Letter to the Editor
Craniomandibular Neurovascular Dysfunction Syndrome and Headache
Article first published online: 8 JAN 2014
© 2013 American Headache Society.
Headache: The Journal of Head and Face Pain
Volume 54, Issue 1, page 172, January 2014
How to Cite
Ruud, J. O. (2014), Craniomandibular Neurovascular Dysfunction Syndrome and Headache. Headache: The Journal of Head and Face Pain, 54: 172. doi: 10.1111/head.12239
- Issue published online: 8 JAN 2014
- Article first published online: 8 JAN 2014
Headache carries the subtitle, the journal of head and face pain. A chance encounter years ago led to my attendance at a meeting of the American Association for the Study of Headache (AASH), now the American Headache Society (AHS). Dentists were invited to join. The reason was to gain a broader knowledge base that could be applied clinically in dental practice where many patients with symptoms involving the face, and especially the temporomandibular joint, were seen. These patients often complained of muscular and vascular issues that could not logically, nor physiologically, be attributed simply to jaw joint pathology. Their initial complaint was often ipsilateral maxillary sinus region discomfort.
Thus began a lifelong search for answers to these patients' needs. Exposure to the work of Drs. Harry Sicher, Walter Penfield, and others provided foundation, as did Gray's Anatomy and other texts. The faculty at AASH meetings questioned the validity of some dental presentations and admonished us to go home to settle our dental arguments. Embarrassing? Yes. Yet, the gentle touch of Drs. Seymour Solomon and Keith Campbell provided encouragement of my easily intimidated curiosity and quest for answers, as I wandered, like a lost infantryman, in no man's land! Neurology is a complicated science … like a treasure hunt, even with just one astrocyte to explore … but there are trillions!! Good news, the mind is a wonderful thing to boggle!
Focus now on the temporomandibular joint symptom complex. My background includes dental education, personally experiencing temporomandibular dysfunction (TMD) syndrome, and a privileged exposure to many patients' problems, both mental and physical. Continuing education, looking for answers, has been professionally and personally fulfilling. From this collective experience and knowledge, a treatment protocol evolved that is scientifically credible and has been clinically proven to be extremely successful. The anatomic and neurological connections of the teeth must be considered. Now, being able to give patients an understandable rationale for their symptom complex contributes greatly to their healing. This had to involve basically ignoring the very jaw joint symptoms that were causing discomfort and psychological distress for the patient in the first place.
The acronyms TMJ (temporomandibular joint dysfunction), CMD (craniomandibular dysfunction), TMD, etc, did not accurately represent the anatomical, physiological, and psychological components of this perplexing symptom/sign complex. Craniomandibular neurovascular dysfunction syndrome (CMNVD) is more inclusive. The jaw joint symptom site, other signs and symptoms, as well as psychological factors such as the stress of daily living can fit within this syndrome. Dr. Allan Purdy's definition of a syndrome is “a disease process with emphasis on the word process.” This is perfectly apropos while trying to understand the pathogenesis of CMNVD.
A review of patient files, a visit with a statistician, and the expression of collected data as bar graphs led to interesting and startling conclusions. Although a crude clinical study, its revelations supported the thesis that a broader, yet definitive approach should be employed in the treatment of CMNVD (TMD). The implications of associated neurovascular pathology are very important to both medicine and dentistry, especially in regard to headache issues.
New, carefully documented studies are now needed to confirm or deny the validity of this work. The importance to medicine, dentistry, and patient welfare is undeniable. Validation will mandate a renewal of cooperation between all health professionals and the recognition of the skill levels required to diagnose, treat, and communicate to patients the generally innocuous nature of CMNVD and its good prognosis. Reducing treatment time from years to weeks is a giant step forward. Any contribution to headache science will be an added benefit.
This thesis is submitted as a challenge to all health professionals to review their personal belief systems regarding TMD. More research needs to be done in the field of dental and facial pain. They must be prepared for a major paradigm shift, if it proves to be scientifically grounded. That is their obligation as students, confidants, and purveyors of knowledge to the human family, to whom we have pledged our oath of service.