BlueCross BlueShield of Tennessee Medical Policy Manual

Intraoral Devices for the Treatment of Headaches

DESCRIPTION

Intraoral devices are proposed as a treatment of headache (e.g., migraine, tension-type). An example of an intraoral device developed for the prophylactic prevention of headache is the Nociceptive Trigeminal Inhibition Tension Suppression System or NTI-tss®. This device fits over the two maxillary central incisors and has a dome-shaped protrusion which extends lingually. The dome is customized by the provider to act as single point contact at the incisal embrasure of the two mandibular central incisors, thereby preventing posterior or canine tooth contact.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Well-designed studies published in peer-reviewed journals are lacking regarding the use of any intraoral device for the treatment of headaches.

SOURCES

Bruno, M.A.D., & Krymchantowski, A.V. (2018). Amitriptyline and intraoral devices for migraine prevention: a randomized comparative trial. Arquivos de neuro-psiquiatria, 76 (4), 213-218. Abstract retrieved October 30, 2018 from PubMed database.

Franco, L., Rompre, P., de Grandmont, P., Abe, S., & Lavigne, G. (2011). A mandibular advancement appliance reduces pain and rhythmic masticatory muscle activity in patients with morning headache. Journal of Orofacial Pain, 25 (3), 240-249. (Level 3 evidence)

Stapelmann, H., & Turp, J. C. (2008). The NTI-tss® device for the therapy of bruxism, temporomandibular disorders, and headache - where do we stand? A qualitative systematic review of the literature. BMC Oral Health, 8 (22). (Level 2 evidence)

U. S. Food and Drug Administration. (2001, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K010876 (NTI-tts®). Retrieved February 6, 2012 from http://www.accessdata.fda.gov. 

ORIGINAL EFFECTIVE DATE:  9/1/2002

MOST RECENT REVIEW DATE:  12/13/2018   

ID_BT

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