Biomedical subjects
Mark H Friedman
Publications and source records attributed to Mark H Friedman.
Local inflammation as a mediator of migraine and tension-type headache.
OBJECTIVE: To demonstrate the relationship of migraine and tension-type headache to a localized maxillary gingival inflammation. BACKGROUND: Intraoral tenderness has been observed consistently in the most common types of primary headache disorders. The laterality and degree of tenderness is related to laterality and severity of reported symptoms, both during headache and in the interictal state. METHODS: Bilateral posterior maxillary palpation and local temperature recordings were performed during unilateral migraine and tension-type headache. Local anti-inflammatory techniques, ie, local chilling and a topical anti-inflammatory gel, were used in these tender areas in episodic migraine and tension-type headache patients. RESULTS: Ipsilateral intraoral tenderness and increased local temperature were consistently observed during unilateral migraine and tension-type headache, suggesting local inflammation. Intraoral chilling and topical application of a nonsteroidal anti-inflammatory drug were highly effective for the treatment of migraine and tension-type headache, both in the acute phase and for headache prevention. CONCLUSION: These results suggest that a local intraoral inflammation may be associated with the pathogenesis of these common headaches.
Intraoral topical nonsteroidal antiinflammatory drug application for headache prevention.
Recent evidence suggests an association between migraine and tension-type headache and local inflammation occurring in a maxillary nerve segment. This study was designed to evaluate the efficacy of topical ketoprofen for the prevention of migraine, tension-type, and posttraumatic headache. Patients with a headache frequency of at least once a week recorded the frequency, severity, duration, and type of headache for 60 days. After 30 days, patients applied the medication daily for the next 30 days to the periapical area of the maxillary molars on the symptomatic side(s). Headache medications and analgesics were permitted, as needed. Headache burden was defined as the average intensity of each headache (0-10 scale) multiplied by its duration, in hours. The average monthly headache burden score for the 20 patients enrolled in this study decreased from 454.8 (30-day baseline) to 86.5 P < 0.001 during the 30-day treatment phase. Analgesic and headache medication intake were significantly reduced from baseline during the treatment phase, and side effects were minimal.
Migraine, tension-type headache and facial pain. A common intraoral etiology and treatment.
A maxillary alveolar mucosal inflammation, demonstrated by local tenderness and increased temperature, is present in migraine, tension-type headache and facial pain patients even when the patient is asymptomatic. Research is presented showing effective treatment of these conditions with fewer side effects than with standard medication by local anti-inflammatory methods. These alternative methods include: chilling, application of anti-inflammatory gel and low-level (non-cutting) laser. Local treatment also mediates cervical muscle spasm, adding to its overall effectiveness.