Headache Types and Treatment Options

What is headache?

Headache is a term used to describe aching or pain that occurs in one or more areas of the head, face, mouth, or neck. Headache involves the network of nerve fibers in the tissues, muscles, and blood vessels located in the head and at the base of the skull.

Almost everyone has occasional headaches, especially when they are sick, tired or otherwise under stress. Headache is the result of pain signals caused by interactions between the brain, blood vessels, and surrounding nerves. During a headache, the pain comes not from the brain. It comes from specific nerves surrounding the skull, head muscles, and blood vessels that are activated and send pain signals, interpreted by the brain as a headache. The reasons why these nerves are activated are not clearly understood. Most headaches go away on their own or are easily treated with over the counter (OTC) drugs.

Headache types

There are two main categories of headache: primary and secondary.

The major types of primary headaches include:

• Tension headache



• Cluster headache



• Migraine

Primary headaches are not caused by other underlying medical conditions. More than 90% of headaches are primary.

Secondary

Secondary headaches result from other medical conditions, such as cerebrovascular disease, head trauma, infection, tumor, and metabolic disorder. These account for fewer than 10% of all headaches. Head pain also can result from syndromes involving the eyes, ears, neck, teeth, or sinuses. In these cases, the underlying condition must be diagnosed and treated. Also, certain types of medication produce headache as a side effect.

Many people have occasional headaches that get better on their own or go away with OTC drug treatment. Most of these people never see a healthcare provider for their headaches, however, there are several circumstances in which an evaluation by a physician may be useful or important:

• Headaches that are getting worse over time



• Severe headaches that start suddenly



• Headaches that start after a head injury



• Headaches that always occur on the same side of the head



• Headaches that are not responding to treatment



• Severe headaches that interrupt work or the enjoyment of daily activities



• Daily headaches



• Aggravated by exertion, coughing, bending, or sexual activity

Tension Headache

Tension headaches are the most common type of headaches. They affect up to 75% of all headache sufferers. Tension headache is usually episodic but may be chronic, occurring daily or almost daily for more than 15 days a month. This type of headache is linked with tension in neck and scalp muscles, affecting blood flow within the skull.

Tension headaches often start in the afternoon or early evening. The pain is typically on both sides of the head, pressing or tightening. Some people get tension headaches in response to stressful events. Tension headaches usually do not get worse with physical activity (such as walking or climbing stairs).

Treatment

The occasional tension headache can be alleviated by a hot shower, massage, sleep, and through patient recognition and avoidance of stress factors.

For episodic tension headaches that occur less than three times per week, OTC pain relievers such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) are convenient and effective. Combination products of pain medication with caffeine may help some people, but also may be habit forming. Use of any OTC pain reliever should be limited to no more than two or three days per week. If pain medications are overused, rebound headaches may occur on the days that medications are not taken.

Chronic tension headaches are more difficult to treat, because rebound headaches are common when pain relievers are stopped. The most effective medications for treatment of chronic tension headaches are tricyclic antidepressants (amitriptyline HCl, doxepin HCl, nortriptyline HCl). However, it is often more effective to prevent these headaches than to treat them.

Some people are able to treat their tension headaches without medications. An ice compress, a heating pad or a massage to any tight areas in the neck and shoulders can be extremely helpful. Relaxation techniques, such as deep breathing exercises or acupuncture, may help to decrease the frequency of headaches.

Cluster Headache

Cluster headaches are relatively rare, affecting about 1% of the population. They are distinct from migraine and tension headaches. Cluster headaches primarily affect men between the ages of 20 and 40. Attacks usually occur in a series, or "clusters" of 1 - 8 headaches per day over a period of several weeks to months. The pain is extremely severe but the attack is brief, lasting 15 minutes to 3 hours. The pain of cluster headache almost always occurs on one side of the head. During cluster headaches, the eye on the same side as the pain may become teary or droopy or develop a small pupil. There may also be nasal congestion on the affected side of the face.

About 80% of cluster headaches occur at night, and in about 70% of patients, drinking alcohol can trigger a cluster headache. Unlike migraine sufferers, those with cluster headache often feel better if they keep moving during the headache.

Treatment

It is difficult to stop the pain of a cluster headache that is in progress, because the headache usually disappears by the time the patient reaches the emergency room or doctor's office. Because the onset of cluster headache attacks is rapid and may occur several times a day, the best approach to treatment is with daily preventive drugs to decrease the severity and frequency of headaches. Lithium (Carbolith, Duralith, Lithane, Lithobid, Lithonate and others) and Verapamil (Isoptin, Calan, Chronovera, Verelan, Novo-Veramil) are the two drugs that are most effective at accomplishing this. Other drugs used for this purpose include Prednisone (Deltasone, Meticorten, Orasone 1, Winpred and others), cyproheptadine (Periactin) and methysergide (Sansert). Prophylactic medications usually are begun early during a cycle of cluster headaches and continued for two weeks longer than the usual cycle.

Abortive treatments include inhalation of 100% oxygen. Inhaling 100% oxygen for about 15 minutes through a facemask has proven to be helpful when it is done at the first signs of an attack. This oxygen must be prescribed by a doctor and obtained through a medical supplier. Other types of drugs that may be effective when used at the outset of cluster pain include the triptans (Imitrex, Maxalt, Zomig, Axert, Amerge), ergotamine (Cafergot) and indomethacin (Indocin).

Migraine Headache

Migraine headaches are less common than tension headaches. About 6% of all men and 18% of all women experience a migraine headache at some time. Migraine headache occurs on one or both sides of the head. The pain is typically pulsating or throbbing in nature. Nausea, with or without vomiting, as well as sensitivity to light and sound often accompany migraines. Migraines are made worse by activity, bright lights and bright noises. In most cases, migraine attacks are occasional, or sometimes as often as once or twice a week, but not daily. Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods.

One unique feature of migraines is an unusual sensation that a migraine is about to occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and nervousness. Not all people who get migraines have prodromes.

An aura is a complex of neurological symptoms that occur just before or at the onset of migraine headache. An aura involves a disturbance in vision that may consist of brightly colored or blinking lights in a pattern that moves across the field of vision. Most patients with migraine have attacks without aura. About one in five migraine sufferers experiences an aura.

Treatment

How your migraines are treated will depend on the frequency and severity of attacks. People who have a headache several times per year often respond well to nonprescription pain relievers.

There are two types of medications to treat migraines:

• abortive medications - drugs that are taken when a headache starts



• preventive medications - drugs that are taken every day to prevent migraines

Abortive Medications

Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. When possible, an abortive medication should be taken immediately after an aura or migraine headache starts. However overusing abortive medications can lead to chronic headaches, that occur day after day without a specific cause or diagnosis. Several prescription and nonprescription drugs are used as abortive medications: aspirin, ibuprofen (Advil, Apsifen, Motrin, Nuprin and other brand names) or naproxen (Aleve, Anaprox, Naprosyn)

Effective agents available by prescription include:

• Triptans - sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig) and rizatriptan (Maxalt). Triptan drugs are effective in 60% to 65% of patients, completely or significantly relieving migraine pain and associated symptoms within 2 hours of administration. Triptans reduce inflammation and constrict the blood vessels. The triptan with the longest history of use is sumatriptan (Imitrex).



• Ergots - sublingual ergotamine (Ergomar) and dihydroergotamine (Migranal). Ergots cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than the triptans. Ergots are not as safe as the triptans.



• Midrin. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative)

Preventive Medications

Preventive medication are prescribed when migraine attacks that don't respond well to abortive medications or adverse reactions to abortive medications occur, migraine attacks occur too often, complicated migraines. Many drugs are listed as potentially useful to prevent recurrent migraine attacks. The drugs in the following classes are useful to prevent recurrent migraine attacks:

• Beta-blockers. Propranolol (Inderal) and nadolol (Corgard) have a good track record of being safe and effective. Metoprolol (Lopressor) and atenolol (Tenormin) are reasonable alternatives. Beta-blockers have been used for many years to prevent migraine headaches. It is not known how beta-blockers prevent migraine headaches.



• Tricyclic antidepressants. These medications are very effective, but often have troublesome side effects such as sedation, blurred vision, dry mouth and constipation. The first choice is often amitriptyline (Elavil). Nortriptyline (Pamelor, Aventyl), doxepin (Sinequan), imipramine (Tofranil) also can be tried.



• Anticonvulsants. Of the drugs in this class, valproate (Depakote, Epival) has the best evidence to support using it for prevention. Gabapentin (Neurontin) and topiramate (Topamax) also are effective. It is not known how anticonvulsants work to prevent migraine headaches.



• Serotonin antagonists. Methysergide (Sansert) has been available for many years and is very effective. Methysergide prevents migraine headaches by constricting blood vessels and reducing inflammation of the blood vessels. However, this medication has side effects that are potentially very serious and therefore is not widely used.

Rebound Headache

Increasing headache over time with repeated use of pain medicines can lead to a rebound headache. The headache is typically located on both sides of the head and is described as a pressing or tightening type of pain. When headache sufferers use too much pain medicine, their headaches often recur. This leads to a repeated cycle of taking more medicines and still having headaches. Rebound headache may appear if:

• taking analgesics on 15 or more days per month for more than 3 months



• taking opioid or combination medication 10 or more days per month for more than 3 months

When analgesics are discontinued, the headache may get worse for several days and it may take up to 30 days to recover from the rebound process. Non-drug approaches, such as biofeedback, relaxation therapy, and exercise, can be helpful in reducing both headache frequency and need for medication.

Headache Triggers

Triggers are not direct causes of the headache, but they facilitate or provoke the beginning of an attack. Anything that stimulates the pain receptors in the head and neck can cause a headache. Some of the more common triggers for headache:

• Emotional triggers: problems at work, success at work or school, anticipation, anxiety, an emotional crisis, a new job. Emotions can bring on headaches, keep them going, and make them worse. Emotions don't cause your headaches, they just make you more vulnerable to them.



• Environmental triggers: bright light, different kinds of aromas like perfume, tobacco, odors (such as gasoline), loud noises, altitude, barometric pressure changes.



• Stress triggers: strenuous exercise, excessive physical work at the work place or at school, physical sickness, not enough sleep or too much sleep



• Chemical triggers: changes in hormone levels (that occur during the premenstrual period, during the post-menstrual period), low blood sugar.



• Food and beverage triggers: caffeine, alcohol (especially red wine), hard cheese, vinegar, hot dogs, chocolate, nuts, MSG (monosodium glutamate), pizza, pork. Foods containing nitrites as preservatives can also trigger headaches. Fasting or missing meals is a major headache trigger.



• Changes in the weather can change body chemistry, and have been known to trigger headaches.



• Heavy cigarette smoking.

Yury Bayarski is the author of Price-RX.com - a prescription drug price comparison website. Please follow this link if you would like to read more about headache relief prescription drugs.

Texas Finds Hope For Treating Depression - A Genetic Link to Medication's Effectiveness

Genetic testing may help determine the most effective medications for depressed patients in the future. This month, the American Journal of Psychiatry published research citing patients' responses to the anti-depressant medication, Celexa, in association with certain genetic variations.

According to Dr. Gonzalo Laje, co-author of the study and associate clinical investigator at the National Institute of Mental Health, patients were twenty-three percent more likely to respond to the medication when a particular variation in the GRIK4 gene, along with a previously discovered variation on the HTRZA gene, were present.

"We are better able to see how genetic variations help determine how a person may or may not respond to a certain medication. This is an advancement toward personalized medicine," said Laje.

The healthcare and health insurance industries have been plagued with medical and financial issues associated with depression. In 2002, adults served by local mental health authorities in Texas included over 53,000 depression patients -- and that number only includes those who sought care at those facilities, which, by no means, reflected the whole of the depressed populace at the time.

State budget cuts to mental health services would dramatically reduce the number of those able to receive treatment, which would push problems -- many argue preventable problems -- into the emergency rooms. Ninety percent of suicides are due to untreated or under-treated mental illnesses; for Dallas, Houston, and Austin, where facilities are already overwhelmed by the sheer number of uninsured patients seeking care, any further strain could collapse a barely-balanced system.

As the population in Texas state mental hospitals goes down, the prison population goes up. According to the Texas Criminal Justice Policy Council, in 1970, there were approximately 12,400 mental health patients in state hospitals on any given day, including those suffering from depression. That number declined to just over 2,300 by 1999, while the prison mental health population rose to almost 16,000, exceeding the1970 state mental health institute population.

This dramatic increase in prison numbers has not only created problems in the general populace, but has also sucked down state funding. Texas could save an estimated $590 million a year by treating 'revolving door offenders' instead of jailing them.

While the precise number of depressed patients in each state is difficult to determine, according to the National Institute of Mental Health, there are 20.9 million adults in the United States suffering from depression at any given time. That's almost ten percent of the country.

Women are more prone than men, and symptoms are usually recognized between the ages of fifteen and thirty, though the mental health community has been taking childhood and adolescent-onset depression much more seriously in recent years. Severity ranges from mild -- which only slightly impairs functioning, perhaps manifesting itself as one "not living up to potential" -- to severe, which often devastates relationships, income, and day-to-day living, and can lead to suicide.

While depression is considered a treatable disease, just how treatable has been up for debate virtually since the illness began to be studied. Patient compliance has been a major issue, partly due to the nature of the disease itself, which produces persistent feelings of hopelessness, helplessness, worthless, and loss of interest and motivation.

The worse one feels, the harder it may be to feel hopeful and motivated enough to seek, and then follow through with, the proper care. If one does overcome these symptoms sufficiently to accept treatment, various factors, including financial barriers, accessibility problems, and lack of response to medications, can make it difficult to continue the regimen.

Lack of response to medications has been one of the more persistent and difficult obstacles to conquering the condition. For some, the first medication seems to work wonders, but many are not so lucky. Several cycles of different types of antidepressants are often required to pinpoint effective prescriptions, if they are found at all. Choice of medications are many and overwhelming, and include:




- Selective serotonin reuptake inhibitors (SSRIs), like Celexa, Paxil, Prozac and Zoloft;


- Tricycles, like Elavil, Norpramin, Tofranil, Aventyl, and Pamelor;


- Serotonin and norepinephrine reuptake inhibitors (SNRIs), like Effexor and Cymbalta;


- Norepinephrine and dopamine reuptake inhibitors (NDRIs), like Wellbutrin;


- Monoamine oxidase inhibitors (MAOIs), like Marplan, Nardil, and Parnate.





It is believed that the causes of depression are varied, and often depend on the functioning of certain neurotransmitters, such as serotonin, norepinephrine, and dopamine. Though there are commonalities among many of the medications, each can have varying side effects -- some severe - can focus on different neurotransmitters, and can produce different response levels, depending on the patient.

Laje's research could prove to dramatically shorten the lengthy trial-and-error process often necessary for determining prescriptions, as science currently has no truly effective way of profiling patients in this manner. "This [study on Celexa] gives us very relevant information to where we should be looking," said Laje, which is, at least, more progress than Western medicine has made in treating depression for quite some time.

"There's no one marker that's going to tell you whether you respond or not [to medications]. It's a lot of markers, each one having a small effect," said Dr. Julio Licinio, chairman of psychiatry and behavioral sciences at the University of Miami's Miller School of Medicine. ". . .[scientists] may be able to develop a genetic panel to tell us whether a person is likely to respond to an SSRI or not."

More and more depressed individuals are turning to natural health treatments, however, such as herbs, acupuncture, massage, and other forms of complementary medicine. St. John's Wort (Hypericum perforatum) is the most prescribed treatment for depression in Germany, and is used commonly throughout Europe for mild to moderate cases. Results of studies are mixed, however, and the National Institutes of Health is still undertaking research to determine the herb's effectiveness on mild cases. Other natural supplements used to treat depression include ephedra, gingko biloba, Echinacea, ginseng, various Chinese formulas, and SAM-e, perhaps the most promising natural treatment in recent years.

Being aware of the psychological issues affecting your health is an important part of taking care of yourself. Minding your health will certainly affect you as you age, and eventually your wallet. If you're a young individual who tries to keep informed and maintain a healthy condition and lifestyle, you should take a look at the revolutionary, comprehensive and highly-affordable individual health insurance solutions created by Precedent specifically for you. Visit our website, www.precedent.com, for more information. We offer a unique and innovative suite of individual health insurance solutions, including highly-competitive HSA-qualified plans, and an unparalleled "real time" application and acceptance experience.

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Living Migraine Free

Don't treat your migraines, prevent them. A life without migraines is obtainable, I know. I was a migraine sufferer for 12 years and have been treating... preventing them for my patients for 15 years. The 95+% success rate achieved at my office comes from a combination of research, common sense and the hard work of my patients.

When I was a teen I suffered from terrible migraines several times a week. Like most of you I tried medications and bio feedback with little help. Regular chiropractic care offered relief, but my migraines continued. Relief came to me by accident, I was doing a food shopping and did not have enough money for everything. I had choice of eating or drinking my daily 2 liter bottle of Pepsi, I chose eating. Like magic my migraines disappeared over the next week. It took several weeks to recognize that soda, alcohol, etc. were causing my migraines, but once I eliminated them I felt great. Trigger foods are well documented but aren't the whole answer.

When I first started treating patients I was sure that a simple elimination diet was the answer for my migraine patients, but many did not respond. I was determined to find the answer to treating migraines. I did a review of thousands medical research articles on migraines and found the clues I needed. The best way to treat migraines is to successfully prevent them. In order prevent migraines I needed to determine the true underlying reason migraines occur.

They key to preventing migraines is realizing that they are caused by an overload of toxins in the body. A migraine can be seen as a really severe hangover caused not by alcohol, but all types of toxins from in and out of the body. The liver, the body's main system for eliminating toxins is overwhelmed in migraine suffers. The liver is not diseased, it just is not functioning fast enough to keep the body detoxified. Simple examples of a toxin can be alcohol, chemicals, caffeine, and drugs. Toxins also include hormones and chemical compounds the body naturally produces, but cannot detoxify fast enough. Toxins can even be foods if the digestive tract cannot break them properly, such as preservatives, artificial coloring and artificial flavorings This simple concept has lead to thousands of former migraine suffers living pain free. If toxins and slow liver function lead to migraines; then reducing the toxic load and increasing the livers function will prevent migraines.

Tracey T. was 40 years old and had been suffering with migraines for 13 years. She was taking Pamelor, Topamax, Esgic Plus, and Zomig with no relief. She was under the care of a neurologist, her 4th one, and getting a migraines daily. She was in good health overall and followed a healthy lifestyle; exercised and avoided alcohol and caffeine. She began her nutritional supplements, improved her diet and increased her water intake. Her 2 month check up showed that she had had only 1 migraine in 8 weeks and several mild headaches. She was working with her doctor to eliminate her medication and was now only taking 1, at reduced amount. A six month review showed that she was off all medication and doing great.

There are 10,000s of medical studies on migraines. The medical research I reviewed overwhelmingly supports a lifestyle change with nutritional supplementation approach.

Medical Research .... How it supports this approach

1. low B vitamins and Magnesium levels ....... needed nutrients in liver detoxification

2. woman 3x more likely to suffer with migraines .... woman produce more hormones to that need to be detoxified,

3. increase frequency and severity of migraines with menstrual cycle ..........the female body produce up to 4x as many hormones during a menstrual cycle

4. elimination diets helpful .... reduces toxin intake, less to detoxify so the liver can keep up with demand

5. medications cause 30-40% of headaches ...... medications need to be detoxified by the liver, increasing the toxic load

6. triggered by smoke, perfume, etc..... smells are all chemical compounds that increase the toxic load on the liver

There are also two lab tests that support that prove that slower liver detoxification is associated with migraines. The first is a liver function test, this is not your typical blood test. A functional liver test will measure how long it takes your body to breakdown and detoxify different chemical compounds including; caffeine, aspirin, and acetaminophen. The second test in cutting edge genome scanning. Migraine sufferers have been linked to a genetic defect in liver detoxification.

The liver needs about 8 weeks of reduced toxic load and nutritional support to detoxify. When my patients start the process we ask them to keep a diary of every migraine, how severe it was and how long it lasted. Most patients start to see a decrease in the frequency or severity within 3 weeks and are migraine free by their 8th week. Woman can usually tell they are better by their 3rd menstrual cycle. You may find that the 1st and 2nd week are a little rough as you adjust to your new diet and the body dumps the toxins. The following are some guidelines to follow:

Lifestyle changes to Prevent Migraines

I recommend that my patients shoot for 100% success. The more you limit the toxins entering your body the greater your chance of success. An elimination diet alone will not work for most migraine sufferers. You will need to take nutritional supplements along with your lifestyle changes to live migraine free. Life does not always allow you to stay within the guideline, do the best you can.

Avoid the following:

caffeine and deceffeianted coffee, teas and sodas

chocolate

artificial coloring

artificial flavoring

preservatives

nuts

personal care products with heavy perfumes, switch to all natural

cleaning products, switch to all natural

cigarette smoking or second hand smoke

alcohol - all forms

Consume the following:

60-80 ounces a day

High fiber foods; fruits, vegetables, grains

Nutritional Support: to promote increase liver detoxification

Artichoke

Tumeric

Silmayrin

Glutathione

Cysteine

Cod liver oil

All natural multivitamin

B complex

Patients who are using OTC and prescription medication are slower to detoxify. Migraine suffers presently taking prescription medications should talk to their doctors. Together you can work out a plan to reduce and then eliminate your medications. Patients using medications on an as needed basis try to reduce the frequency of use, after a couple of weeks with new diet and lifestyle.

Questions and Answers:

Q: Why doesn't my doctor know this?

A: Doctors are trained to treat diseases, not dysfunction. Doctors are most likely causing 30-40% of all migraines from the migraine medication they are prescribing and the rebound effect they cause.

Q: Is your protocol safe?

A: The lifestyle changes and nutritional support recommend are very safe

Q: Can I continue on my medication?

A: Yes, continue on your medication and start the protocol when you are feeling better talk to your doctor

Q: Are there any side effects?

A: You may feel a little worse for 1-2 weeks, but it is worth it to be migraine free in about 8 weeks

Q: What kind and where can I get the nutritional supplements?

A: The nutritional supplements listed are available in any good health food store. My office use professional grade nutrients that are available only through healthcare professionals, they are not available health food stores.

I welcome your comments and questions. Please email me at szodkoy@hotmail.com if you have any questions.

Dr. Steven Zodkoy
Chiropractor
Certified Clinical Nutritionist
Certified Nutritional SpeCialist
Diplomate American Clinical Board of Nutrition

Chronic Headaches and Pain Alleviated by Dentistry

You may not immediately think of your dentist the next time you suffer from a migraine, but you might be surprised to know that there are many causes of headache, face, neck and shoulder pain that can be relieved by dental treatments. If this is not something you've tried, consider scheduling a consultation to find out if you suffer from temporomandibular joint disorder, a condition in which the upper and lower teeth are misaligned, causing muscle contractions in the jaw joint that lead to tension and pain.

A number of treatment options are available, depending on the cause of your pain. For example, you may not know it, but you might be clenching and unclenching your teeth many times throughout the day or night. This can wear down your teeth and create tension in your jaw, creating your headaches and other pain. If your dentist finds this is the case, he or she will prescribe useful home exercises and physical therapy, to be used in combination with a mouth guard that reduces the intensity and frequency of your oral stress and protects your teeth from further wear and destruction. This will restore the muscles of your head and neck area to normal length, function, posture and full range of motion, helping to reduce your symptoms.

The following treatments may also be helpful for treating chronic headaches and related pain:

Occlusal Splint - Also called a night guard, the Occlusal Splint protects the teeth from further wear and reduces the severity of grinding at night, allowing the muscles to rest. In severe cases, the splint may need to be worn all day to allow the joints and muscles to rest.

Jaw Rest - You must rest your jaw for it to heal. Do not:

- chew gum


- bite your nails


- clench your teeth together


- chew on pencils


- eat excessively chewy and crunchy foods during treatment

Moist Heat - penetrating moist heat promotes blood flow, aiding in healing and relaxation of the muscle and helping pain medications work more effectively. A wet washcloth with a hot water bottle will do, or purchase moist heating pads.

Exercises - Some simple jaw and neck exercises may be recommended to help the muscles stretch. A good time to do some of these is in the warm, moist environment of the shower or bath, particularly in the morning and/or before bedtime.

Physical Therapy - Physical therapy can help relax the muscles and increase joint flexibility. We can teach you some simple stretching therapies during your office consultation. If necessary, you will be referred to a physical therapist.

Stress Management - Stressed-out muscles that are contracted and cramped lead to pain. Emotion and stress can cause your muscles to become stressed-out. Any stress reliever that works for you is helpful. Reading, exercising, listening to music, going for a walk are all ways people reduce the stress in their lives. You may want to consider counseling to learn stress management. The point is, it is almost impossible to get relief from TMJ if your underlying emotional issues are not addressed. If you can't do it yourself, don't be afraid to ask for help.

Anterior Deprogrammer - A less well known treatment method is an anterior deprogrammer. This device contacts the four lower incisors when you close your mouth, and reduces resistance when the lower jaw moves back and forth, reducing muscle contraction intensity and helping teeth the become properly aligned. An anterior deprogrammer is meant for short term use and emergency situations.

Medication - Pain medication may be prescribed. Often, over the counter analgesics such as ibuprofen are enough. These medications relieve pain and reduce inflammation during the healing process. Occasionally a mild muscle relaxant may be prescribed.

The most effective drugs for TMJ management include:


1. Non-narcotic analgesic drugs such as acetaminophen (Tylenol).


2. Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, Trilisate, ibuprofen, Naproxen and prescription strength NSAIDS.


3. Muscle relaxant drugs such as Carisoprodol (Soma) and Cyclobenzaprine (Flexeril).


4. Tricyclic anti-depressant medications such as Amitriptyline (Elavil), Nortriptyline (Pamelor), and Doxepin (Sinequan).

Referral - In some cases, a speCialist may be needed from physicians, oral surgeons, orthodontists, psychotherapists, physical therapists, or prosthodontists. Very severe cases may be referred from the start to a pain center or a dentist whose main focus is the treatment of temporomandibular disorders.

Dr. Michael Iott has the education, training and experience to diagnose and treat the cause of your chronic headaches and pain. Why not schedule a consultation and allow Dr. Iott to offer you the very best options to relieve your symptoms? Click here to contact Dr. Iott's office now.

What can you do to help yourself at home?

- Limit your jaw opening (yawning, etc.) to no more than 2 finger widths.


- Rest your jaw by avoiding heavy chewing (e.g. gum, bagels, tough meats).


- Avoid grinding and clenching your teeth by keeping the teeth slightly apart and the jaw relaxed.


- Avoid leaning or sleeping on the jaw.


- Avoid tongue thrusting and chewing fingernails or non-food objects.


- Avoid playing wind, brass and string instruments that stress, retrude or strain the jaw.


- Use cold/ice packs or moist heat compresses as directed by your doctor or therapist.


- Use over-the-counter medications such as aspirin, ibuprofen, Naproxen, Tylenol or Percogesic, as directed by your doctor or therapist.

If you are experiencing chronic headaches, pain in your face, neck, shoulders and upper back, or any of the other symptoms described here, call our office to schedule a private consultation.

Depression Medication

Depression can affect any one of us at any time of our lives and is more than just feeling a bit fed up or down in the dumps. When you cannot just snap out of it and the symptoms of depression persist for more than a couple of weeks, and interfere with your ability to carry out your normal routines on a daily basis, then your health care provider or GP may prescribe some form of medication to help you combat the depression.

There are many different types of anti-depressants available and the earlier ones include Tricyclic antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs). Newer types include Selective Serotonin Reuptake Inhibitors (SSRIs) and others, which may not fall into one specific category but which all work by impacting on the chemicals in the brain that are responsible for our mood and how we feel.

The following list represents the most commonly prescribed drugs for depression, their brand names and the name of the pharmaceutical company producing them (in brackets), as well as a brief description of how the different types are believed to work.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants are so called because of their molecular structure in that they contain three rings of atoms. Although no one understands exactly how they work, it is thought that the beneficial effects are due to their ability to balance the natural neurotransmitter chemicals in the brain. The most common side effects are dry mouth and drowsiness and possibly blurred vision, sweating, and a slight hesitancy when passing urine. The following list represents some of the most commonly prescribed Tricyclic antidepressants:

- Doxepin - Brand names: Adapin (Lotus Biochemical Corporation) and Sinequan (Pfizer Inc)


- Clomipramine - Brand names: Anafranil (Geneva Pharmaceuticals)


- Nortriptylene - Brand Names: Aventyl (Eli & Lilly) and Pamelor (Novartis Pharmaceuticals)


- Imipramine - Brand Names: Tofranil (Novartis Pharmaceuticals)


- Protriptyline - Brand Names: Vivactil (Merck & Co)


- Trimipramine - Brand Names: Surmontil (Wyeth-Ayerst Pharmaceuticals)

Monoamine Oxidase Inhibitors (MAOIs)

This type of medication works by inhibiting the activity of the enzyme monoamine oxidase, which in turn increases the levels of the neurotransmitters serotonin and norepinephrine. They are not prescribed as often as they used to be as the newer type of medication known as SSRIs have become more popular. MAOIs would usually be prescribed when other medications have proved ineffective. MAOIs can interact with foods containing tyramine and raise blood pressure; they can also interact unfavourably with many other drugs and over the counter preparations. Some MAOIs include:

- Isocarboxazid - Brand Name: Marplan (Oxford Pharmaceutical Services)


- Phenelzine - Brand Name: Nardil (Pfizer Inc)


- Tranylcypromine - Brand Name: Parnate (Glaxo Smith Kline)

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs work by selectively inhibiting the reuptake of the neurotransmitter serotonin in the brain so that levels of serotonin are increased. They are generally considered safer than other types. Side effects include nausea, anxiety, sleep disturbances and sexual dysfunction. They can also interact with other drugs. Some of the more commonly prescribed SSRIs include:

- Citalopram - Brand Name: Celexa (Forest Pharmaceuticals)


- Escitalopram - Brand Name: Lexapro (Forest Pharmaceuticals)


- Fluoextine - Brand Name: Prozac (Eli & Lilly)


- FLuvoxamine - Brand Name: Luvox (Solvay Pharmaceuticals)


- Paroxetine - Brand Name: Paxil (Glaxo Smith Kline)


- Setraline - Brand Name: Zoloft (Pfizer Inc)

Some other types of medication

There are other types of medication available for depression which are not included in the previous categories but which all work in various ways to alter the balance of chemicals in the brain to alleviate depression. For example:

- Bupropion - works by inhibiting the reuptake of both norepinephrine and dopamine. Often used to treat the type of depression known as Seasonal Affective Disorder (SAD), as well as ADHD and as part of a stopping smoking programme. Brand Name: Wellbutrin (Glaxo Smith Kline)

- Duloxetine - works by inhibiting the reuptake of both serotonin and noradrenaline (SNRI). Brand Name: Cymbalta (Eli & Lilly)

- Venlafaxine - Also an SNRI. Brand Name: Effexor (Wyeth-Ayerst Pharmaceuticals)

- Maprotiline - Known as a tetracyclic antidepressant because its molecular structure consists of 4 rings in a T shape. Brand Names: Ludiomil (Novartis Pharmaceuticals)

Which type medication is most suitable?

The type of medication prescribed by your GP will depend on many factors including the kind of depression diagnosed, the severity of the symptoms, other medication that you may be taking and of course the potential risk of any side effects.

It is not possible to predict with any degree of accuracy which one will be most effective and it can take a number of weeks for any effects to be noticed. If after six weeks or so there is no improvement, then another medication may be prescribed until you find the most appropriate one for you.

Regardless of the type of depression diagnosed, the right medication can alleviate the symptoms of depression and help you get back to your old self again.

Depression is a serious condition that can strike anyone at anytime. For more information about depression and self help come and visit =>Fighting Depression.

All You Need To Know About Antidepressants

Many people often have misunderstandings about what antidepressants are capable of.

First of all, they are not pick me up pills; they don't artificially bring on a feeling of happiness, euphoria, or unrealistic well-being. Nor do antidepressants insulate you from life, make you not care about vital things, or make you oblivious to sorrow or loss.

What antidepressants do is avert depressed persons from sliding into the blackest depths of depression when something awful happens. They can still feel wounded, pain, and apprehension, but they feel these the way people normally do when they don't have depression. They also can help depressives sleep soundly, increase their energy, and improve their ability to concentrate.

The way antidepressants work is interesting. There are two chemicals, serotonin and norepinephrine, that have to do with the transmission of impulses between nerve cells in the brain and seem to be allied with depression. It would appear as if depressed people use up these chemicals at an accelerated rate than other people. Antidepressants help to retain these chemicals, apparently leading to feelings of reduced anxiety, more security, increased self-worth, assertiveness, and resilience.

There are a mixture of types of antidepressants, but they fall into a number of straightfoward categories. These are tricyclics, MAOIs, and lithium, and the newer medications: hetereocyclics and Prozac and Prozac-related drugs.

Until rather recently, tricyclics were the normal treatment for depression. These medications include imipramine (Tofranil), amitriptiline (Elacil), Vivactil, Norpramin, Pamelor, and Sinequan. Still in conventional use today, 40 to 70 percent of depressed patients improve substantially with tricyclics.

Although they are quite efficient medications, there are some negatives to their use. They generally take several weeks of constant administration to be successful, which is difficult to handle when people are sincerely distressed. Also, it is relatively easy to take a disastrous overdose. In general, tricyclics should only be used on a short-term basis. They are not addictive, but they must be used with care, especially with people who have cardiovascular disease.

Monoamine oxidase inhibitors (ie. MAOIs) include Marplan, Parnate, and Nardil. They are a different class of drugs and cause a different reaction in the brain. These drugs are helpful from some people who do not respond to tricyclics. These drugs can have disagreeable side effects, but the main disadvantage of MAOIs is that they can also cause a stroke if certain foods containing the compound tyramine (cheese, red wine, pickles) are consumed while they are being used.

Lithium is generally the treatment of choice for bipolar disorder (the cycle of manic highs with depressed lows). In the correct dose, lithium reduces by about 50 percent the chances of another manic episode within a year. Mood swings become fewer, shorter, and less harsh. The success rate for lithium treatment is 70 percent, and 20 percent of people become symptom-free. It is generally seen as a maintenance drug. Once the patient is on Lithium, they are on it for life.

One of the most well-known drugs on the market today is Prozac. It has been followed into the marketplace by many other new antidepressant medications like Zoloft and Paxil, two near cousins, Effexor and Serzone, and some more distant cousins, notably Wellbutrin, Desyrel, and Buspar.

Unlike tricyclics, which affect the levels of both serotonin and norepinephrine in the brain, Prozac, Zoloft, and Paxil affect only serotonin. Hence they are known as selective serotonin reuptake inhibitors, or SSRIs, meaning that they prevent or slow down the reabsorption of serotonin. Effexor and Serzone affect both serotonin and norepinephrine, and the others have more complex effects. All, however, have been shown to be effective in the treatment of depression. The choice of which of these medications to use for a particular person has to do with their dosage and side-effect profile. Paxil, for example, seems to have a soothing effect on anxiety that Prozac lacks. Effexor has the reputation of being more energizing than Prozac.

Compared with tricyclics, the side effects of Prozac and its cousins are usually small. Tricyclics can give you dry mouth, make you constipated, and actually slow you down, whereas Prozac has none of these problems and gives you a little more energy. However, there are some side effects with the newer antidepressants which should be mentioned. Most notable among these is a reduction of interest in sex and complications maintaining an erection. Although the male performance problems usually go away after a few weeks, many people on SSRIs report a continued diminished interest in sex, which can certainly add to marital problems.

For more info on antidepressants visit All you need to know about Antidepressants