I don't need to be asked to post here.

Hm. Stephanie asked the "dental types" to reply. How does "dental
types" include you but not Jan? Am I unaware of some degrees you've
earned since getting better from the AGELK? In fact, if you're really
all better, why ARE you back in this newsgroup if it's not for dental
groupies? If you're not here to learn or get better, you must also be a
groupie. Last I heard, you sho warn't no dentist.

While the Standard NTI-tss device can be worn indefinitely (while sleeping),
the NTI-tss Daytime Device is recommended for the migraine sufferer (in
addition to the use of the Standard Device) for 4 to 8 weeks during waking
hours (but still impossible to use while eating, thereby preventing
supraeruption).  The Daytime Device takes advantage of the naturally
protective nociceptive trigeminal inhibition reflex which suppress the
powerful temporalis muscles. It is the protective reflex experienced when
biting down, expecting something soft, but encountering something hard.

Migraine and tension-type headaches are both medically diagnosed benign
conditions.  These conditions are confirmed to be benign only after thorough
medical tests have confirmed that there are no disease processes that are
the cause of the patient's pain.   An NTI-tss device should only be used for
migraine and/or tension-type headache reduction after the condition has been
medically diagnosed.

The protocol for delivery of an NTI-tss device for a migraine and/or
tension-type headache sufferer is identical to that for the muscular
parafunction (bruxism/TMD) patient.  However, unlike the bruxism/TMD
patient, where the use of a standard NTI-tss device during sleep alone is
highly effective, the migraine and/or tension-type headache sufferer will
most likely require a "daytime" NTI-tss device as well, for the most stable
and predictable results.

Although there is little, if any, intense pericranial muscular contraction
throughout the day, the presence of an NTI-tss daytime device (for the first
four to six weeks of treatment) is essential.  Stressful situations (that
is, a "trigger" for a migraine sufferer) can occur at any time.  A "trigger"
is really an activation of the patient's sympathetic nervous system. The
intrafusal fibers of spindle organs that reside within the fatigued
pericranial musculature are innervated by the SNS.  Until the musculature
has had adequate time to recover from its chronic intense nocturnal
parafunction (four to six weeks with regular nighttime NTI-tss use), the
intrafusal fibers of those spindles still reside within fatigue,
dysfunctional musculature and may hyper contract, which is highly painful
and may be the source of the migraine pain. (See:  Sympathetically
Maintained Spindular Dysfunction: A Model for the Etiology of Chronic
Tension-type Headache and Migraine.

The presence of a daytime NTI-tss allows the patient to gently "tap" their
lower incisors on the Discluding Element during stressful events, thereby
exploiting the nociceptive trigeminal inhibition (NTI) reflex, which serves
to suppress and relax the pericranial musculature and disrupt the
neuromuscular mechanism leading to the migraine pain.

A daytime NTI-tss is not necessarily the same as the patient's standard
nighttime device.  Since parafunctional excursive and protrusive activity
during the daytime is insignificant, the degree of vertical opening and
anterior extension of the Discluding Element can be reduced for the patient's
comfort (that is, it should NOT act as an irritant to the patient, thereby
becoming a trigger itself!).   A daytime device (above) would ideally
provide minimal posterior disclusion in centric and in slight excursive
movements.  A daytime NTI-tss device will typically provide for an incisal
occlusal stop on the lingual side of maxillary incisors, contacting with the
mandibular central incisors.

In moderate excursive or protrusive  movement, canine or posterior teeth may
contact each other(circled above), allowing for the perpetuation of
temporalis dysfunction (the patient usually has no awareness of the
activity, even in the daytime).  These potential contacts could allow for
intense muscular activity, making the daytime design contraindicated for
nighttime use.  If the patient complains of new symptoms during the day
following daytime use, it is most likely due to their excursive activiities.
If so, incease vertical slightly if tolerated.

A "daytime" NTI-tss is recommended for at least the first four to eight
weeks of treatment for the migraine and/or tension-type headache patient (in
addition to use of a nighttime NTI-tss), to be worn at all times, except for
when eating.  Following that time, daytime use is optional for the patient.
As long as the patient continues to remove the daytime device while eating
(which provides alveolar stimulation, thereby preventing posterior
supra-eruption), there are no adverse dental effects.  As the nocturnal
parafunctional intensity continues to be suppressed night after night, the
abilitiy to "trigger" a migraine during the day decreases.  After 6 to 8
weeks, the daytime NTI-tss is no longer necessary, because the
"pre-existing" condition (which was being prepertuated by nightly activity)
of pericranial spindular dysfunction, no longer exists.

The need for occlusal equilibration may become obvious during this time.
When the patient removes their daytime device, they may become highly aware
of occlusal interferences.  These are SNS irritants as well and should be
equilibrated!  Otherwise, the patient will find themselves always wanting to
wear the daytime device (because their teeth feel awkward).

Although the daytime design may be more pleasing to the patient, it is
important to stress to them that if canine or posterior clenching is
possible in protrusive or excursive movement, it is not to be worn while
sleeping (within a night or two,  the patient will "defeat" it, that is,
seek out and find teeth to clench on in excursive positions, thereby making
their condition  worse!)