A Migraine Treatment Patients Can Really Sink Their Teeth Into
- From: "Tim Dixon" <timgdixon-no-spam@xxxxxxx>
- Date: Wed, 28 Dec 2005 08:13:50 -0800
>From Practical Neorlogy, October 2005
By Andrew Blumenfeld, MD and James Boyd, DDS
Conventional pharmacotherapies for migraine headache can have undesirable
systemic side effects, and medications currently accepted for prophylactic
treatment (e.g., propranolol, amitriptyline, verapamil) rarely have a better
than 55 percent efficacy. Furthermore, the potential teratogenic effects of
some migraine prophylactic agents (e.g., divalproic sodium) make birth
control a necessity in women of childbearing age. Along with these
shortcomings, compliance becomes an issue; frequently, transformation to
chronic daily headache occurs.
A new non-pharmacologic method for prophylactic treatment of medically
diagnosed migraine pain as well as tension-type headaches, called the
Nociceptive Trigeminal Inhibition Tension Suppression System, is an
intra-oral device that reduces trigeminally-mediated muscular activity and
the resultant noxious afferent input. In patients with migraine and
tension-type headache, pericranial muscle tenderness (specifically of the
temporalis) is a common complaint, frequently detectable upon palpation.
Intraoral devices have been used to protect teeth from the intense
hyperactivity of the trigeminally-innervated muscles of mastication,
primarily the temporalis and masseter muscles.
These devices have no systemic effects and are thus safe in pregnancy,
lactation and in elderly patients on multiple other medications. There are
two types of intraoral devices now currently available: the traditional
full-occlusal splints and dis-occlusion splints. The full-occlusal splint
covers all of the teeth. Such splints still allow hyperactivity to
perpetuate or intensity for as least 50 percent of patients by providing the
necessary resistance to clench on. A dis-occlusion splint allows only
reciprocating anterior incisor contacts, thereby inhibition
trigeminally -innervated pericranial muscular contraction (most notably, of
the temporalis) to less than a third of maximum.
Nocturnal trigeminal motor hyperactivity and the resultant noxious afferent
input can be interrupted by a dis-occlusion splint such as the NTI and
allows the practitioner to give his patient a non-pharmaceutical option for
migraine prevention. The NTI device is essentially a prefabricated matrix
which a dentist custom fits to the patient. When used during times of
muscular parafunction (i.e., during nocturnal jaw clenching, a common trait
of migraineurs) the NTI device has been shown to reduce migraine events by
77 percent in 82 percent of subjects.
.
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