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NTI Tension Suppression System
The most effective FDA-approved method of migraine
prevention
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Presented at the Headache and Migraine
Trust International Congress 2008
September 6th,
2008, London UK (download
in pdf)
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CHRONIC DAILY HEADACHE TREATED NON-PHARMACEUTICALLY
WITH
A NOCICEPTIVE TRIGEMINAL INHIBITION DENTAL SPLINT
Andrew Blumenfeld, MD
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Background:
The NTI (Nociceptive Trigeminal Inhibition)
intraoral device is FDA approved for the prophylactic treatment
of medically diagnosed migraine pain and is hypothesized to reduce
noxious afferent activity through reduction of intensity of
nocturnal hyperactive trigeminal motor activity (jaw
clenching).
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Molar and canine tooth contact allows
for pathologic intensity of
trigeminal motor hyperactivity (nocturnal jaw clenching)
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An NTI device is custom made by a dental
professional, providing only for incisor-edge contact and minimal jaw-opening
(to minimize TMJ strain)
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Providing for only incisor-edge contact
with an NTI device minimizes trigeminal nociception.
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Methods - 20 consecutive CDH
patients treated in a headache center, scoring “severe and disabling” on
their HIT-6 questionnaire despite maximal oral prophylactic medication, were
properly fitted with an NTI device and wore nightly for 9 months.
At initiation of therepy, subjects reported waking headache-free only .4
mornings per week. HIT-6 questionnaires were completed, and number
of headache-free mornings per week reported, at 4 wks, 8 wks, and 9 months
following the initial fitting.
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Pre-treatment
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Following first month,
and eventual shifts
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Following 9 months continual use
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Results - By the fourth week
of nocturnal NTI use, nearly 75% reported significant positive improvements
in their HIT-6 scores. By the second month, all HIT-6 scores had stabilized.
Following seven months of continual nocturnal NTI use, 50% reported considerable
improvement in the quality of their lives, with half of those reporting that
their headaches no longer had any impact on their lives. Positive responders
(65%) reported a 1250% average increase in headache-free mornings per week
(.4/week to 5/week).
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Conclusions – The considerable
long-term improvement on the lives of the majority of patients with severe
and disabling intractable Chronic Daily Headache, and considerable increase
in headache-free morning upon waking over a nine-month period, well after
the cessation of placebo effect as a confounding factor, suggests that intense
nocturnal jaw clenching and resultant nociceptive input to the trigeminal
sensory nucleus should be considered as a perpetuating co-factor of CDH attack
frequency and severity. An NTI device, provided by an experienced and
knowledgeable practitioner, should be considered an important non-pharmacologic
prescribed therapeutic option for improving the quality of life of severe
headache patients.
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