Head and Neck Pain: Hand Tremor with Dental Medicine Implications

Practical Pain Management. Vol.9, No.7 September 2009

by Edwin A. Ernest, III, DMD

This article has a distinctly personal application for me. In May of this year, I experienced elective neurosurgery for a movement disorder defined as Essential Tremor. The disorder of hand tremors in my case was bilateral in nature with the onset of symptoms occurring around age 60. It is believed that approximately 50% of essential tremor patients suffer a genetic-linked cause.

And, in my case the condition was progressively resistant to medication management. A neurologic exam and work-up confirmed the suspected diagnosis. Surgical implantation of electrodes in the brain and a battery controller in the chest has stopped the tremors completely, and has enabled me to resume normal activities of my profession and personal life. An additional test I received before surgery was evaluation for trigeminal nerve involvement as a source of causation. For me the test was negative. Why was the test done? Because there is more to the movement disorder story than meets the eye.

Many of us know that certain medications and mandibular vertical dimension problems can cause symptoms of oro-facial dyskinesia, a movement disorder of the mandible and often the tongue. It is a debilitating condition. What is not generally known is that the impact of altered mandibular vertical dimension can also cause even more complex whole-body effects. Brendan C. Stack, DDS, MS, of Vienna Virginia,1 has done much of the research on trigeminal nerve-related hand and body tremors and his successful work includes treatment of Tourrette’s syndrome as well. I could wish that my case of tremors was trigeminal nerve in origin since the treatment would be non-surgical, but I have learned a lot about centrally-mediated hand tremors and, because of that knowledge—together with Dr Stack’s research—I am able to describe for you the following case of right hand tremor of cervical and trigeminal origin.

Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain

Practical Pain Management. Vol.9, No.1 Jan/Feb 2009
by Leonard B. Goldstein, DDS, PhD and Howard W. Makofsky, PT, DHSc, OCS

Nearly fifty percent (50%) of the population is affected by cervical spine pain and/or headaches during their lives.1 Headache is not only one of the most common human ailments,2 but also accounts for the expenditures of billions of health care dollars annually and is a leading cause of lost time from work.3

Cervical dysfunction may be seen in up to seventy percent (70%) of the population suffering from any type of headache.4 This suggests that the cervical spine may be either a causative or contributing factor in the pathogenesis of many headaches.5

The pilot study by Placzek, Pagett, et al. demonstrated and supported the theory that headache may be influenced by cervical muscle strength, and that weakness of the cervical spine musculature may lead to abnormal stress on the upper cervical facets which are related to head and neck pain. It is further speculated that stability, and thus normal function and biomechanics, is dependent on a balance of anterior and posterior cervical muscle balance. Despite advances, the pathogenesis of tension-type headache is not clearly understood. However, cervical musculoskeletal abnormalities have been linked to multiple headache types.6-8

In the study published by Fernandez-De-Las-Penas, Perez-De-Heredia, Molero-Sanchez, and Miangolarra-Page,9 the authors presented results similar to those previously reported:

impairment in deep neck flexor muscles in individuals with cervicogenic headaches, and
deficits in the performance of the cranio-cervical flexion test (ie., reduced endurance or holding capacity of the deep neck flexor muscles).
Please refer to the Jan/Feb 2009 issue for the complete text.