Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with “general HA.” Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Occlusal splints-types and effectiveness in temporomandibular disorder management

“…Individuals with TMDs are susceptible to migraines and tension-type headaches ( Saha et al, 2019 ). Several studies have been conducted to understand the relationship between headaches and TMDs to conclude that temporomandibular disorders are the second most common cause of musculoskeletal discomfort and that tension-type headaches are strongly associated with TMDs ( Kostrzewa-Janicka et al, 2013 , Manrriquez et al, 2021 ). In addition to the increasing prevalence of chronic headaches, TMDs can exacerbate primary headaches ( Saha et al, 2019 ).…”

“…In addition, a study examining the association between TMD treatment and their influence on headache treatment found that the treatment of TMDs greatly reduced headache frequency and intensity ( Costa et al, 2015 ). Several studies and strong evidence suggest that occlusal splint therapy for TMDs may help to treat and reduce migraine and tension-type headaches ( Cooper and Kleinberg, 2009 , Costa et al, 2015 , D’Ermes et al, 2012 , Kostrzewa-Janicka et al, 2013 , Manrriquez et al, 2021 , Quayle et al, 1990 , Saha et al, 2019 ).…”

Influence of Soft Stabilization Splint on Electromyographic Patterns in Masticatory and Neck Muscles in Healthy Women

“…The effectiveness of the use of stabilization splints, both soft and hard, has been demonstrated in various scientific reports. Stabilization splint therapy has been described as a well-established treatment for TMDs [ 10 , 11 ], bruxism [ 12 , 13 ], and headache [ 14 ]. Soft stabilization splints are effective in the symptomatic management of TMDs, especially for symptoms such as temporomandibular joint (TMJ) clicking, TMJ pain, and masticatory muscle pain [ 15 ].…”

Oral splints in the management of nociceptive pain and migraines: A scoping review

“…Manrriquez et al ( 23 ), in a systematic review and meta-analysis, demonstrated that SSs induces a reduction of headache intensity or frequency in patients with TMD headache comorbidity. However, the evidence quality in this study was low, with only nine studies being analyzed in the qualitative synthesis and five studies in the quantitative synthesis (meta-analysis).…”

“…However, the evidence quality in this study was low, with only nine studies being analyzed in the qualitative synthesis and five studies in the quantitative synthesis (meta-analysis). However, the authors reported no significant difference in the use of partial hard or soft splints or full arch splint use ( 23 ). A recent review investigating the effects of a SSs on headaches in patients with TMDs, revealed that even though SS therapy reduced headache intensity and frequency, the evidence quality was inadequate due to the high bias risk and small sample size, which indicated that there is a need for more research ( 23 ).…”