Influence of Myofascial Pain on the Pressure Pain Threshold of Masticatory Muscles in Women With Migraine

Ferreira-Pinto, Leandro; Carvalho, João José Freitas de; Cunha, Carolina Ortigosa; Silva, Rafael dos Santos; Fiamengui-Filho, Jorge Francisco; Conti, Paulo César Rodrigues

doi:10.1097/ajp.0b013e31826232f6

Cited by 20 publications

(22 citation statements)

References 31 publications

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Section: Diagnostic Methodsmentioning

confidence: 91%

“…More than that, the presence of both conditions could aggravate the clinical presentation. In fact, even lower PPT values are observed in patients having both disorders concurrently, in comparison with those having only migraine or myofascial TMD (46). This overlap in clinical presentation is even stronger and confusing when we associate myofascial TMD and TTH (Table 1) (53)(54)(55)(56)(57).…”

Section: Diagnostic Methodsmentioning

confidence: 98%

“…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.…”

Section: Classificationmentioning

confidence: 99%

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

Conti

Costa

Gonçalves

et al. 2016

J of Oral Rehabilitation

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There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.

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Section: Diagnostic Methodsmentioning

confidence: 91%

Section: Diagnostic Methodsmentioning

confidence: 98%

Section: Classificationmentioning

confidence: 99%

See 1 more Smart Citation

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

Conti

Costa

Gonçalves

et al. 2016

J of Oral Rehabilitation

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“…Associated with the basic scientific findings for muscle pain as a consequence of central neurone hyperexcitability (18), muscle pain could be a signature of both primary and central sensitisation. Furthermore, there is evidence showing that even lower PPT values are observed in subjects having both disorders concurrently (MMF pain + migraine or high frequency headaches), in comparison with those having only MMF pain (19). Although there was no significant difference between Group 1 (headache + MMF pain) and Group 2 (only MMF pain) in regard to the baseline PPT values for the masseter and the right forearm, the values for the anterior belly of the temporalis muscle were significantly lower in the headache group.…”

Section: H E a D A C H E A T T R I B U T E D T O M A S T I C A T O R mentioning

confidence: 99%

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

Costa

Porporatti

Stuginski‐Barbosa

et al. 2015

J of Oral Rehabilitation

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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.

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“…Also, a possible puzzling aspect is the fact that the mechanical sensitivity reported by migraineurs can be result of the “natural” pericranial tenderness, typical of such population, regardless of the occurrence of migraine attacks. It has been demonstrated that PPT of women with migraine is reduced, even when no myogenous TMD is previously diagnosed ( 23 ). As stated before, this could be attributed to the well-known mechanisms of central and peripheral sensitization phenomena.…”

Section: Discussionmentioning

confidence: 99%

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

Costa¹,

Porporatti²,

Calderón³

et al. 2016

Med Oral

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BackgroundThe evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism.Material and MethodsA total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable.ResultsMean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpation-induced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69).ConclusionsPalpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxism. Key words:Diagnosis, temporomandibular joint disorders, migraine, tension-type headache, bruxism.

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Influence of Myofascial Pain on the Pressure Pain Threshold of Masticatory Muscles in Women With Migraine

Abstract: Migraine, especially when accompanied by myofascial pain, reduces the PPT of masticatory muscles, suggesting the importance of masticatory muscle palpation during examination of patients with migraine.

Cited by 20 publications

References 31 publications

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

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

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

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

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