you wake up...
...do you feel fabulous?
James P. Boyd, DDS, developer of the NTI Therapeutic procol and the NTI device (AMPSA CS ® outside the United States), the first dental device to be cleared by the FDA for the prevention of medically diagnosed migraine pain, discusses the most important and most over-looked aspect of the diagnosis of chronic headache and migraine pain outside the United States.
Seems like a silly question,
doesn't it? If I had to boil it down to one
concept that has made NTI therapy successful, it's
the acknowledgement that most chronic migraine and
headache sufferers don't (or won't) admit that upon
waking in the morning, having some degree of
discomfort above their shoulders in completely
"normal" for them. Not just headache or even
full blow migraine. It could be the
facial/forehead and back-of-the-neck combination
pain, sore and stiff jaw, or "sinus" headache.
In comparison to the migraine
episodes they experience, their morning headaches
are somehow "manageable", and therefore in their
mind, not worthy of including in their complaints to
their health care provider.
They've seen plenty of doctors
for their headaches. They're asked specific
questions regarding the degree of pain that alters
their normal function like, "When you get your worst
headaches...", and "What makes your headache
worse?", or "How many times per week/month do you
have a migaine?". Rarely, if ever,
is a chronic migraine or headache sufferer asked,
"Exactly when DON'T you have any degree of
headache, even the slightest?".
There are two simple questions to ask in a interview of a headache patient.
Question 1: On a scale of 0-10, with 10 being the worst discomfort above the shoulders that you could imagine (includes neck, jaw, sinus, headache or migraine pain), and 0 being no pain at all, how many mornings per week do you wake with a ZERO, that is, you feel fabulous?
That last part needs to be
emphasized. To anyone else, not having pain
upon waking is normal. Sure, you can still
feel tired, but a lack of pain isn't
remarkable to the normal person. For the
chronic headache and migraine pain sufferer, a
degree of pain IS normal. For them, having no
discomfort at all would be, well, fabulous.
Perhaps unintentionally, the chronic headache and
migraine pain sufferer avoids that acknowledgement.
Most chronic headache sufferers will hesitate with their reply, and then begin to rationalize their their answer before they provide it. They'll begin by stating, "Well, when I get my really bad headaches...", or, "Nobody ever really feels fabulous", or some justification as to why it's "within normal limits" for them to have discomfort upon waking. The practitioner must press on, and confirm how many mornings per week that the patient wakes with ZERO pain.
Experienced practitioners will soon find that being pain free is quite rare for the chronic headache sufferer, especially upon waking. The practitioner can remind the sufferer that waking daily with, say, liver pain, or kidney pain, is certainly not normal, and so it is with chronic headache pain. They can't be helped to the fullest extent if their entire presentation is not understood.
Question 2: On those days that you don't wake with a ZERO (that is, you have "a number"), what's the average "number" that you have?
Now the practitioner will have
a clearer picture of the patient's condition and
likelyhood of the presense of nocturnal jaw
clenching. Waking 5 days per week with a level
4 headache, to some chronic sufferers, is not
worthy of reporting. They have learned
that they must deal with thet discomfort and reserve
their complaints for the degree of migraine pain
alters their daily lives. They are wary of
being labeled "drug overuse" patients, because in
some practitioners minds, constant headache,
especially upon waking, could only be due to
The chronic sufferer figures
that their worst headaches and migraine attacks are
far more important to try and manage than their
chronic "normal discomfort" existence.
Besides, no one has been able to diagnose and
alleviate their normal discomfort, anyway.
However, to the practitioner, this information
is critical in the assessment of the cause and/or
perpetuation of their patient's condition.
This is not to suggest that
chronic nocturnal masticatory parafunction (ie,
intense jaw clenching) is the lone cause of chronic
headache or migraine pain. On the contrary, it
is better considered as being a primary complicating
factor and/or perpetuating influence on chronic
headache and migraine pain. Better stated,
habitual nocturnal jaw clenching cannot, by itself,
cause chronic headache or migraine pain, but chronic
headache and migraine pain cannot be completely
managed in the presense of undiagnosed and
uncontrolled nocturnal jaw clenching. In fact,
without controlling nocturnal jaw clenching,
traditional medical management of chronic headache
and migraine pain typically less that satisfactory
of falis altogether. As Andrew Blumenfeld, MD,
likes to say, "Controlling chronic jaw clenching
doesn't cure migriaine, but it can help reduce the
frequency of migraine attacks...sometimes to zero".
Following the first month of NTI therapy, the practitioner can re-ask the two question above. Although the patient might first proclaim, "I'm still having headaches" (as if no improvement had occurred), the practitioner may discover that the patient is now waking less frequently "with a number" and that the level of that number is reduced.. Continually using the two questions above is a handy tool to follow a patient's progress.-James P. Boyd, DDS, Developer of the NTI therapeutic protocol.
|To find an NTI
provider, go to: www.TheHeadacheRemedy.com
|Dr. Boyd on Good Morning
American, September, 2001:
|AMPSA CS ® is a registered trademark of Therapeutic Solutions International, Inc., a product whose technology has been licensed from Boyd Research. It is the same as the NTI-tss® device and derived from the same patent.|