Evaluation of OnabotulinumtoxinA Treatment in Patients with Concomitant Chronic Migraine and Temporomandibular Disorders

Abstract

Introduction: Migraine and temporomandibular disorders (TMD) are both common diseases and TMD are reported as a risk factor in migraine progression. OnabotulinumtoxinA is used in the treatment of chronic migraine (CM), and also has a potential role in TMD treatment. In this study, it is aimed to compare the efficacy of onabotulinumtoxinA treatment in CM patients with and without TMD. Methods: In this retrospective study, 30 CM patients (age range: 18-65 years), satisfying the inclusion and follow-up criteria in their medical records were investigated. The PREEMPT injection protocol was taken as reference and onabotulinumtoxinA 155-195 U with fixed-dose has been administered into 31 specific sites within the head/neck muscles in included subjects. Two cycles of treatment were assessed in all patients at the baseline and 12 weeks later. The headache diaries, which were completed routinely one month before, and during 6 months followup after the treatment, were assessed. The effect of onabotulinumtoxinA treatment was compared between CM patients with and without TMD/ bruxism. Results: Of 30 female patients, 17 had concomitant TMD. In week 24, there were significant improvement in the groups with and without TMD regarding to the mean change of frequencies in the days with migraine compared to the initial findings (p<0.001). However, there was no significant difference between the two groups. Conclusions: OnabotulinumtoxinA is an effective and safe treatment for CM. Its efficacy appears to be similar in CM patients with and without TM, speculating that the comorbidity of TMD did not play a role for the treatment response.

Toxina botulínica no tratamento de pacientes com disfunção temporomandibular e cefaleia: Uma revisão de escopo

“…Outro estudo citou como forma de avaliação da qualidade de vida a utilização de escala visual para o paciente marcar a percepção de impacto da doença em seu dia a dia, a qual foi considerada pelo próprio autor uma forma simples de julgamento visto que não utilizou questionários específicos para avaliação de bem estar (Farrier et al, 2020). O terceiro artigo que explorou melhora de qualidade de vida, utilizou questionários específicos para cefaleia, com indicadores demográficos, aferições de freqüência de sintomas, investigação de necessidade de terapia farmacológica diária e média cumulativa de horas com dor (Kocaman et al, 2018).…”

“…Um terço dos artigos não apresentou grupo controle e seus autores mensuraram no mesmo grupo os efeitos antes e após a intervenção com toxina botulínica A (Freund et al,2002;Sidebotton et al, 2013;Baker, 2017;Kocaman, et al, 2018;Khan, 2018;Daily et al, 2021;Al-Hussain et al, 2021;Alshalah et al,2021;Oksanen et al, 2022).…”

“…Uma pesquisa turca, da Faculdade de Medicina de Istambul apurou com diários de cefaléia, o número de dias por mês sem sintomas, a necessidade de uso de analgésicos e relaxantes musculares e a média de horas de dor, relacionando os dados à qualidade de vida. Com a utilização de dois ciclos de administração de toxina onabotulínica os pesquisadores reconheceram melhora dos parâmetros ao final do sexto mês, reconhecendo melhora clínica global no tratamento de cefaleia primária associada ou não à DTM (Kocaman, 2018).…”

“…O ensaio clínico que pareou para comparação as doses de 80, 140 e 200 U registrou redução da massa óssea da mandíbula dose dependente e redução da espessura muscular com doses superiores a 140 U (De La Torre et al, 2022). A toxina onabotulínica foi associada à elevação da sobrancelha em 7% dos pacientes num acompanhamento de seis meses (Kocaman et al, 2018).…”

Beyond Pain: The Effects of OnabotulinumtoxinA Therapy on Sensitization and Interictal Symptoms in Chronic Migraine

“…However, the possible effectiveness of the PREEMPT protocol on TMD comorbid symptoms has not been investigated properly. In 2018, Kocaman et al found that the presence of TMD symptoms did not constitute a predictive factor for response to BoNT-A treatment in a population of 30 patients with CM [74,75]. The possible mechanism of action of BoNT-A on comorbid TMD and migraine has been investigated by Lacković et al on an animal model.…”