New Studies Point To Common Etiologic Cause of Migraines and Essential Hypertension? Sphenopalatine Ganglion (SPG) has a Central Role.

HypnosisTwo new  studies  published Jan 1, 2018  in the International Journal of Cardiology and Cephalgia point the way for a new understanding in the cause of Migraines and Hypertension being closely linked.  This may open the doors to new ways to examine the underlying causes of two common disorders.

The PUBMED abstracts of all studies cited are available  at the bottom of this post.

The article in Cephalgia , “Migraine and the Risk of Incident Hypertension Among Women” was a prospective cohort study of 29,040 women without hypertension at baseline.  The study examined the increase risk of hypertension in women   “classified as having active migraine with aura, active migraine without aura, a past history of migraine, or no history of migraine”  The article concluded “Women with migraine have a higher relative risk of developing hypertension compared to women without migraine.”

The second article,”Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension.  A randomized controlled single-blinded study  in the International Journal of Cardiology.

Findings of decreased  24 hour and daytime blood pressure decreased in the study group a month after SPG block.  Significant response was noted in 36% of ptients identified as responders.  The study concluded that “SPG block is a promising, minimally invasive option of BP decrease in hypertensives”

 Combining these two studies and understanding the complex natures of the Sphenopalatine Ganglion with its Sympathetic and Parasympathetic fibers ties together autonomic nervous system that traverses the the trigeminal nerves along with the somatosensory trigeminal fibers.

Increasing the frequency of SPG Blocks increase their effectiveness.  Self-Administration will ultimately make all of these interventions far more effective and affordable.

A third study in the Journal of Headache Pain that was published on January 18, 2018  looked at Sphenopalatine Ganglion Stimulation as a treatment for Cluster Headache.  Cluster Headache is one of the Autonomic Trigeminal Cephalgias that also is controlled by the Trigeminal Nerve, both the Somatosensory nerves and the Sympathetic and Parasympathetic nerves of the autonomic nervous system.

The study “Sphenopalatine ganglion stimulation for Cluster Headaches, results from a large, open-label European registry.  The study concluded that “SPG stimulation is an effective therapy for CH patients providing therapeutic benefits and improvements in use of medication as well as headache impact and quality of life.”

Another article, Diagnosis, pathophysiology and management of cluster headache.” published inLancet Neurology on January 17, 2018  The study states “Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. ”  These are the exact nervous systems structures discussed in the previous articles.

Cluster headaches are “trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both”  The articl describes CH  Cluster headachehypothesized to  “involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system.”

These same structure are also of great interest to doctors treating orofacial pain and TMJ disorders.  Shimshak in his 1998 paper showed that patients with TMJ disorders utilized health care 300% the rate of non-TMJD in every singe field of medicine (except pregnancy and childbirth).  It has been reported (not confirmed) that Blue Cross of Pennsylvania whose data was used for the studies made Dr Shimshak destroy research papers related to the study. ( I presume this was due to not wanting to cover TMJ disorders”.  This is understandable when one considers that the exact same nervous structures are invloved in TMJ disorders ie the Somatosensory nerves of the trigeminal nervous system along with Sympathetic and Parasympathetic fibers of the autonomic nervous system that travel along the trigeminal branches.

Neuromuscular Dentistry has been extremely effective at treating not just TMJ disorders but also Migraines, Chronic Daily Headaches, Sinus Pain Eye pain , trigeminal autonomic cephalgias and orofacial pain. Much of the success of Neuromuscular Dentistry may have to do with the actions of the Myomonitor (also BioTens) on both the somatosensory nerves of the trigeminal and facial nerve but also on the sympathetic and parasympathetic nerves of the autonomic nervous system that travel with the somatosensory nerves.

The Myomonitor would act on the Sphenopalatine ganglion (pterygopalatine ganglion) where it sits in the pterygopalatine fossa on the second division (maxillary) of the trigeminal nerves bilaterally.  It has a 50 year safety record of using skin electrodes to deliver ultra-low stimulation to the sphenopalatine ganglion.   This connection should be easy to see after reading the article on Sphenopalatine Ganglion Stimulation.

Cephalalgia. 2018 Jan 1:333102418756865. doi: 10.1177/0333102418756865. [Epub ahead of print]

Migraine and the risk of incident hypertension among women.

Abstract

Background

Few studies have examined whether migraine is associated with an increased risk of incident hypertension. Methods We performed a prospective cohort study among 29,040 women without hypertension at baseline. Women were classified as having active migraine with aura, active migraine without aura, a past history of migraine, or no history of migraine. Incident hypertension was defined as new physician diagnosis or newly self-reported systolic or diastolic blood pressure ≥140 mmHg or ≥90 mmHg respectively. Cox proportional hazards models were used to evaluate the association between migraine and incident hypertension. Results During a mean follow-up of 12.2 years, 15,176 incident hypertension cases occurred. Compared to those with no history of migraine, women who experience migraine with aura had a 9% increase in their risk of developing hypertension (95% CI: 1.02, 1.18); women who experience migraine without aura had a 21% increase in their risk of developing hypertension (95% CI: 1.14, 1.28); and women with a past history of migraine had a 15% increase in their risk of developing hypertension (95% CI: 1.07, 1.23). Conclusions Women with migraine have a higher relative risk of developing hypertension compared to women without migraine.

KEYWORDS:

Migraine; epidemiology; hypertension; women

Int J Cardiol. 2018 Jan 1;250:233-239. doi: 10.1016/j.ijcard.2017.10.042. Epub 2017 Oct 16.

Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension. A randomized controlled single-blinded study.

Abstract

BACKGROUND:

Sympathetic fibers connect sphenopalatine ganglion (SPG) with the central nervous system. We aimed to study the effect of SPG block in blood pressure (BP) in never treated patients with stage I-II essential hypertension.

METHODS:

We performed bilateral SPG block with lidocaine 2% in 33 hypertensive patients (mean age 48±12years, 24 men) and a sham operation with water for injection in 11 patients who served as the control group (mean age 51±12years, 8 men). All patients have been subjected to 24h ambulatory blood pressure monitoring prior and a month after the SBG block in order to estimate any differences in blood pressure parameters. We defined as responders to SBG block those patients with a 24h SBP decrease ≥5mmHg.

RESULTS:

We found that 24h and daytime DBP (p=0.02) as well as daytime DBP load (p=0.03) were decreased in the study group a month after SPG block. In addition, a significant response was noted in 12/33 responders (36%) regarding: a. SBP and DBP during overall 24h and daytime (p<0.001) and night-time periods, b. pre-awake and early morning SBP and c. SBP (daytime and night-time) and DBP (daytime) load. No differences regarding BP were found in the sham operation group.

CONCLUSIONS:

SPG block is a promising, minimally invasive option of BP decrease in hypertensives, probably through SNS modulation. Additionally, due to its anesthetic effect, SPG block might act as a method of selection for those hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.

KEYWORDS:

24h blood pressure measurement (24h ABPM); Arterial hypertension; Neural block; Sphenopalatine ganglion

J Headache Pain. 2018 Jan 18;19(1):6. doi: 10.1186/s10194-017-0828-9.

Sphenopalatine ganglion stimulation for cluster headache, results from a large, open-label European registry.

Abstract

BACKGROUND:

Cluster headache (CH) is a disabling primary headache disorder characterized by severe periorbital pain. A subset of patients does not respond to established pharmacological therapy. This study examines outcomes of a cohort of mainly chronic CH patients treated with sphenopalatine ganglion (SPG) stimulation.

METHODS:

Patients were followed in an open-label prospective study for 12 months. Ninety-seven CH patients (88 chronic, 9 episodic) underwent trans-oral insertion of a microstimulator targeting the SPG. Patients recorded stimulation effect prospectively for individual attacks. Frequency, use of preventive and acute medications, headache impact (HIT-6) and quality of life measures (SF-36v2) were monitored at clinic visits. Per protocol, frequency responders experienced ≥ 50% reduction in attack frequency and acute responders treated ≥ 50% of attacks. HIT-6 responders experienced an improvement ≥ 2.3 units and SF-36 responders ≥ 4 units vs. baseline.

RESULTS:

Eighty-five patients (78 chronic, 7 episodic) remained implanted and were evaluated for effectiveness at 12 months. In total, 68% of all patients were responders, 55% of chronic patients were frequency responders and 32% of all patients were acute responders. 67% of patients using acute treatments were able to reduce the use of these by 52% and 74% of chronic patients were able to stop, reduce or remain off all preventive medications. 59% of all patients were HIT-6 responders, 67% were SF-36 responders.

CONCLUSIONS:

This open-label registry corroborates that SPG stimulation is an effective therapy for CH patients providing therapeutic benefits and improvements in use of medication as well as headache impact and quality of life.

KEYWORDS:

Cluster headache; Long term effectiveness; Neuromodulation; Neurostimulation; Sphenopalatine ganglion

Lancet Neurol. 2018 Jan;17(1):75-83. doi: 10.1016/S1474-4422(17)30405-2. Epub 2017 Nov 23.

Diagnosis, pathophysiology, and management of cluster headache.

Abstract

Cluster headache is atrigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient’s quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. The hypothalamus appears to play a fundamental role in the generation of a permissive state that allows the initiation of an episode, whereas the attacks are likely to require the involvement of the peripheral nervous system. Triptans are the most effective drugs to treat an acute cluster headache attack. Monoclonal antibodies against calcitonin gene-related peptide, a crucial neurotransmitter of the trigeminal system, are under investigation for the preventive treatment of cluster headache. These studies will increase our understanding of the disorder and perhaps reveal other therapeutic targets.

PMID: 29174963
Cranio. 1998 Jul;16(3):185-93.

Health care utilization by patients with temporomandibular joint disorders.

Abstract

The claims data base of a large New England managed care organization was used to compare the health care utilization patterns of patients with TMJ disorders to non-TMJ subjects. Inpatient, outpatient and psychiatric claims data were examined over a wide range of diagnostic categories. Age and sex adjusted results showed that, overall, patients with TMJ disorders were greater utilizers of health care services and had higher associated costs than non-TMJ subjects. For some of the major diagnostic categories, such as nervous, respiratory, circulatory, and digestive, the inpatient and outpatient claims differences in utilization and costs were as large as 3 to 1. For only one diagnostic category, pregnancy and childbirth, were utilization and costs greater for non-TMJ subjects than TMJ patients. The psychiatric claims for TMJ patients exhibited differences that were at least twice as large as those for the non-TMJ subjects.

PMID: 9852811

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