Schedule an
Appointment Now
480-945-3629
Medical and Medicare
Insurance Accepted
Opioids Should Not Be Used in Migraine
Keywords: opioid, migraine, narcotic, acute treatment, chronic migraine, nociception
Stewart J. Tepper MD
Opioids should not be used for the treatment of migraine. This brief review explores why not. Alternative acute and preventive agents should always be explored.
Opioids do not work well clinically in migraine. No randomized controlled study shows pain-free results with opioids in the treatment of migraine. Saper and colleagues’ 5-year study showed minimal effectiveness, with many contract violations, interfering with the therapeutic alliance.
The physiologic consequences of opioid use are adverse, occur quickly, and can be permanent. Decreased gray matter, release of calcitonin gene-related peptide, dynorphin, and pro-inflammatory peptides, and activation of excitatory glutamate receptors are all associated with opioid exposure. Opioids are pro-nociceptive, prevent reversal of migraine central sensitization, and interfere with triptan effectiveness.
Opioids precipitate bad clinical outcomes, especially transformation to daily headache. They cause disease progression, comorbidity, and excessive health care consumption. Use of opioids in migraine is pennywise and pound foolish. Article first published online: 27 APR 2012 DOI: 10.1111/j.1526-4610.2012.02140.x
Here at AZ TMJ, we also believe that the use of narcotics/opioids for migraine treatment comes with more risks and side effects, than benefits. We focus on conservative treatment options like trigger points to find the root cause of your headache. Dr. Stan Farrell is a member of the American Headache Society and has extensive training in the treatment of all types of headaches. If you have been prescribed or are currently taking narcotics for the treatment of your migraine headaches, you owe it to yourself to come and see Dr. Farrell; there may be a more conservative alternative available. Call and schedule an appointment at 480-945-3629. www.az-tmj.com
Pain and Pain Behavior in Burning Mouth Syndrome: A Pain Diary Study
Key words: burning mouth syndrome, pain behavior, pain coping, pain diary, stomatodynia
Heli Forssell, DDS, PhD/Tuija Teerijoki-Oksa, DDS, PhD/Ulla Kotiranta, DDS/Rosita Kantola, DDS/ Marjaliina Bäck, DDS/Tiina-Riitta Vuorjoki-Ranta, DDS/Maria Siponen, DDS/Ari Leino, DDS/ Pauli Puukka, MsocSc/Ann-Mari Estlander, PhD
Aims: To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis.
Methods: Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores.
Results: The overall mean pain intensity score of the 14 -diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects.
Conclusion: There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.- J OROFAC PAIN 2012;26:117–125
Burning mouth syndrome causes chronic burning pain in your mouth. The pain from burning mouth syndrome may affect your tongue, gums, lips, inside of your cheeks, roof of your mouth, or widespread areas of your whole mouth. The pain can be severe and very frustrating to deal with because it can be hard to pinpoint the cause. Fortunately, the emerging specialty of Orofacial Pain focuses on these types of conditions, as well as other difficult conditions to treat like Trigeminal Neuralgia. Dr. Stan Farrell is Board Certified in Orofacial Pain and has several conservative treatment options available for Burning Mouth patients. Call and schedule a consultation today @ 480-945-3629. www.az-tmj.com
Influence of Temple Headache Frequency on Physical Functioning and Emotional Functioning in Subjects with Temporomandibular Disorder Pain
Key words: headache, jaw function, TMJ, TMD , temporomandibular disorders, tension-type headache
Thomas List, DDS, Odont Dr/Mike T. John, DDS, MPH, PhD/Richard Ohrbach, DDS, PhD/Eric L. Schiffman, DDS, MS/Edmond L. Truelove, DDS, MSD/Gary C. Anderson, DDS, MS
Aims: To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache.
Methods: The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD–II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form–12 [SF–12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist–90R/SCL–90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning- was analyzed using linear regression and trend tests for proportions.
Results: Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning,- reflected in depression and anxiety, was also associated with increased frequency- of headache (both P < .001).
Conclusion: Headache frequency- was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches. J OROFAC PAIN 2012;26:83–90
As research has shown, suffering from TMD and concurrent headaches has proven to substantially reduce not only physical functioning but emotional functioning, as well. Here at AZ TMJ, we focus our practice solely on treating TMJ disorders and concurrent migraine headaches. Dr. Stan Farrell is Board Certified and has extensive training in treating all types of orofacial pain disorders. If you suffer from jaw pain, TMJ, headaches or other facial pain, you’ve come to the right place! There are many non-surgical, conservative treatment options available to help you regain your daily functioning. Call and schedule an appointment today at 480-945-3629. www.az-tmj.com
Occlusal splint for sleep bruxism: an electromyographic associated to Helkimo Index evaluation
Keywords: Sleep bruxism, TMJ, TMD, Occlusal splints, Masseter, Temporalis
This study aims to evaluate long-term effects of using an occlusal splint in patients with sleep bruxism (SB), using surface electromyography (EMG) of masseter and temporalis muscles, as well as the Helkimo Index.
The subjects were 15 individuals aged from 19 to 29 years, bearers of SB, with presence of signs and symptoms of temporomandibular disorders (TMD), which never have used occlusal splints.
The subjects answered the Helkimo’s Index and underwent EMG before and after 60 days of occlusal splints use. There was no indication of a significant decrease in mean EMG levels over the therapy in the muscles.
A significant decrease in TMD signs and symptoms were observed in SB patients after 60 days of occlusal splints therapy. Sleep and Breathing Volume 12, Number 3 (2008), 275-280, DOI: 10.1007/s11325-007-0152-8
According to the results of this research, sleep bruxism patients had a significant decrease in their TMJD signs and symptoms after 60 days of splint therapy. This is important to note because many patients may not have immediate results and is also consistent with our average treatment being around 90 days. The type of appliance used and the skill of the practitioner fabricating, fitting and adjusting the appliance ultimately determine its success. Dr. Stan Farrell is Board Certified in Orofacial Pain, making him one of the best choices for treating your TMJ disorder pain and discomfort. Call and schedule a consultation at 480-945-3629. www.az-tmj.com
Primary Headache and Sleep Disturbances in Adolescents
Keywords: headache; sleep; adolescents, trigger point, migraines, children, teens
Deborah K. Gilman PhD, Tonya M. Palermo PhD, Marielle A. Kabbouche MD, Andrew D. Hershey MD, PhD, Scott W. Powers, PhD, ABPP
Objective.—The aim of the present study was to assess sleep patterns and the prevalence of sleep problems in adolescents with primary headaches using a validated sleep screening instrument, as well as to test the association between headache and pain features and adolescent sleep behaviors.
Background.—Sleep disturbance is a common complaint that has long been associated with primary headaches, but there exists limited evidence of the headache-sleep relationship among teens.
Methods.—Sixty-nine adolescents aged 13 to 17 years (M= 14.7; SD= 1.4) were evaluated for headaches at 2 pediatric neurology departments (90% migraine; 10% tension-type headache diagnoses). Participants completed the School Sleep Habits Questionnaire and a standardized questionnaire regarding headache characteristics.
Results.—Sleep complaints were prevalent among adolescents with headaches including insufficient total sleep (65.7%), daytime sleepiness (23.3%), difficulty falling asleep (40.6%), and night wakings (38%). Statistically significant relationships between headache characteristics (eg, frequency, pain intensity) and teen sleep behaviors also emerged.
Conclusions.—Our findings provide further support for an association between headache and sleep disturbances among adolescents with primary headaches. This information may provide further understanding of the nature and course of the patient’s headache experience, as well as facilitate treatment planning to include recommendations for promoting good sleep hygiene.
As this study indicated, 65% of the adolescents with headaches reported insufficient total sleep. Lack of sleep, as we know, can lead to many health problems. If your child is complaining of headaches, it’s important to identify and treat the cause. Many headaches are triggered and maintained by muscle, nerve, or joint problems. Decreasing and controlling these triggers can decrease the frequency and/or intensity of the headaches. Dr. Stan Farrell is well versed in the treatment of all headaches and uses conservative, non narcotic treatment methods that are proven to provide relief over the long term without the dangers of addiction to prescription medication. Call and schedule a consultation with Dr. Farrell today at 480-945-3629. www.az-tmj.com
A Double-Blind Comparison of OnabotulinumtoxinA (BOTOX®) and Topiramate (TOPAMAX®) for the Prophylactic Treatment of Chronic Migraine: A Pilot Study
Keywords: onabotulinumtoxinA; chronic migraine; prophylaxis; adverse events; headache; BOTOX; TOPAMAX; topiramate
Ninan T. Mathew MD, Sayyed Farhan A. Jaffri MD
Background.— There is a need for effective prophylactic therapy for chronic migraine (CM) that has minimal side effects.
Objective.— To compare the efficacy and safety of onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) and topiramate (TOPAMAX®, Ortho-McNeil, Titusville, NJ) prophylactic treatment in patients with CM.
Methods.— In this single-center, double-blind trial, patients with CM received either onabotulinumtoxinA, maximum 200 units (U) at baseline and month 3 (100 U fixed-site and 100 U follow-the-pain), plus an oral placebo, or topiramate, 4-week titration to 100 mg/day with option for additional 4-week titration to 200 mg/day, plus placebo saline injections. OnabotulinumtoxinA or placebo saline injection was administered at baseline and month 3 only, while topiramate oral treatment or oral placebo was continued through the end of the study. The primary endpoint was treatment responder rate assessed using Physician Global Assessment 9-point scale (+4 = clearance of signs and symptoms and −4 = very marked worsening [about 100% worse]). Secondary endpoints included the change from baseline in the number of headache (HA)/migraine days per month (HA diary), and HA disability measured using Headache Impact Test (HIT-6), HA diary, Migraine Disability Assessment (MIDAS) questionnaire, and Migraine Impact Questionnaire (MIQ). The overall study duration was approximately 10.5 months, which included a 4-week screening period and a 2-week optional final safety visit. Follow-up visits for assessments occurred at months 1, 3, 6, and 9. Adverse events (AEs) were documented.
Results.— Of 60 patients randomized to treatment (mean age, 36.8 ± 10.3 years; 90% female), 36 completed the study at the end of the 9 months of active treatment (onabotulinumtoxinA, 19/30 [63.3%]; topiramate, 17/30 [56.7%]). In the topiramate group, 7/29 (24.1%) discontinued study because of treatment-related AEs vs 2/26 (7.7%) in the onabotulinumtoxinA group. Between 68% and 83% of patients for both onabotulinumtoxinA and topiramate groups reported at least a slight (25%) improvement in migraine; response to treatment was assessed using Physician Global Assessment at months 1, 3, 6, and 9. Most patients in both groups reported moderate to marked improvements at all time points. No significant between-group differences were observed, except for marked improvement at month 9 (onabotulinumtoxinA, 27.3% vs topiramate, 60.9%, P = .0234, chi-square). In both groups, HA/migraine days decreased and MIDAS and HIT-6 scores improved. Patient-reported quality of life measures assessed using MIQ after treatment with onabotulinumtoxinA paralleled those seen after treatment with topiramate in most respects. At month 9, 40.9% and 42.9% of patients in the onabotulinumtoxinA and topiramate groups, respectively, reported ≥50% reduction in HA/migraine days. Forty-one treatment-related AEs were reported in 18 onabotulinumtoxinA-treated patients vs 87 in 25 topiramate-treated patients, and 2.7% of patients in the onabotulinumtoxinA group and 24.1% of patients in the topiramate group reported AEs that required permanent discontinuation of study treatment.
Conclusions.— OnabotulinumtoxinA and topiramate demonstrated similar efficacy in the prophylactic treatment of CM. Patients receiving onabotulinumtoxinA had fewer adverse effects and discontinuations.
As this research indicated, there is a need for a treatment for chronic migraine that has minimal side effects. OnabotulinumtoxinA (BOTOX) has proven to have the same effectiveness as leading migraine medication with fewer adverse side effects. At AZ TMJ, Dr. Stan Farrell is Board Certified in Orofacial Pain and a Member of The American Headache Society. He has extensive training in the use of Botox for the treatment of migraine headaches and even TMJ. If you’ve experienced adverse side effects from your headache medication, Botox may be a viable option for you. Call and schedule an appointment at AZ TMJ today, at 480-945-3629. www.az-tmj.com
Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients
Keywords: obstructive sleep apnea; ambulatory blood pressure monitoring; sleep position; body posture
M Berger1, A Oksenberg1, D S Silverberg2, E Arons1, H Radwan1 and A Iaina2
Abstract
Obstructive sleep apnea (OSA), is a common clinical condition affecting at least 2-4% of the adult population. Hypertension is found in about half of all OSA patients, and about one-third of all patients with essential hypertension have OSA. There is growing evidence that successful treatment of OSA can reduce systemic blood pressure (BP).
Body position appears to have an important influence on the incidence and severity of these sleep-related breathing disturbances. We have investigated the effect of avoiding the supine position during sleep for a 1 month period on systemic BP in 13 OSA patients (six hypertensives and seven normotensives) who by polysomnography (PSG) were found to have their sleep-related breathing disturbances mainly in the supine position.
BP monitoring was performed by 24-h ambulatory BP measurements before and after a 1 month intervention period. We used a simple, inexpensive method for avoiding the supine posture during sleep, namely the tennis ball technique. Of the 13 patients, all had a reduction in 24-h mean BP (MBP). The mean 24-h systolic/diastolic (SBP/DBP) fell by 6.4/2.9 mm Hg, the mean awake SBP/DBP fell by 6.6/3.3 mm Hg and the mean sleeping SBP/DBP fell by 6.5/2.7 mm Hg, respectively.
Conclusion: All these reductions were significant (at least P < 0.05) except for the sleeping dbp. The magnitude of the fall in sbp was significantly greater in the hypertensive than in the normotensive group for the 24 h period and for the awake hours. In addition, a significant reduction in bp variability and load were found. Since the majority of osa patients have supine-related breathing abnormalities, and since about a third of all hypertensive patients have osa, avoiding the supine position during sleep, if confirmed by future studies, could become a new non-pharmacological form of treatment for many hypertensive patients.
At AZ TMJ, we have found that through a combined treatment with an oral sleep appliance and limiting the supine sleeping position our patients have had greater success in limiting the number of Apnea events they have per night. Many of our patients are getting better quality sleep, which is in turn lowering their blood pressure, as this research has confirmed. Dr. Stan Farrell is a member of the American Academy of Dental Sleep Medicine and has extensive training in the treatment of sleep apnea with an oral appliance. Call and schedule a consultation today and see if an oral appliance may be an option for you at 480-945-3629. www.az-tmj.com
Temporomandibular Disorder (TMJ) and Psychosomatic Symptoms from Adolescence to Young Adulthood
Keywords: TMJ, TMD, muscle spasms, mental component, psychosomatic symptoms
Tuija I. Suvinen, DDS, PhD/Marjatta Nyström, DDS, Odont Dr/Marjut Evälahti, DDS/Eija Kleemola-Kujala, DDS, Odont Dr/Antti Waltimo, DDS, Odont Dr/Mauno Könönen, DDS, Odont Dr
Aims: To assess the prevalence of subjective symptoms of pain and/or temporomandibular disorder (TMD) dysfunction and their association with psychosomatic (PS) symptoms in a longitudinal follow-up study of Finnish young adults over an 8-year period.
Methods: One hundred twenty-eight Finnish young adults (60 men and 68 women) were assessed longitudinally at the ages of 15, 18, and 23 years using routine stomatognathic methods and a standardized questionnaire.
Results: The prevalence of reported TMD symptoms ranged from 6% to 12% for pain symptoms, from 12% to 28% for dysfunctional symptoms, and from 4% to 7% for a combination of these 2 types of symptoms. The prevalence of PS symptoms, which were constantly present in many of the patients who reported them, ranged from 7% to 11%. A significant correlation (P.05) was found between TMD pain and PS symptoms at the ages of 15 and 18 years. PS symptoms were not significantly correlated to TMD dysfunction symptoms or to experiencing no symptoms at any age. The majority of subjects in all age groups with both TMD and PS symptoms were female, in a ratio of approximately 2 to 1.
Conclusion: The prevalence of TMD and PS symptoms was low in adolescence and young adulthood, and there was a significant association, although relatively weak, between PS symptoms and reports of either TMD pain or a combination of TMD pain and dysfunction symptoms. J OROFAC PAIN 2004;18:126–130
As this research has concluded, there is a significant association between TMJ disorders and psychosomatic symptoms. Many physical disorders and pain are believed to have a mental component derived from the stresses and strains of everyday living. This is the case for example, of jaw pain or muscle spasms, which appear to be caused by bruxism (clenching and grinding). Many people have no idea or control over their clenching and grinding, thus the mental component. If you are suffering from TMJ disorders or severe muscle spasms, there are many conservative treatment options that can help. Call and schedule an appointment with Dr. Stan Farrell at AZ-TMJ, 480-945-3629. www.az-tmj.com
Attention in Children and Adolescents with Headache
Keywords: children; adolescent; headache; attention problems; migraine
Daria Riva MD*, Arianna Usilla PsyD, Federica Aggio MD, Chiara Vago PsyD, Chiara Treccani PsyD, Sara Bulgheroni PsyD
Objective.— The previous studies reporting consistent visual reaction times slowing in patients with migraine prompted us to verify if headache could be associated to a broader impairment of attention. This study aims to undertake a thorough investigation of attentional performance by extending the evaluation to children with primary headache of different types.
Methods.— We compared 62 children with headache (14 migraineurs with aura, 29 without aura and 19 with tension type headache) and 52 controls without headache, matched for age, sex, and intelligence using Conners’ Continuous Performance Test.
Results.— The 3 clinical groups did not differ in attentional measures. The headache patients, collapsed in 1 single sample, had mean scores in Hit Reaction Time significantly different from those of controls and also had a higher percentage of atypical scores in 2 indices of the Conners’ Continuous Performance Test (faster mean reaction time and more commissions).
Conclusions.— Our results confirm the presence of an association between attentional problems and headache that may impact academic learning and daily activities on the long term. The finding that the 3 clinical groups did not show significant differences in attentional performance supports the hypothesis that migraine and tension headache form a continuum that may share the same pathophysiological mechanisms. These results are discussed considering that neurotransmitters and the cerebral circuits subserving headache, personality profile, and attention could overlap, thus predisposing these children to even mild attention malfunctioning. Article first published online: 15 NOV 2011 American Headache Society.
Children with migraine headaches are at risk to developing attention problems that could impact their academic learning and daily lives. Dr. Stan Farrell is well versed in the treatment of all types of headaches. His treatments are conservative, non-invasive and are proven to alleviate pain without the use of narcotics. Dr. Farrell is Board Certified and a member of the American Headache Society. If your child suffers from headaches, schedule an appointment with Dr. Farrell at AZ TMJ today. www.az-tmj.com
Psychologic implications of surgical-orthodontic treatment in patients with anterior open bite
Key Words: TMJ Surgery, Orthodontics, Bite, surgical-orthodontic treatment
Hoppenreijs/Hakman/van’t Hof/Stoelinga/Tuinzing/Freihofer
International Journal of Adult Orthodontics and Orthognathic Surgery
Aims: Two hundred eighty-two patients who received surgical-orthodontic treatment to correct anterior open bite were retrospectively evaluated by interview and questionnaires to determine the motivation and expectations before treatment, experience during treatment, psychosocial impact, functional and esthetic results, and satisfaction.
Methods: All patients underwent a Le Fort I osteotomy, and 126 patients also received a bilateral sagittal split advancement osteotomy. The mean follow-up was 6 years. The most important reasons for treatment, as cited by the patients, were biting and chewing problems (28%), dissatisfaction with facial appearance (26%), and symptoms of temporomandibular joint (TMJ) dysfunction (21%). Patients with anterior open bite had a critical attitude toward facial appearance; therefore, esthetic aspects should be taken seriously.
Results: The expectations on chewing ability, phonetics, nasal passage, and facial appearance were met by the treatment; however, expectations on TMJ function, interincisal relationship, and biting ability were not completely fulfilled. There was a subjective improvement of TMJ sounds in 27% and a worsening in 14% of the patients. Dysesthesia of the infraorbital nerve was noticed in 4% of patients and of the mental or inferior alveolar nerve in 23% of the patients. Chewing and biting abilities improved in 54% and 73%, respectively. Facial appearance, self-confidence, and social interaction had improved. Patients had expected more information before and psychologic support after treatment. Despite the relapse of open bite in 20% of the patients, 75% were satisfied with the dental and 85% with the facial appearance.
As this research has indicated, surgical-orthodontic procedures for TMJ Dysfunction are not always guaranteed to be successful. Only 27% showed improvement in popping/clicking sounds and 14% actually got worse. Additionally, 20% of the patients surveyed had a relapse of their open bite. There are many non-surgical, conservative options available for the treatment of TMJ Dysfunction. Here at AZ TMJ, we focus on conservative types of treatments that have been proven to be successful and are backed by research. Dr. Stan Farrell is Board Certified in Orofacial Pain, making him one of the best options in the Phoenix area to treat a wide variety of head pain and TMJ disorders. Call and schedule a consultation at 480-945-3629. www.az-tmj.com
Blog Archives
- Headaches (40)
- Sleep Apnea and Snoring (20)
- TMJ / TMD (53)
- Services provided by an Arizona Licensed General Dentist
- 9481 E. Ironwood Square Dr. Scottsdale, AZ 85258 | 480-945-3629 | info@azheadache.com | Contact Us
-
Find AZTMJ on:
- © Copyright