American Headache Society Article Ties TMJ Disorders And Symptoms To Migraine, Chronic Daily Headache And Episodic Tension-Type Headaches. I Hate Headaches.org Explains Relation To TMJ Disorders.

    GURNEE, IL, October 04, 2009 /24-7PressRelease/ -- Headaches destroy the quality of life for millions of Americans. The direct medical costs of just migraine treatment for medically insured Americans was estimated at a projected national burden of migraine of $11.07 billion in a study in Headache. 2008 Apr;48(4):553-63. This study only dealt with the direct medical costs of migraine not the other economic cosequences. When one considers the entire spectrum of headaches and measures all costs the toll will be in the hundreds of billions. "Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study" published in Headache. 2009 Sep 14 is exciting new research. (Pub Med abstract is reprinted below)

The study concluded that Temporomandibular disorder symptoms are more common in migraine, episodic tension-type headache and chronic daily headaches. This is exciting because treatment of Temporomanibular disorders often allows patients to live free of most pain and without a lifetime need of drugs. These medications often lead to future medical problems. The increase in the percentage of patients with headaches is startling. A single TMD symptom increased headaches from 56.5% vs 31.9% campared to patients with no symptoms. Additional symptoms increased the perentage with headaches significantly. Patients with two TMD symptoms reported headache 65.1% vs 36.3% in patients without TMD symptoms. When three sypmtoms of TMD were present amazingly the increase was 72.8% vs 37.9%.

I HATE HEADACHES LLC has recently created a new resource for headache patients that explains the relation of TMJ disorders, the trigeminal nerves and all types of headaches. The site is http://www.ihateheadaches.org and was founded by Dr Ira L Shapira who also founded http://www.ihatecpap.com to explain how comfortable oral appliances can be used to treat Sleep Apnea as an alternative to CPAP. Sleep apna and Headaches are intimately related. There is a report by the National Heart Lung and Blood Institute (NHLBI) that considers Sleep Apnea to be a TMJ disorder. The report "Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders disorers" can be found @ http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf There is an intimate relation of TMJ disorders with many diverse symptoms which is why these disorders have been given the moniker "The Great Imposter".

Patients wearing oral appiances for treting sleep apnea often experience bite changes. Many of these patients find the bite changes to be favorable leading to elimination of TM Joint problems, neck pain, headache pain and other symptoms. The American Academy of Sleep Medicine (AASM) recognizes oral appliances as a first line treatment for mild to moderate apnea and recommend that dentists treating sleep apnea have expertise in treating TMJ disorders.

Another study "Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. " showed that "Transformed migraine exacts a significantly higher economic toll on patients and health care systems compared with other forms of migraine."

Transformed migraine, is a chronic progressive disorder characterized by escalating frequency of headache attacks. This study showed a large increase in costs for patients with transformed migraine. (Pub Med abstract below).

A search of Pub Med utilizing the terms Migraine and Trigeminal Nerve brings up 556 articles. The Trigeminal Nerve is often calle the dentists nerve. The trigeminal nerve is one of 12 pairs cranial nerves has more neural imput than any other nerve in the body and more input than the entire spinal column. The Trigeminal nerve goes to the teeth, the aw muscles, the jaw joints, the tensor of the ear drum and the tensor of the soft palate the opens and coses the eustacian tubes, the lining or the sinuses, the anterior two thirds of the tongue and it controls blood flow to the anterior 2/3 of the brain which is why it is soimportant in Migraine. It is also intimately connected to proprioception throughout the body. When TMJ disorders are present yoou create what in computer lingo would be stated "Garbage in- Garbage out". An article in Sleep and Health Journal "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" explains some of thesymptoms patients experience and can be read @ http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor and another story in Sleep and Health Journal explains Neuromuscular Dentistry http://www.sleepandhealth.com/neuromuscular-dentistry was originally published in the American Equilibration society newletter.

1: Headache. 2009 Sep 14. [Epub ahead of print] Links
Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study.

Gonçalves DA, Bigal ME, Jales LC, Camparis CM, Speciali JG.
From the Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University, Brazil (D.A.G. Gonçalves and C.M. Camparis); Merck Research Laboratories, Whitehouse Station, NJ, and Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.E. Bigal); INBIO - Instituto de Neuropsicologia e Biofeedback, Ribeirao Preto, Sao Paulo, Brazil (L.C.F. Jales); Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, Sao Paulo, Brazil (J.G. Speciali).
Objectives.- A population-based cross-sectional study was conducted to estimate the prevalence of migraine, episodic tension-type headaches (ETTH), and chronic daily headaches (CDH), as well as the presence of symptoms of temporomandibular disorders (TMD) in the adult population. Background.- The potential comorbidity of headache syndromes and TMD has been established mostly based on clinic-based studies. Methods.- A representative sample of 1230 inhabitants (51.5% women) was interviewed by a validated phone survey. TMD symptoms were assessed through 5 questions, as recommended by the American Academy of Orofacial Pain, in an attempt to classify possible TMD. Primary headaches were diagnosed based on the International Classification of Headache Disorders. Results.- When at least 1 TMD symptom was reported, any headache happened in 56.5% vs 31.9% (P _ .0001) in those with no symptoms. For 2 symptoms, figures were 65.1% vs 36.3% (P _ .0001); for 3 or more symptoms, the difference was even more pronounced: 72.8% vs 37.9%. (P _ .0001). Taking individuals without headache as the reference, the prevalence of at least 1 TMD symptom was increased in ETTH (prevalence ratio = 1.48, 95% confidence interval = 1.20-1.79), migraine (2.10, 1.80-2.47) and CDH (2.41, 1.84-3.17). At least 2 TMD symptoms also happened more frequently in migraine (4.4, 3.0-6.3), CDH (3.4; 1.5-7.6), and ETTH (2.1; 1.3-3.2), relative to individuals with no headaches. Finally, 3 or more TMD symptoms were also more common in migraine (6.2; 3.8-10.2) than in no headaches. Differences were significant for ETTH (2.7 1.5-4.8), and were numerically but not significant for CDH (2.3; 0.66-8.04). Conclusion.- Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine. Future studies should clarify the nature of the relationship.
PMID: 19751369 [PubMed - as supplied by publisher]

1: Headache. 2009 Apr;49(4):498-508. Epub 2009 Feb 25. Links
Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study.

Munakata J, Hazard E, Serrano D, Klingman D, Rupnow MF, Tierce J, Reed M, Lipton RB.
IMS Consulting, Falls Church, VA 22046, USA.
OBJECTIVE: To evaluate the impact of incident transformed migraine on health care resource utilization, medication use, and productivity loss. In addition, the study estimates the total direct and indirect costs associated with transformed migraine. BACKGROUND: Emerging evidence indicates that migraine may be a chronic progressive disorder characterized by escalating frequency of headache attacks, often termed transformed migraine. Little is known about the economic impact of transformed migraine. METHODS: AMPP is a 5-year, national, longitudinal survey study of headache in the US. The study utilized data from the 2006 follow-up survey based on an initial sample of 14,544 adults identified as having migraine in either the 2004 screening or 2005 baseline survey. A diagnosis of migraine was assigned based on criteria proposed by the International Classification of Headache Disorders, 2nd Edition. Participants completed self-administered, validated questionnaires on headache features, frequency, impairment, resource use, medication use, and productivity loss. Direct and indirect headache-related costs were estimated using unit cost assumptions from the PharMetrics Patient-Centric database, wholesale acquisition costs (Red Book), and wage data from the US Bureau of Labor Statistics. Those who developed transformed migraine were compared with those who did not develop transformed migraine in the 1-2 year interval between screening/baseline and follow-up. RESULTS: A total of 7796 (54%) identified migraine cases completed the 2006 follow-up survey. Of those cases, 359 (4.6%) developed transformed migraine. Participants who developed transformed migraine reported significantly more primary care visits, neurologist or headache specialist visits, pain clinic visits, and emergency room visits compared with participants whose migraine remained episodic. Hospital nights and urgent care visits did not reach statistical significance. Transformed migraine participants reported significantly more time missed at work or school because of headaches and more time where work or school productivity was reduced by _50% in the previous 3 months because of headaches. Average per-person annual total costs, including direct and indirect costs, were 4.4-fold greater for those who developed transformed migraine ($7750) compared with those who remained episodic ($1757). CONCLUSION: Transformed migraine exacts a significantly higher economic toll on patients and health care systems compared with other forms of migraine. Our findings support the need to prevent migraine progression and to provide appropriate management and treatment of transformed migraine.
PMID: 19245386 [PubMed - indexed for MEDLINE]

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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