Are Headache and Temporomandibular Disorders Related? A Blinded Study

Abstract

To investigate overlaps between headache and temporomandibular disorders (TMD) in a clinical headache population and to describe the prevalence of TMD in headache patients, 99 patients referred to a specialized headache centre were diagnosed according to Research Diagnostic Criteria for TMD (RDC/TMD) and classified in headache groups according to the International Classification of Headache Disorders, second edition for headache diagnoses in a blinded design. The prevalence of TMD in the headache population was 56.1%. Psychosocial dysfunction caused by TMD pain was observed in 40.4%. No significant differences in TMD prevalence were revealed between headache groups, although TMD prevalence tended to be higher in patients with combined migraine and tension-type headache. Moderate to severe depression was experienced by 54.5% of patients. Patients with coexistent TMD had a significantly higher prevalence of depression-most markedly in patients with combined migraine and tension-type headache. Our studies indicate that a high proportion of headache patients have significant disability because of ongoing chronic TMD pain. The trend to a higher prevalence of TMD in patients with combined migraine and tension-type headache suggests that this could be a risk factor for TMD development. A need for screening procedures and treatment strategies concerning depression in headache patients with coexistent TMD is underlined by the overrepresentation of depression in this group. Our findings emphasize the importance of examination of the masticatory system in headache sufferers and underline the necessity of a multidimensional approach in chronic headache patients.

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

“…Menstrual migraine is well known to be more severe and refractory to treatment than non-menstrual migraine 10,24 , and a limitation of our study was not to characterize this migraine subgroup, since this would require longitudinal follow-up and use of dairies. We found strong association between migraine and TMD pain, as previously described 10,[12][13][14][15][16][17][18][19][20] . Gonçalves et al, in a population-based study, found that TMD symptoms are more likely to occur among those who present any headache type.…”

“…Gonçalves et al, in a population-based study, found that TMD symptoms are more likely to occur among those who present any headache type. When three or more TMD symptoms were present, headache occurred in 72.8% versus 37.9% of those who did not present any TMD symptoms 13 , as confirmed by others 15 . Furthermore, when assessing a clinic-based sample, they found that the comorbidity of TMD with migraine, CDH, and TTH, happened only for the muscular form, and not for the articular type 18 .…”

“…Furthermore, when assessing a clinic-based sample, they found that the comorbidity of TMD with migraine, CDH, and TTH, happened only for the muscular form, and not for the articular type 18 . They also found that severity of TMD correlated with increased headache frequency 15,18 . Our data strongly support their findings and this is of importance, since BevilaquaGrossi et al reported that TMD with myofascial pain is strongly associated to increased headache frequency 27 .…”

“…Additionally, TMD is a risk factor for increased headache frequency 10,[12][13][14][15][16][17][18][19][20] . Nonetheless, as with many of the identified risk factors for increased migraine frequency, most of the studies diagnosed both migraine and TMD based on self-reported symptoms or on questionnaires.…”

Éditorial

“…C'est aussi une région où il importe de tirer profit de l'expertise des intervenants des domaines dentaire et médical lors de l'investigation des états douloureux qui s'accompagnent d'un cortège de symptômes et de manifestations allant bien au-delà des limites topographiques des structures d'où peut provenir la douleur. Les maux de tête, les cervicalgies, les otalgies et acouphènes dont se plaignent souvent ceux souffrant de désordres temporomandibulaires en sont un bel exemple [1,7]. Et que dire des douleurs orofaciales hétérotopiques, comme celles d'origine cardiaque, susceptibles de mettre la vie du patient en danger [5] ?…”