Migraine is a disease of a hypersensitive, hypervigilant trigeminal nervous system. Migraines affect over 37 milion americans but more than 3 million patients progress to Chronic Migraine, a more disabling disease.
Standard medical practice recognizes several risk factors for chronic migraine including mood disorders, obesity, snoring, untreated sleep apnea and overuse of analgesic medications.
Snoring and Sleep Apnea are considered TMJ disorders by the NHLBI of the NIH who published a report “The Cardiovascular and Sleep Related Consequences of TemporoMandibular Disorders”
This report ties together Migraines, Headaches, Snoring TMJ disorders and Trigeminal Nervous Disorders in a clearly understood paper.
Every headache and migraine sufferer should read this report.
The Trigemino-vascular system is responsible for migraines and all headaches (near 100%) are caused and/or mediated by the Trigeminal Nervous System. The Trigeminal nerve is commonly referred to as the Dentist’s nerve who are recognized for their expertise in understanding it neurological pathways and functions.
Physiologic Dentists have learned special techniques for changing the how the trigeminal nerve functions and are considered to be the Trigeminal nerve specialists by many.
Migraine medications treat the changes in brain chemistry that are associated with migraine but frequent use of these medications can actually make the condition worse and require patients to continually increase their dosages and change or add medications.
Medication Overuse Headache or Rebound Headache can then result. The best way to understand how patients respond to medication overuse and the withdrawal is to look at heroin addiction ar alcohol addiction. As long as the drug is continued the patient does OK but when it is stopped they go into withdrawal.
Recovering from medication overuse is a painful and miserable experience whether the drug is alcohol, heroin or prescribed medications. Opiod medications are far and awy the worst drugs to cause withdrawal because of changes that occur in brain glial cells with their use.
Medication Overuse Headache or MOH does not sound as bad as Rebound Headache or Acute Drug Withdrawal but all theseterms describe the process.
Curing and preventing headaches and Migraines by changing input into the brain is what Physiologic Dentistry can accomplish.
One of the biggest challenges to curing and eliminating migraines through Physiologic Dentistry is that patients are addicted to their medications and even when the underlying cause of headaches is corrected it can be extremely difficult getting the patient thru the recovery and drug withdrawal phase.
Overuse headache and rebound headache do not always mean the same to the patient and the physician. The biggest problem with medication overuse is the patient condemns themselves to a future of increasing frequency of headaches in addition to the acute rebound headache.
The International Classification of Headache Disorders (ICDH-3 beta) defines MOH as a new type of headache or a marked worsening of a patients pre-existing primary headache in someone who overuses medication.
The current classification defines the headache also by the type of medication utilized. This new classification includes headaches that do not resolve after withdrawal from the medication.
A VERY SCARY ASPECT OF THE NEW CLASSIFICATION IS THAT IT RECOGNIZES THAT MOH CAN EXIST AFTER AS LITTLE AS 3 MONTHS ON A MEDICATION.
Unfortunately patients utilizing medicine in a manner they consider appropriate for their disabling condition may find themselves on a route that takes them into ever worse complications and increased pain.
MOH differential diagnosis can include chronic migraine, New Daily Persistent Headache and secondary headache. MOH is marked by a history of migraine and and frequency of drug use as baseline and for acute episodes.
An interesting aspect I have seen with patients treated for severe chronic daily headaches and migraines is that there is not a severe rebound headache and withdrawal seems to give very manageable symptoms as long as patients gradually taper off medications.
Physiologic dentistry utilizes a diagnostic physiologic orthotic that is adjusted as a patient goes thru the healing process.
Permanent corrections always are done only after patient has substantially improved. I frequently see patients who eliminate all or most medications gradually when the headache and migraine pain is dissipated.
It is not uncommon to have cervical issues that must be addressed by physical therapy, osteopathic adjustments, chiropractic adjustments or trigger point injections.
One proposed pathway for development of MOH is central sensitization. This is why there is such a high correlation of migraine patients and TMJ dysfunction patients. Both of these disorders are intamately connected thru the trigemino-vascular system.
Sphenopalatine Ganglion Blocks are often extremely effective in controlling headache and migraine symptoms while patients go thru prescription medication withdrawal.
Physiologic orthotics control input to the CNS and help idecrease central sensitization especially when used in combination with SPG Blocks.
Many patients with MOH fit the diagnostic DSM-IV substance abuse criteria. The issue of somatopsychic pain must be considered. In my experience getting patients to withdraw from medications is easier after their pain is relieved. If pain continues it is not real fair to put patients into this substance abuse category.
Relief of pain thru Physiologic Dentistry is a Cure for many patients with migraine overuse headaches