December 2016: Chronic Daily Headaches (CDH)
Happy Holidays all! I can barely get over the fact that Summer is over, let alone that Thanksgiving has already come and gone and that Christmas and Haunukkah are just a few weeks away. It seems like the office may even be in the end-of-year rush already, so if you or a loved one need an exam in 2016, stop reading this and give us a call, and then continue reading. And of course if you have flex money to spend before the end of the year, we are always happy to help you with that as well. 

I'm very excited to present this month's newsletter because I believe that the technology that we will soon have at our fingertips will drastically improve the quality of life for many of our patients. I'm also a bit hesitant to introduce this technology at this time because we may not have it in the office for 3-4 months, but I promised something exciting in the last newsletter so here it goes. The technology is called SightSync and it's from a company called EyeBrain Medical. It's a new approach to chronic headache treatment and the results so far have been extremely encouraging. So if you or someone you know suffers from chronic headaches or migraines, and has already tried multiple treatments with little or no improvement in symptoms, then you'll want to read the article that follows. It gets pretty technical so if you have no interest in the topic, I suppose you can skip the main article this time. But if chronic headaches affect you or a loved one, it should hold your interest. If you do skip the article though, take a glance at the end of the newsletter for holiday hours and other reminders.

Thank you as always for your time, kindness, and for choosing our practice to provide eye care to your families. We appreciate you all so much, and again, Happy Holidays from our family to yours! 

 
Sincerely,

Charles Bittel III, O.D.
Charles Bittel, O.D.
Joo Chi, O.D.
Chronic Daily Headaches (CDH)        

Headaches are miserable. Some are lucky enough to only experience them once in a blue moon, while others are chronically plagued by debilitating headaches. They can keep adults from going to work or taking care of their kids, and they can force kids to miss large amounts of school while they hole up in their room away from friends and family. And perhaps one of the most frustrating elements of headaches is that there is often not a definitive cause, and therefore not a definitive way to prevent or treat them. 

Individuals that experience headaches on a daily or almost daily basis, who have been unresponsive to one or more treatment options, are said to suffer from Refractory Chronic Daily Headaches (CDH). It is widely believed that migraine headaches originate in the brainstem through an interaction with the trigeminal nerve, the major pathway to the head and scalp. New research is exploring the link between over-stimulation of the trigeminal nerve and CDH. More specifically, it is thought that a misalignment in the central nervous system results in poor synchronization of the peripheral and central visual tracking systems, thereby over-stimulating the trigeminal nerve and causing CDH. Basically, some people inherently have a misalignment of their eye muscles. Therefore the eye muscles have to work extra hard throughout the day to keep the eyes in alignment. This over-stimulates the trigeminal nerves that reside in the eye muscles, ultimately causing CDH. The proposed treatment, therefore, is spectacle lenses (glasses) with prismatic correction to help the eye muscles align, reduce over-stimulation of the trigeminal nerve, and alleviate symptoms of CDH.  

Here are a few diagrams of the trigeminal nerve pathway to help visualize how a nerve around the eyes can translate into more than just pain around the eyes. Sufferers of CDH not only report symptoms of headaches and migraines, but of stiff necks and chronic dry eye as well. These first 2 diagrams show how the ophthalmic branch (V1) of the trigeminal nerve surrounds the eyes:



And this third diagram represents the path of the trigeminal nerve all the way to the brainstem:


The study was conducted from Sept. 2012 to June 2013. Candidates for the study suffered from daily or almost daily headaches and were resistant to traditional therapeutic modalities. Subjects were first evaluated with SightSync, a device designed to measure binocular misalignment. The deviation of central and peripheral misalignment is measured, and measurements taken from SightSync were used to determine candidacy for the study. Candidates enrolled in the study were made glasses with variable prisms to reduce over-stimulation of the trigeminal nerve. The ability to manufacture glasses with variable prism (prism that changes in its amount from distance to near) is a unique proprietary technique that in conjunction with SightSync will ideally help those with CDH. 

186 patients with severe headaches for which other treatment methods were ineffective were enrolled in the study. Patients received a pair of variable prism spectacles based on their SightSync measurements. 7 patients were lost to follow-up. 146 of the remaining 179 patients (81.6%) had a positive response to treatment. Furthermore, 69.66% of patients reported that they reduced their medication usage since wearing the variable prism glasses. 

Since the 2013 study, there have been a handful of early commercial investigators that have been using SightSync in practice. Of those wearing neuroLens technology (the variable prism glasses), 60% reported the headaches had decreased substantially, 19% said they decreased slightly, and 14% said they were basically gone. So only 7% of the early phase commercial patients reported no change in symptoms. For a treatment to have a positive impact on 93% of its wearers says a lot, especially when dealing with patients that have likely already tried multiple treatments for their headache symptoms. 

So needless to say that we were very excited to be selected as a sight for the next wave of commercial investigation of SightSync and neuroLens technology. This means we will have a SightSync machine in the office that will allow us to screen for headaches and related symptoms that may stem from binocular misalignment. For those that are symptomatic and test positive on the SightSync, we will have access to the lab in South Dakota that is producing the neuroLenses. We should have the SightSync by March or April 2017. As for now, we are compiling a list of patients that potentially have CDH that we will call as soon as we have SightSync up and running in the office. So if you or a loved one or friend or co-worker suffers from chronic headaches for which there has been no adequate or acceptable cure, email Dr. Bittel at bittelod@gmail.com and he will answer any questions you may have and put you or your loved one on the SightSync list if appropriate.
Holiday Hours, Insurance, and Flex Dollars

Holiday hours as of now will be as follows:

The office will be closed Dec. 24-26
We will be open 8-12 on Saturday Dec. 31 and 8-5 on Jan 2. 

* Please keep in mind the last week of the year is traditionally very busy. We have extra doctor hours to try and accommodate everyone that needs an exam before the end of the year. We appreciate your patience if we are busy in the office and take longer than normal to help you out. If you know you'll need an exam or have insurance to use before Dec. 31, we encourage you to call or come in as soon as possible. 

Insurance: Keep in mind many plans end on Dec. 31 and start over Jan. 1. So if you have not used a materials benefit in 2016, feel free to give us a call to see if you're eligible for anything before the end of the year. Even if you're not eligible for a frame, you may have a lens benefit available to update an older pair of glasses.

Flex Dollars: Remember to use your flex dollars if they expire on Dec. 31! Perhaps a new pair of our beautiful new Balenciaga frames is on your holiday wish list.

 



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