I am continuing looking at Orofacial Pain and actually checking the references used in the paper “Orofacial pain management: current perspectives” from Pain Res. 2014; 7: 99–115.
This paper will focus on an article cited “Myofascial Pain Syndrome as a Contributing Factor in Patients with Chronic Headaches” that concludes “Subjects with chronic headaches had a higher prevalence of TrPs, and headache complaints could be reproduced during stimulation of active TrPs that were localized more frequently in temporalis and occiptofrontalis muscles. The presence of TrPs may be a contributing factor in the initiation and/or perpetuation of chronic headaches.”
This is a paper about Orofacial Pain looking at Chronic Headaches and Myofascial Trigger Points. It specifically looks at occipital frontal and temporalis muscle trigger points. The Temporalis muscle overlies much of the occipitalfrontal muscle and is typically the initiating cause of dysfunction. Travell described the formation of myofascial trigger points as due to overuse syndromes also called repetitive strain injuries.
This study found that 77% of the headache patients had myofascial trigger points and 89$ of these had active trigger points that could cause referred headache.
The first conclusion should most definitely be “Subjects with chronic headaches had a higher prevalence of TrPs, and headache complaints could be reproduced during stimulation of active TrPs that were localized more frequently in temporalis and occiptofrontalis muscles. The presence of TrPs may be a contributing factor in the initiation and/or perpetuation of chronic headaches.”
This paper should definitively settle the question whether trigger point examination should be done in all headache patients, the answer is an unqualified YES.
The second question is whether therapy in orofacial pain patients with headaches should address these trigger points, and again an unqualified YES.
The third question is if an oral appliance can prevent and help eliminate these trigger points and the related orofacial pain should it be used? Again the only answer is YES.
Should this be just a night “stabilization appliance” of a 24 hour orthotic? This is a question that needs to be addresed with the patient. There is some risk involved in an anterior positioning neuromuscular appliance. They are extremely successful (see https://thinkbetterlife.com/orofacial-pain-management-current-prospectives-patients-deserve-care-relieves-pain/)
Does the patient have a right to demand the best treatment to improve their quality of life? YES
Do patients need to be informed of risks? Yes
Diagnosis in 100 % of headache ptuients should include trigger point evaluation. All patients with trigger point invoked headaches from masticatory muscles should be offered both stabilization appliances and the more effective anterior positioning appliance. In my experience the best orthotics are produced via neuromuscular dentistry including muslce relaxation with ULF-TENS and computerized measurements.
This link leads to multiple patient testimonials of the effectiveness of nueromuscular diagnostic orthotics. Orofacial Pain Testimonials on Reddit utilizing neruomuscular dentistry: https://www.reddit.com/r/NeuroMuscularDent/
The following is a remark by me on the TMJ/TMD Facebook Discussion Group.
Ira L Shapira This is another article by Fricton (abstract) He says “pathologic and functional processes in the masticatory muscles. ” Functional processes could be restated as “occlusal function” You will notice that he does not include in his treatment protocol correcting functional problems from occlusion but does state.”reduction of contributing factors” I wrote a brief piece on this as well: https://thinkbetterlife.com/orofacial-pain-myofascial…/ Dent Clin North Am. 2007 Jan;51(1):61-83, vi.
Myogenous temporomandibular disorders: diagnostic and management considerations.
Myogenous temporomandibular disorders (or masticatory myalgia) are characterized by pain and dysfunction that arise from pathologic and functional processes in the masticatory muscles. There are several distinct muscle disorder subtypes in the masticatory system, including myofascial pain, myositis, muscle spasm, and muscle contracture. The major characteristics of masticatory myalgia include pain, muscle tenderness, limited range of motion, and other symptoms (eg, fatigability, stiffness, subjective weakness). Comorbid conditions and complicating factors also are common and are discussed. Management follows with stretching, posture, and relaxation exercises, physical therapy, reduction of contributing factors, and as necessary, muscle injections.