Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold

Abstract

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P < 0·001). Mean and standard deviation (SD) PPT values, from 1·33 (0·54) to 1·96 (1·06) kgf cm(-2) for the anterior temporalis in Group 1 (P = 0·016), and from 1·27 (0·35) to 1·72 (0·60) kgf cm(-2) for the masseter in Group 2 (P = 0·013), had significant improvement considering baseline versus the 5th-month assessment. However, no differences between the groups were found (P > 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement.

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

“…In agreement with these results, previous studies obtained hypoalgesia only in the area where treatment was applied, and in these studies, the participants also presented with more than one disorder. 56,57 However, other studies in which the sample consisted of patients without comorbidities have shown that the application of manual therapy and therapeutic exercises produced generalized hypoalgesia. [58][59][60][61] These results have shown overall positive outcomes for muscle pain, given an increase in PPTs at the anterior temporalis (area of migraine pain) and at the masseter muscle (area of TMD pain).…”

Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

“…Until 2014, the only option to classify secondary headaches was through the guidelines of the International Headache Society fully described in the three versions of the ICHD (7,64,66). However, because of the high co-occurrence of headache and TMD in the clinical practice of oro-facial pain specialists and the extensive research made by dentists in this particular field (4,18,19,32,46,(67)(68)(69)(70)(71)(72)(73)(74), the new DC/TMD, which can be considered the newest 'reference standard' for TMD classification, also proposed criteria to define headache attributed to TMD (17). These criteria discriminate the location of secondary headache only to the temple area and the causation criteria are restricted to the report of familiar headache modified by jaw movement, function or parafunction associated with the clinical provocation of headache.…”

“…On the other hand, another study showed that when migraine and TMD coexists, a significant improvement of headache was achieved when both were treated simultaneously (70). However, it seems that the headache attributed to TMD does not interfere with the TMD management in patients with myofascial TMD (67). These data reinforce the importance to differentiate between the type of comorbidity between headaches and TMD and strengthen the recommendation for multidisciplinary approaches, when necessary, focusing on and addressing both conditions, by a team of oro-facial pain specialists and a neurologist (headache specialist).…”

Headache attributed to TMD Is Associated With the Presence of Comorbid Bodily Pain: A Case‐Control Study

“…Recent studies suggest that TMDH is amenable to the management of TMD . Patients with TMDH exhibited a significantly increased pressure pain threshold (PPT) in the temporalis muscles, while TMD patients without TMDH had a significantly increased PPT in the masseter muscles . In a study comparing TMD with and without temple headaches, patients with temple headaches had increased TMD pain intensity, increased TMD signs, increased sensitivity in trigeminal and non‐trigeminal sites, greater number of painful sites, and increased headache frequency .…”