Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial

Abstract

Aims: To investigate the effects of adding orofacial treatment to cervical physical therapy in patients with chronic migraine and temporomandibular disorders (TMD). Methods: A total of 45 participants with chronic migraine and TMD aged 18 to 65 years were randomized into two groups: a cervical group (CG) and a cervical and orofacial group (COG). Both groups continued their medication regimens for migraine treatment and received physical therapy. The CG received physical therapy only in the cervical region, and the COG received physical therapy in both the cervical and orofacial regions. Both groups received six sessions of treatment that consisted of manual therapy and therapeutic exercise in the cervical region or the cervical and orofacial regions. Scores on the Craniofacial Pain and Disability Inventory (CF-PDI) and the Headache Impact Test (HIT-6) were primary outcome variables, and the secondary outcome variables were scores on the Tampa Scale for Kinesiophobia (TSK-11), pain intensity measured on a visual analog scale (VAS), pressure pain thresholds (PPTs) in the temporal, masseter (2 points, M1 and M2) and extratrigeminal (wrist) regions, and maximal mouth opening (MMO). Data were recorded at baseline, posttreatment, and after 12 weeks of followup. The α level was set at .05 for all tests and two-way repeated-measures analysis of variance (ANOVA) for within-and between-group interactions. Results: There were 22 CG participants (13.6% men and 86.4% women) and 23 COG participants (13% men and 87% women). The ANOVA analysis revealed statistically significant differences for group × time interaction in CF-PDI, HIT-6 in the last follow-up, pain intensity, PPTs in the trigeminal region, and MMO (P < .05), with a medium-large magnitude of effect. No statistically significant differences were found in the PPTs of the extratrigeminal region or in the TSK-11 (P > .05). Conclusion: Both groups reported a significant improvement in CF-PDI, HIT-6, and pain intensity. Cervical and orofacial treatment was more effective than cervical treatment alone for increasing PPTs in the trigeminal region and producing pain-free MMO. Physical therapy alone was not effective for increasing the PPTs in the extratrigeminal region (wrist) or decreasing the level of TSK-11.

Efficacy of Manual Therapy in Temporomandibular Joint Disorders and Its Medium-and Long-Term Effects on Pain and Maximum Mouth Opening: A Systematic Review and Meta-Analysis

“…The average subject age was 41.5 years. The studied pathologies included mouth opening pain [ 18 , 19 , 21 , 22 ], mouth opening limitation [ 19 , 20 , 22 ], myofascial symptoms [ 14 , 18 , 19 ], non-reducing disc displacement [ 19 , 20 ] and chronic migraine [ 14 ].…”

“…The treatment of TMD is usually addressed with several therapies, including splints, psychotherapy [ 10 , 11 ], acupuncture [ 12 ], and various physiotherapy techniques such as transcutaneous electrical nerve stimulation (TENS), lasers, massage therapy [ 13 ], joint mobilization and therapeutic exercise (TE) [ 14 ].…”

“…Numerous studies have researched the effectiveness of TE in different subacute and chronic musculoskeletal pathologies [ 12 , 13 , 14 , 15 ], and TE is often recommended for TMD in conjunction with manual therapy (MT) [ 9 , 16 ]. Although the effectiveness of these therapies has been studied in the short and mediumterm, returning diverse results [ 16 , 17 ], no systematic reviews have analyzed the medium- and long-term effects of MT and TE for TMD.…”

Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women withTMD. A randomised, controlled trial

“…Furthermore, a recent study showed that cervical and orofacial treatment was more effective than cervical treatment alone to increase PPTs in the trigeminal area of patients with TMD and migraine. Thus, treating solely the neck, as we did on the present study, is probably not enough to enhance sensibility of the masticatory muscles, but associating techniques on the stomatognathic system and on the neck would be more effective.…”

“…In accordance with these results, previous studies have shown that isolated upper cervical manual techniques, including SNAG mobilisation and suboccipital muscle inhibition, caused significant reduction in headache severity compared to a placebo group when applied to subjects with cervicogenic and tension‐type headaches. The application of manual therapy techniques to the cervical spine in combination with exercise has been shown to be effective in reducing pain in patients with tension‐type headaches, with cervicogenic headache, with migraine, but, to the best of our knowledge, remains unknown for secondary headache attributed to TMD.…”