The Trigeminal nerve is acknowledged to play a role in most migraines and Tension-type Headaches. Neuromuscular dentistry is increasingly being used to treat not just TMJ problems but also to reduce or eliminate migraine, Chronic Daily Headache (CDH), Episodic Tension Type Headache (ETTH), Opthalmic Migraines, Sinus Headaches Concerning Neuromuscular Dentistry Barry Cooper reports “Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.”
Some of the material below is partially reprinted from a blog on http://www.ihateheadaches.org a website dedicatedto helping patients eliminate headaches and improve their quality of life,
Migraine triggers Such As Smells Are A Trigeminal Nerve Effect.
A study from Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston showed that “Trigeminal nerve fibers in nasal and oral cavities are sensitive to various environmental hazardous stimuli, which trigger many neurotoxic problems such as chronic migraine headache and trigeminal irritated disorders” This study supports the use of Neuromuscular dentistry to decrease nociceptive input from the stomatognathic system into the trigeminal nerve. This should raise the threshold for environmental triggers to set of migraines.
The study by Wu J, Zhang X, Nauta HJ, Lin Q, Li J, Fang L appeared in Biochem Biophys Res Commun. 2008 Nov 28;376(4):781-6. The authors state that “the role of JNK kinase cascade and its epigenetic modulation of histone remodeling in trigeminal ganglion (TG) neurons activated by environmental neurotoxins remains unknown.” While they do not understand all of the chemical pathways the fact that they exist and are stimulated in the sinus and innervated by the trigeminal nerve support neuromuscular dental treatment to prevent migraine.
Another study from the Department of Ophthalmology, University of Washington, Seattle, Washington, USA concluded that “Sympathetic nerves enter the orbit via the first and second divisions of the trigeminal nerve and a plexus of nerves surrounding the ophthalmic artery.” This would support neuromuscular control thru the trigeminal nerve of opthalmic signs and symptoms being trigeminally innervated and therefore like to respond to removal of noxioux input from the masticatory system. There is now a rational for using neuromuscular dentistry to relieve and prevent opthalmic migranes.
The authors state ” Sympathetics innervate ocular structures via the posterior ciliary nerves. Sympathetic axons travel anteriorly in the orbit via the nasociliary and lacrimal nerves to innervate the sympathetic eyelid muscles. Sympathetic nerves also travel with the frontal branch of the ophthalmic nerve to innervate the forehead skin. The ophthalmic artery and all of its branches contain a perivascular sympathetic nerve supply that may be involved in regulation of blood flow to ocular and orbital structures.” This again supports migraine and opthalmic symptoms being mediated by the trigeminal nerve. Neuromuscular dentistry attempts to reduce the noxious input to prevent neural input from reaching a threshold that causes pain and other symptoms.
The above study, “Human orbital sympathetic nerve pathways” was published in Ophthal Plast Reconstr Surg. 2008 Sep-Oct;24(5):360-6 by Thakker MM, Huang J, Possin DE, Ahmadi AJ, Mudumbai R, Orcutt JC, Tarbet KJ, Sires BS
The following study from Cranio by Dr Barry Cooper and Dr Kleinberg discusses how achieving a physiological state in the trigeminally innervated muscles to find a relaxed jaw position utilizing a Ultra low frequency TENS and a neuromuscular orthotic. The combination of this article with the one quoted previously let us understand and extrapolate how neuromuscular dental orthotics can act as a prophylactic treatment for migraines and other types of headaches. Unlike drug regimens used for migraine prophylaxis there is no danger of toxic drug reactions, liver problems or other drug related side effects. Unlike the drug approach the Neuromuscular Dental approach can relieve a variety of other symptoms related to temporomanibular disorders.
PubMed abstract for your convenience
Cranio. 2008 Apr;26(2):104-17.
Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.
Cooper BC, Kleinberg I. Comment in: Cranio. 2008 Jul;26(3):166; author reply 167.
Department of Oral Biology and Pathology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA. firstname.lastname@example.org
The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
PMID: 18468270 [PubMed – indexed for MEDLINE]