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reduction of medically diagnosed migraine pain |
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Migraine and tension-type headaches are both medically diagnosed benign
conditions. These conditions are confirmed to be benign only after
thorough medical tests have confirmed that there are no disease processes
that are the cause of the patient’s pain. An NTI-tss device
should only be used for migraine and/or tension-type headache reduction
after the condition has been medically diagnosed.
The protocol for delivery of an NTI-tss device for a migraine and/or tension-type headache sufferer is identical to that for the muscular parafunction (bruxism/TMD) patient. However, unlike the bruxism/TMD patient, where the use of a standard NTI-tss device during sleep alone is highly effective, the migraine and/or tension-type headache sufferer will most likely require a “daytime” NTI-tss device as well, for the most stable and predictable results. Although there is little, if any, intense pericranial muscular contraction throughout the day, the presence of an NTI-tss daytime device (for the first four to six weeks of treatment) is essential. Stressful situations (that is, a “trigger” for a migraine sufferer) can occur at any time. A “trigger” is really an activation of the patient’s sympathetic nervous system. The intrafusal fibers of spindle organs that reside within the fatigued pericranial musculature are innervated by the SNS. Until the musculature has had adequate time to recover from its chronic intense nocturnal parafunction (four to six weeks with regular nighttime NTI-tss use), the intrafusal fibers of those spindles still reside within fatigue, dysfunctional musculature and may hyper contract, which is highly painful and may be the source of the migraine pain. (See: Sympathetically Maintained Spindular Dysfunction: A Model for the Etiology of Chronic Tension-type Headache and Migraine. The presence of a daytime NTI-tss allows the patient to gently “tap” their lower incisors on the Discluding Element during stressful events, thereby exploiting the nociceptive trigeminal inhibition (NTI) reflex, which serves to suppress and relax the pericranial musculature and disrupt the neuromuscular mechanism leading to the migraine pain. A daytime NTI-tss is not necessarily the same as the patient’s standard nighttime device. Since parafunctional excursive and protrusive activity during the daytime is insignificant, the degree of vertical opening and anterior extension of the Discluding Element can be reduced for the patient’s comfort (that is, it should NOT act as an irritant to the patient, thereby becoming a trigger itself!). A daytime device (above) would ideally provide minimal posterior disclusion in centric and in slight excursive movements. A daytime NTI-tss device will typically provide for an incisal occlusal stop on the lingual side of maxillary incisors, contacting with the mandibular central incisors. In moderate excursive or protrusive movement, canine or posterior teeth may contact each other(circled above), allowing for the perpetuation of temporalis dysfunction (the patient usually has no awareness of the activity, even in the daytime). These potential contacts could allow for intense muscular activity, making the daytime design contraindicated for nighttime use. If the patient complains of new symptoms during the day following daytime use, it is most likely due to their excursive activiities. If so, incease vertical slightly if tolerated. A “daytime” NTI-tss is recommended for at least the first four to eight weeks of treatment for the migraine and/or tension-type headache patient (in addition to use of a nighttime NTI-tss), to be worn at all times, except for when eating. Following that time, daytime use is optional for the patient. As long as the patient continues to remove the daytime device while eating (which provides alveolar stimulation, thereby preventing posterior supra-eruption), there are no adverse dental effects. As the nocturnal parafunctional intensity continues to be suppressed night after night, the abilitiy to "trigger" a migraine during the day decreases. After 6 to 8 weeks, the daytime NTI-tss is no longer necessary, because the "pre-existing" condition (which was being prepertuated by nightly activity) of pericranial spindular dysfunction, no longer exists. The need for occlusal equilibration may become obvious during this time. When the patient removes their daytime device, they may become highly aware of occlusal interferences. These are SNS irritants as well and should be equilibrated! Otherwise, the patient will find themselves always wanting to wear the daytime device (because their teeth feel awkward). Although the daytime design may be more pleasing to the patient, it is important to stress to them that if canine or posterior clenching is possible in protrusive or excursive movement, it is not to be worn while sleeping (within a night or two, the patient will "defeat" it, that is, seek out and find teeth to clench on in excursive positions, thereby making their condition worse!) 
The above photos demonstrate a custom Daytime NTI-type device. |
