Posts by: Momentum

Is My Headache Related to My Jaw?

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Have you ever wondered where your headache was coming from?  Did you ever think it had something to do with your jaw?  Most people don’t.  Oftentimes people wonder, “Can TMJ cause headaches everyday?” The truth is, yes. Because a headache is so common, it often becomes labeled incorrectly. People suffering from headaches are constantly misdiagnosed and end up at a neurologist rather than a dentist, although the relation between neck and jaw pain with headache is apparent.

There are several different types of headaches that a person can experience. The most common are the following:

  • Tension Headaches – usually the result of fatigue or stress; chronic or episodic. These headaches are frequently caused by clenching the teeth together in the daytime and/or nighttime bruxism. Neck and shoulder muscles are typically sore with chronic tension headaches.
  • Cluster Headaches – very intense and labeled as the “most severe”. This type of headache can be debilitating, and can last for several days as a time.  It is unclear what causes these types of headaches.
  • Sinus Headaches – the result of an inflamed sinus cavity due to infection. These can usually be treated with an antibiotic and/or decongestant.
  • Migraine Headaches – considered vascular in nature. They can be isolated to one side of the head or feel as if they take up the whole head. A number of different stimuli could set off a migraine (diet, bright light, stress, allergies).

The most common headache-related symptoms that patients in my office have include pain in the temples (temporal), pain behind the eyes, pain in the back of the head (occipital), pain in the very front of the head (frontal) or a pressure all around the head that almost feels like they are wearing a tight headband.

neck and jaw pain with headache

Unfortunately, knowledge about the relationship between jaw dysfunction and headaches is not well known.  In recent years, more studies have been done, but the awareness is still not out there.  Underlying jaw problems (TMJ disorders) are often ignored, and if that is the case, then the headache treatments may not even address the actual problem.  As a result, many people have become overmedicated and addicted to pain medications, which in turn cause more health issues.

Let’s start at the beginning.  When you chew, for example, your jaw muscles become tightened when you clench down.  Your jaw is positioned by the way your upper and lower teeth fit together.  This is called your “occlusion”.  If your occlusion is off, as a result of your jaw being dislocated, then your jaw is in a constant strained position.  Over time, this incorrect position will put strain on the surrounding muscles, resulting in referred pain.  This referred pain can manifest itself through the head, neck, shoulders, ears and eyes.  If these surrounding muscles become stressed due to the malocclusion, headaches and TMJ pain will increase.

can tmj cause headaches everyday

 

Most pain comes from muscle. If your muscles are not functioning well because of fatigue from supporting your dislocated TM joints, they produce pain. You can relate it to a hard workout at the gym.  You don’t feel any pain at the time, but the next day, you’re sore.  This is the same idea for the TMJ, only it is much more understated.

Approximately 20 million Americans suffer from TMJ headaches, and they affect many more women than men (8:1).  Although some dentists can recognize the relationship between TMD and headaches, most are unable to manage the problem.  Dr. Richard Klein is specifically trained in diagnosing and treating headaches as they relate to TMJ disorders . His treatment modalities include splint therapy, tens unit usage, physical massaging, heat applications and trigger point injections.

If you are experiencing headaches and/or any of the other symptoms of TMD, please contact Dr. Klein to get a proper diagnosis and begin treating the underlying cause. Your headaches could be reduced or even eliminated with one of the treatments used at Michigan Head & Neck Institute.  Give us a call today at (586) 573 – 0438.

 

 

References:

 University at Buffalo. “Study Suggests Tension Headache May Actually Be TMJD.” ScienceDaily, 14 May 2006. www.sciencedaily.com/releases/2006/05/060514082537.htm

Anderson GC, John MT, Ohrbach R, et al. Influence of Headache Frequency on Clinical Signs and Symptoms of TMD in Subjects with Temple Headache and TMD Pain. Pain. 2011;152(4):765-771.

Okeson, JP. Bell’s Orofacial Pain. The Clinical Management of Orofacial Pain. 6th edition. Chicago: Quintessence Publishing Co, Inc 2005.

https://health.clevelandclinic.org/2015/06/your-jaw-may-be-to-blame-for-your-migraine-headaches/

Headache: The Journal of Head and Face Pain. Volume 21, Issue 4.  22 JUN 2005.

The relationship between headache and symptoms of temporomandibular disorder in the general population. J Dent. 2001 Feb;29(2):93-8.

http://www.emporiagazette.com/news/article_c44f7595-213f-5b30-b3c0-c84683ffb5ea.html

Exercise & OSA

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A common medical condition that Dr. Klein provides treatment for at Michigan Head & Neck Institute is Obstructive Sleep Apnea (OSA). For those who are not familiar with OSA, it is classified as upper airway obstruction during sleep. While there are many ways to treat OSA, this Blog is going to focus on apnea exercises as a means of treatment.

There are countless reasons why exercise is beneficial to the human body. It decreases depression, cardiovascular risk, diabetes, hypertension, daytime impairment, metabolic disorders and chronic pain. It allows for a more natural REM sleep cycle so you are able to get good quality sleep. Some people think that just because they sleep 8 hours, they are fully rested. If your body is waking up repeatedly throughout the night due to airway obstruction, then you are not truly resting. But, are there exercises for snoring and sleep apnea?

can exercise help sleep apnea

Increased exercise has been shown to be effective in improving the severity of a person’s OSA. Additionally, the health issues associated with OSA are decreased. Most people who suffer from OSA are overweight, however some are not, so exercise alone cannot eliminate OSA. Exercise can reduce OSA indirectly with the decrease of fat and body weight. It can improve muscle tone and has the potential to improve nerve damage that has occurred as a result of years of OSA.

Obesity or being overweight is one of the primary risk factors of OSA. People who are overweight have extra tissue in the back of their throat. This extra tissue has the ability to block the airflow because it falls down over the airway, or it could even change the shape of the airway, increasing the likelihood that it will collapse during sleep. It can be extremely challenging for a lot of people diagnosed with OSA to lose weight. Losing just 10% of your body weight can have a huge impact on symptoms. In some cases, losing a significant amount of weight can even cure the condition.

exercises for snoringExercise can reduce a person’s AHI (Apnea-Hypopnea Index), which is calculated by taking the number of apnea events divided by the hours of sleep. A person diagnosed with Severe OSA could start an exercise regimen and go down to a Mild diagnosis over time. You have probably heard of the Epworth Sleepiness Scale before. This is a test that allows you to rate your level of daytime sleepiness. Exercise has shown to be effective in lowering the total score one receives. To take the test, please click on the following link to see how you score.

http://www.michiganheadandneck.com/sleep-apnea-test-epworth-scale/

While higher levels of physical activity mean lower risk for OSA and associated health disorders, lower levels of physical activity are still helpful. Currently, the World Health Organization recommends at least “600 metabolic equivalent minutes (MET minutes)” of physical activity each week. This is equivalent to 150 minutes/week of brisk walking OR 75 minutes/week of running. High levels of activity are considered at 3,000-4,000 MET minutes per week. People who achieve these high levels of activity significantly reduce their risk for disease in general.

If you are someone who is suffering from OSA and experiences daytime sleepiness, fatigue, or pain, there are other forms of exercise that are less aggressive but can still be helpful. Activities as simple as vacuuming, climbing the stairs, gardening or mopping the floor can be beneficial and is certainly better than no exercise at all.

For more information on OSA please contact Dr. Klein at (586) 573-0438.

 

References

Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Per-mutt S, et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1991;144(3 Pt 1):494–498.

Primary Source
Respiratory Medicine
Source Reference: Aiello KD, et al “Effect of exercise training on sleep apnea: a systematic review and meta-analysis” Respir Med 2016. DOI: 10.1016/j.rmed.2016.05.015.

www.medpagetoday.com

 

SLEEP VOLUME 34, ISSUE 12

The Effect of Exercise Training on Obstructive Sleep Apnea and Sleep Quality: A Randomized Controlled Trial

http://dx.doi.org/10.5665/sleep.1422

 

Journal Scan / Research · August 23, 2016

High Level of Activity Reduces Risk of Major Disease

BMJ : British Medical Journal

 

http://www.independent.co.uk/life-style/health-and-families/health-news/exercise-health-disease-amount-you-should-be-doing-every-day-a7181261.html

 

http://www.health.harvard.edu/blog/weight-loss-breathing-devices-still-best-for-treating-obstructive-sleep-apnea-201310026713

What Does TMD Have To Do With My Eyes?

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tmj eye pain

 

You may remember when I have previously referred to TMJ dysfunction (TMD) as “The Great Imposter” because its symptoms can mimic those of many other conditions. Today I’ll be talking about the relationship between TMD and eyes, eye pain, sensitivity to light and other visual disturbances.

Pain in and around the eyes can be an unbearable symptom.  Usually, the cause of TMJ eye pain is due to pressure on the ocular nerves.  These are many possible culprits of this pressure including eye infections, allergies, eye disorders, nerve issues or a larger underlying medical condition.

Most people (and even doctors) would not think that eye pain could come from the jaw joint (TMJ).  However, because of the proximity of the TMJ to the eye socket, a jaw joint dysfunction could very well be the underlying cause of the eye pain. A number of studies have found referred eye pain to be associated with internal TMJ disorders.  In some cases, the TMJ becomes damaged due to dislocation (unilateral or bilateral), arthritis or inflammation, which causes pain in the surrounding areas – including the eye socket.

 

tmj blurred vision

How could the TMJ become dislocated in the first place?  There are a number of reasons including car accidents, sports injuries, whiplash, a fistfight – things that are considered macrotrauma.  There are also less severe but still damaging things (microtrauma) like the strain from a ponytail on top of a woman’s head or the weight of her hair that, over time, could cause TMJ disc dislocation.  Even children who watch TV lying on their stomach with their head propped in their hands could be straining certain muscles (another form of microtrauma).

Direct trauma to the occipital region of the skull (back of the head) can transmit pain through the head and lead to immediate eye pain.  Even without pain, blurred vision can occur which is why many doctors recommend you to wear acuvue trueye daily lenses.  There are 4 pairs of suboccipital muscles that, if irritated, can lead to dizziness and balance problems.  Mixed neurological symptoms including odd visuals can stem from trauma to the suboccipital area.

UntitledTrauma to the frontal region of the skull/head (frontalis muscle) can be equally as damaging.  This muscle controls functions like raising your eyebrows, opening your eyes and wrinkling your forehead.  It is also responsible for severe frontal headaches and migraines.

TMJ dysfunction causes interference with the trigeminal nerve (cranial nerve #5).  The trigeminal nerve connects to the teeth, jaw and eye socket. As the TMD worsens, the nerve irritation worsens, and hence the referred pain (in the eye or wherever the patient is experiencing the pain) worsens.  If inflammation is present in the TMJ’s, swelling and soreness in the eye area is a common response to the friction occurring in the jaw joint.

Typically, severe TMJ eye pain leads to a painful headache and/or migraine.  It can also cause extreme sensitivity to light (Photophobia), inability to focus (driving, reading, watching TV or using a computer), blurred vision, pressure behind the eyes, watery eyes, floaters, droopy eyelids and excessive blinking (Blepharospasm).  Many patients who experience Photophobia are told that they are experiencing a migraine and their treatment consists of painkillers. Meanwhile, the underlying symptom is ignored. Others have been convinced that they have a vision problem and they may be in need of new glasses or contacts in order to be able to read again.

While some surgeries are available for different TMJ dysfunctions, Dr. Klein takes a conservative approach to treating the condition that even most surgeons prefer to be the first course of action. Some of the treatments offered at Michigan Head & Neck Institute include:

 

  • Wearing a corrective orthotic (mouthpiece) that is adjusted as need for each patient
  • Physical therapy (tens unit usage, physical massaging of the TMJs, heat applications)
  • Helpful guidance toward helping each patient understand their condition
  • How to avoid harmful daily habits that might worsen their condition
  • Pain-relieving injections…and other non-invasive options

 

If you are suffering from eye pain, TMJ blurred vision or other visual disturbances, please call our office at 586-573-0438 to schedule your consultation with Dr. Klein today.

Sleep Disturbance in patients taking opioid medication

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Did you know that lack of sleep can increase pain, and pain can create problematic sleep? It is a vicious cycle that affects many people who are being treated for chronic pain. For people taking high doses of opiods (Vicodin, Percocet, Codeine, etc.), these medications can interrupt normal brain activity, leading to poor quality of sleep. The following article documents activity and sleep patterns in 31 participants taking opioid and non-opioid medications for chronic back pain. Patients with chronic pain reported disturbances in sleep, decreased quality of sleep, symptoms of insomnia and increased fatigue. In addition, more time was spent in bed and it took longer for them to fall asleep.

Please click on the following link to learn more about the relationship between pain and sleep.

http://onlinelibrary.wiley.com/doi/10.1111/anae.13601/epdf

How Sleep Disturbances & Insomnia Relate to Pain

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If you are experiencing chronic pain, you are most likely having a hard time sleeping, and sleep deprivation can increase pain levels.  The cycle of chronic pain and sleep deprivation can be extremely difficult to overcome.

Whether you are suffering from mild or chronic daily pain, it still affects a person’s ability to maintain a stable sleep schedule and achieve proper sleep.  While many people think that they are getting enough sleep because they get 7-8 hours per night, this doesn’t necessarily mean that their body is waking up fully rested and functional.  Quantity does not account for quality.

Approximately one in four people with chronic pain have been diagnosed with a sleep disorder.  One of the main functions of the body is to make repairs while we sleep at night.  Without this rest, we are making ourselves prone to different illnesses, migraines and mood disorders.  Individuals with more disrupted sleep have increased production and release of inflammatory markers in the bloodstream, leading to inflammation and pain.

chronic pain and sleep deprivation cycle

Additionally, how the brain perceives things changes with the quality and quantity of sleep.  For example, if patient A and patient B both suffer from Fibromyalgia, but patient A sleeps 7 hours per night and patient B only sleeps 4 hours, studies show that patient B will experience more pain.  While their symptoms may be textbook identical, their realities are nothing alike. An internet survey of over 2,500 people with fibromyalgia showed that insomnia was one of the most commonly identified aggravating factors.

For people suffering from insomnia, this could potentially be fatal.  Insomnia is associated with memory impairment, frequent accidents, depression and other mood disorders.  It interferes with the functioning of certain brain areas and impairs cognitive performance. Simple decision-making can become impossible to a person suffering from insomnia. Here lies another destructive cycle of a once capable person now slipping into depression because they cannot care for themselves anymore.

A statistical analysis of insomnia’s relationship to absences from work caused by illness clearly found that there is a connection. Evidence shows that this effect can go on for up to 2 years after the incidence of insomnia.  Roughly 29% of migraines are caused by insomnia and 40% of psychiatric mood disorders are preceded by insomnia.

sleep and pain management

Pain can modify the way the central nervous system works, so a patient actually becomes more sensitive and feels more pain with the same or less provocation. This is called “central sensitization” because it involves changes in the central nervous system.  These patients are also more sensitive to ordinary touch and pressure as well – things that should not hurt.

Managing insomnia and chronic pain is a multi-step process involving several different types of healthcare providers. Make an appointment for sleep and pain management at Michigan Head & Neck Institute. For more information on sleep disorders and pain, please contact Dr. Richard Klein at info@michiganheadandneck.com.

If you or someone you know could be suffering from any of the above symptoms and/or dysfunctions, please take a moment to complete the following Sleep Disorder test: http://www.michiganheadandneck.com/sleep-apnea-test-epworth-scale/

 

References:

 

Ingraham, Paul. The role of sleep deprivation in chronic pain, especially muscle pain. Updated May 3 2016 (first published 2008).

https://www.painscience.com/articles/insomnia-until-it-hurts.php

 

National Sleep Foundation website

www.sleepfoundation.org

 

Mullington JM, Simpson N, Ph.D., 1 Meier-Ewert HK, Haack M.  Sleep Loss and Inflammation. Best Pract Res Clin Endocrinol Metab. 2010 Oct; 24(5): 775–784.

 

Alhola, Paula, Polo-Kantola, Paivi. Sleep Deprivation: Impact on Cognitive Performance. Neuropsychiatr Dis Treat. 2007 Oct; 3(5): 553–567.

Coins for a Cause

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October is Breast Cancer Awareness Month!
Please meet our cute pink bear bank that is collecting Coins for a Cause. Throughout the month of October, we are collecting coins for cancer awareness. The money will be donated to the Karmanos Center Institute.Collecting Coins for a Cause

The Buzz on Tinnitus

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Have you ever experienced ringing or buzzing in ears that only you can hear? This perception of sound, tinnitus, can manifest itself in many different ways. According to the CDC, tinnitus affects nearly 15% of the American population.

The Buzz on Tinnitus

One cause of tinnitus is an underlying TMJ disorder (TMD). TMD is often called “The Great Impostor” because its symptoms can mimic those of many other conditions. Until recently these symptoms, appearing unrelated, were undiagnosed or misdiagnosed as migraine, tension headache, neuritis, neuralgia, or stress. When standard treatment remedies for these types of disorders proved unsuccessful, patients were labeled as hypochondriacs or neurotic.

A classic example of “The Great Impostor” is TMD causing otalgia (ear pain) in the guise of an ear infection. These patients often exhibit no clinical signs of primary ear pathology, yet they may have ear pain that persists even after an ear infection has been successfully treated. Historically, TMD has been closely linked with Otolaryngology. One of the earliest credible studies describing TMD was published in 1934 by an Otolaryngologist, James B. Costen. He established TMD as a differential diagnosis to be considered when otalgia is present. Today, it is well recognized by certain practitioners within the Health Care Community that these often unexplained, undiagnosed and therefore untreated symptoms are related to a group of problems called Temporomandibular Disorders (TMD). Many Ear, Nose & Throat (ENT) specialists are screening for TMD during consultation appointments today.

image 4 2

Keep in mind that the chewing muscles are near to some of the muscles that insert into the middle ear and so may have an effect on hearing. This can either promote or exacerbate pre-existing tinnitus. Secondly, there can be a direct connection between the ligaments that attach to the jaw and one of the hearing bones that sits in the middle ear. Lastly, the nerve supply from the TMJ has been shown to have connections with the parts of the brain that are involved with both hearing and the interpretation of sound.

image 4 3

Many patients with temporomandibular disorder and coexisting tinnitus find that therapy improves or resolves their tinnitus in conjunction with their TMD symptoms. Asking targeted questions and performing clinical testing can be of significant value in helping practitioners identify which patients with TMD and coexisting tinnitus will experience improvement in, or resolution of, their tinnitus when TMD symptoms have improved significantly.

If you are experiencing tinnitus and it is related to your TMJ, then you might have other symptoms like any of the following:

• head, back and neck and pain
• dizzy spells
• ear pain
• ear infections
• ear congestion
• loss of hearing
• stuffed up ears
• sinus pain
• sore throat
• migraines and headache
• blurred vision

If your bite is not aligned properly, the trigeminal nerve can cause tinnitus and earache. It’s not actually an ear infection, but just an irritation that is caused by the activity in your trigeminal nerve.

image 4 4

One of these muscles goes to the eardrum and is called the Tensor Tympani. It can create the tone of noise by stretching the ear drum similar to changing the tone of a guitar by tightening the strings. The other muscle is a jaw muscle but they used to be a single muscle (Medial Pterygoid and Tensor Tympani) early in our development. They share the same trigeminal nerve connections.

tinnitus treatment

While most have mild symptoms, ringing in the ears is a common condition that patients often don’t tell their doctors about. In a 2007 National Health Interview Survey (raw sample – 75,764 respondents), of those who experienced tinnitus, only about half had discussed their problem with a physician (49.4%).

In addition, individuals with tinnitus often have higher rates of depression, anxiety, low self-esteem and poor quality of life. Bothersome tinnitus can lead to sleep disturbances as well, which only worsens the mental stress and anxiety. This can eventually lead to disability.

If you, or someone you know, is experiencing any combination of even a few of the symptoms listed above, please talk to your doctor about a possible TMJ problem or call us today.

 

Tinnitus Treatment:

While some surgeries are available for different TMJ dysfunctions, Dr. Klein takes a conservative approach to treating the condition that even most surgeons prefer to be the first course of action. Some of the treatments offered at Michigan Head & Neck Institute include:

• Wearing a corrective orthotic (mouthpiece) which can be adjusted as needed for each patient

• Physical therapy which can include tens unit usage, physical massaging of the area around the TMJ joints and heat applications

• Helpful guidance toward helping each patient understand their condition, and how to avoid harmful daily habits that might worsen their condition

• Pain-relieving injections, and other non-invasive options

 

References:

JAMA Otolaryngol Head Neck Surg. Published online July 21, 2016. doi:10.1001/jamaoto.2016.1700
Centers for Disease Control and Prevention/National Center for Health Statistics. Center for Health Statistics. Current estimates from the National Health Interview Survey, 1996. Vital Health Stat 10. 1999;(200):1-203.
Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010;123(8):711-718.
The Journal of the American Dental Association
Volume 128, Issue 10, October 1997, Pages 1424-1432

American Tinnitus Association Website

Macomb 2016 Hall of Fame Inductee Featuring Dr. Richard Klein

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The Macomb Hall of Fame honors individuals and organizations that have made outstanding contributions to improving the economic, family, and community life of Macomb County.

On September 22, 2016, Dr. Richard Klein of Michigan Head & Neck Institute will be inducted into the Macomb Hall of Fame along with 5 other inductees for his contributions over the past 4 decades. Read below for a brief overview of his many accomplishments over the years.