCLE: Is this a Migraine disorder or a TMJ disorder leading to abnormal muscle function.

Treatment of migraines, tension-type headaches and chronic daily headaches is frequently succesful considered to be primarily in the hands of neurologists but there is increasing evidence that neuromuscular dentistry may be a more ideal treatment for migraines, even unilateral migraines. The authors of a new study “Pressure pain sensitivity mapping of the temporalis muscle revealed bilateral pressure hyperalgesia in patients with strictly unilateral migraine” in the June 2009 issue of Cephalgia used mapping of pressure points to conclude that “This study showed bilateral sensitization to pressure in unilateral migraine, suggesting the involvement of central components.”

This author believes that their study which was beautifully done did not support the conclusions. The non-migraine controls differed in areas of sensitivity from the controls and this led to their conclusions. In fact, Neuromuscular Dentistry would expect patients with abnormal jaw and muscle function to have altered function leading to nociceptive input from the trigeminally innervated muscles which could then cause the central sensitization. The pain is real but the cause is peripheral leading to central sensitization not central leading to periferal problems.

An excellent discussion of Neuromuscular Dentistry that was originally published in “Contact” a journal of the American Equilibration Society is now available in Sleep and Health Journal at https://www.sleepandhealth.com/neuromuscular-dentistry

An excellent reference to learn about Neuromuscular Dentistry and migraine treatment is available at http://www.ihateheadaches.org/migraine-headaches.html Neuromuscular dentistry (NMD) is especially effective for treating Chronic Daily Headaches or Tension-Type headaches. In migraine treatment NMD can be a powerful force for prevention of migraines. It is actually excessive nociceptive (pain impulses) into the trigeminal nervous system that causes central sensitization and subsequent vascular headaches and muscle tenderness. It is primarily due to neurologists not being trained in how the stomtognathic system functions that leads to sometimes excessive use of drugs to treat migraines and other types of headaches.

Patient Testimonial: https://www.youtube.com/watch?v=IOJTPQEGr1w
The use of Botox to treat migraines is conclusive evidence that the pain is primarily a peripheral input that creates a central problem.

An excellent article for patients who want to understand how TMJ disorders, Migraines and other pain syndromes are related and why they are so often misdiagnosed is: https://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor. An excellent resource to understand how TMJ disorders affect the entire body is available from the National Heart lung and Blood Institute (NHLBI) of the NIH. The article “Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders” can be found at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf

Patients wishing to see Dr Shapira can contact him through his website http://www.delanydentalcare.com/neuromuscular.html or call toll free at 1-800-TM-JOINT

Migraines, tension headaches, cluster headaches and especially morning headaches are usually related to either TMJ disorders (TMD) or Sleep apnea. Sleep disordered breathing including high airway flow resistance or UARS upper Airway Resistance Syndrome are known to be closely related to fibromyalgia, another disease that is often considered to be the result of central sensitization. Neuromuscular Dentistry and Dental Sleep Medicine correction of sleep disordered breathing can often lead to remarkable improvements in the quality of life for patients. These treatments are often drug free and as pain decreases so do depression and anxiety problems.

Additional information on Sleep Apnea, Dental Sleep Medicine and use of oral appliances to treat snoring, UARS and Apnea can be found at http://www.ihatecpap.com Patients in Northern Illinois who are interested in using oral appliances to treat their sleep disordered breathing can contact Dr Shapira at his general dental practice in Gurnee, Il thru his website http://www.delanydentalcare.com/sleep_apnea.html Patient wishing to see Dr Shapira in Skokie, Schaumburg, Vernon Hills, Bannockburn or Chicago to treat sleep apnea can contact him at his website http://www.chicagoland.ihatecpap.com/ or by phone toll-free at 1-8-NO-PAP-MASK

Cephalalgia. 2009 Jun;29(6):670-6.
Pressure pain sensitivity mapping of the temporalis muscle revealed bilateral pressure hyperalgesia in patients with strictly unilateral migraine.
Fernández-de-las-Peñas C, Madeleine P, Cuadrado ML, Ge HY, Arendt-Nielsen L, Pareja JA.

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain. cesar.fernandez@urjc.es
Previous studies on pressure pain sensitivity in patients with migraine have shown conflicting results. There is emerging evidence suggesting that pain sensitivity is not uniformly distributed over the muscles, indicating the existence of topographical changes in pressure pain sensitivity. The aim of this study was to calculate topographical pressure pain sensitivity maps of the temporalis muscle in a blind design in patients with strictly unilateral migraine compared with controls. For this purpose, an electronic pressure algometer was used to measure pressure pain thresholds (PPT) over nine points of the temporalis muscle: three points in the anterior, medial and posterior parts, respectively. Pressure pain sensitivity maps of both sides (dominant or non-dominant; symptomatic or non-symptomatic) were calculated. The analysis of variance showed significant differences in PPT values between both groups (F = 279.2; P < 0.001) and points (F = 4.033; P < 0.001). Patients showed lower PPT at all nine points than healthy controls (P < 0.001). We also found lower PPT in the centre of the muscle compared with the posterior part of the muscle within both groups (P < 0.01). Interaction between group and points (F = 1.9; P < 0.05) was also found. Within the migraine group, PPT levels were decreased bilaterally from the posterior to the anterior column of the temporalis muscle (Student-Newman- Keuls analysis; P < 0.05), with the most sensitive in the anterior part of the muscle. For controls, PPT did not follow such anatomical distribution, the most sensitive point being the centre of the mid-muscle belly. This study showed bilateral sensitization to pressure in unilateral migraine, suggesting the involvement of central components. PMID: 19891059 [PubMed - in process]