Taking a bite out of headache pain Posted Aug 4, 2003 5:49 PM By Linda Searing, HealthDay (HealthDay is the new name for HealthScoutNews.) Can a little mouth device with a big name be the answer to chronic headache pain? It depends on whom you ask. The U.S. Food and Drug Administration approved the nociceptive trigeminal inhibition-tension suppression system (NTI-tss) for the prevention of migraine and tension-type headache pain. Dr. Marvin Mansky, a Manhattan dentist, admits he "didn't think it was a great idea" at first. But now, after he's treated some 350 patients with it, and wears one himself occasionally, he's a confirmed believer. "It reduces the frequency and intensity of migraines dramatically," Mansky says. "For some people, it stops the migraines completely." Made of clear plastic, the inch-wide device fits over two front teeth — usually but not always the top teeth, Mansky says. It keeps the back teeth from coming together and thus prevents clenching — which the developer of the device, also a dentist, claims is the root of many headaches. Prolonged, intense clenching, say proponents of the device, profoundly stresses the temporal muscles that open and close the jaw, often triggering migraines and tension headaches. However, Dr. Stephen Silberstein, a neurology professor at Thomas Jefferson University in Philadelphia and president-elect of the American Headache Society, disputes the connection between clenching and headaches. "There's scientific evidence to show that only rarely does clenching ever produce headaches," Silberstein says. "If you have a sore jaw, if you grind your teeth, [the device] will probably help you. But don't expect more than that." "There's no question there's a value to devices," he says. Although unfamiliar with this particular device, Silberstein says it's "logical" that if it stops people from grinding their teeth, it would relieve any pain stemming from teeth grinding. "If you have tennis elbow and you put a brace on it, the problem's going to get better — but it's not going to help your foot," he says, adding that the same idea applies to teeth clenching and migraines. "You have to be very careful with devices and their magic." Still, some people swear by the NTI device. Take the first person Mansky fitted with one — a woman who had such head pain, he says, "she was ready to do anything, even jump off the bridge." Immediately, he says, her pain on a 1-to-10 scale went from 10 to a 2, and within two weeks it was gone. Another woman "now, during the day, loves going places because before [she wore the device] she didn't sleep during the night and always wanted to nap," he says. Quality of life for this woman and others he's fitted with the device has definitely improved, Mansky says. For that, many people seem willing to pay roughly $750 for the tiny tooth protector. Mansky and other dentists around the country can mold and custom-fit the device to someone in their offices in about an hour. Most people wear it while sleeping, although some wear a slightly less obtrusive device during the day as well, Mansky says. Chronic headaches afflict an estimated 45 million Americans, resulting in more than 8 million doctor visits a year, according to the National Institute of Neurological Disorders and Stroke. For relief, sufferers turn to over-the-counter and prescription medicines, dietary controls, exercise, yoga, biofeedback, stress-reduction techniques, whirlpool baths, cold packs and more. "But the only device that works for headache problems," Silberstein says, "is to put an electrode in the brain and stimulate the brain." Otherwise, he says, eliminating caffeine in the diet and stopping any use of analgesics would do as much to halt headaches as would a dental device. "I'm dubious about these things," he says. But, responding to previous criticism of the device, its inventor — California dentist Dr. James P. Boyd — cites a study from Ireland published in 2001 in the medical journal Headache that showed the jaw-clenching muscles in migraine sufferers were nearly 70% larger as well as stronger than those in people without migraines. Boyd believes that points to a clear link between clenching and migraines. And Mansky agrees. "People who clench are the people who tend to get tension-type headaches," he says. "We offer a money-back guarantee [on the device], and we don't get very many back. Most of the time it's really, really successful." His success rate with it for the last 3½ years has been "certainly in the 90th percentile or higher," Mansky says. "It's that effective." More information To learn more about headaches, check with the American Council for Headache Education.