The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have causal relations, or may be associated in the same patient with mutual reinforcements. We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated. The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache. For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemicrania were not modified by polysomnography. The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication. Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction. In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.

Abstract

Headaches occurring during the night or early morning are often related to a sleep disturbance.

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are highly prevalent and may impair several oral function-related aspects. This study aimed at evaluating the impact of the presence and severity of temporomandibular disorder signs and symptoms on oral health-related quality of life. METHODS:Participated in the study 135 dentistry students of the Federal University of Paraiba. The presence of temporomandibular disorder was determined by means of an anamnesis questionnaire and a summarized clinical evaluation protocol. Oral health-related quality of life was determined by the summarized Oral Health Impact Profile version translated and validated for the Portuguese language. Statistical comparisons between Oral Health Impact Profile-14 means related to the presence of temporomandibular disorder signs and symptoms were achieved with Mann-Whitney and Kruskal-Wallis tests. RESULTS: Volunteers with temporomandibular disorder (p<0.001), needing treatment (p<0.001) and higher severity (p<0.001) had higher impact on oral health-related quality of life. Volunteers with clinical temporomandibular disorder signs had further quality of life impairment, being that individuals with simultaneous muscle and joint temporomandibular disorders (p=0.034) had higher Oral Health Impact Profile-14 scores. Most impaired domains were physical pain (p=0.045), functional limitation (p=0.007) and psychological discomfort (p=0.045). Influence of temporomandibular disorder presence and severity on oral health-related quality of life* Influência da presença e gravidade da disfunção temporomandibular na qualidade de vida relacionada com a saúde oral

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