Patients with migraine are more likely than nonmigraineurs to have temporomandibular disorder (TMD).1 According to the results of a new study presented at the 14th annual International Headache Conference in Philadelphia, TMD may also be associated with increased headache frequency.2 The magnitude of this association may be influenced by severity of TMD, said lead study author Daniela Gonalves, DDS, MScb, professor in the department of dental materials and prosthodontics, Araraquara Dental School, So Paulo State University, Brazil.
Dr Gonalves' team identified 300 patients seeking treatment for TMD at an Orofacial Pain Clinic and University Dental School. The International Classification of Headache Disorders, 2nd edition, criteria were used to determine whether a patient had migraine, episodic tension-type headache (ETTH), chronic daily headache (CDH), or no headache. Symptoms of TMD were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders. TMD was classified as myofascial, articular, or mixed; chronic pain severity, depression, other physical symptoms, and mandibular functioning limitations were also assessed.
Results of the study showed that myofascial and mixed TMD increased the risk of CDH, migraine, and ETTH. "Since a positive and statistically significant association was observed among grades of TMD chronic pain and headache prevalence, as well as headache frequency, our results can confirm that TMD may be an aggravating factor for headache and a risk factor for chronification," said Dr Gonalves. "Simultaneous evaluation and treatment of headache and TMD is of great importance for a positive prognosis for both."
Dr Gonalves recommends that all physicians routinely screen for symptoms of TMD in patients who present with CDH; the questions should focus on the most common symptoms. "Ask about presence of masticatory muscle pain or fatigue of the jaw, temporomandibular joint sounds or pain, and difficulty or impairment during mandibular functions," she said. "A more complete evaluation should include a specific physical and oral exam conducted by a dentist."
Once TMD has been identified in a patient with primary headache syndrome or migraine, Dr Gonalves recommends that both a dentist and a neurologist should see the patient. "There are several treatment options for TMD that include use of oral appliances, physical therapy, and medication," she said. "Since TMD is a multifactorial condition, more than 1 treatment modality could be chosen after a complete evaluation comprising patient history, oral exams, psychological evaluation and, in some cases, imaging exams."
There is a lack of a consensus on whether TMD and CDH share a common etiology. "Since CDH reflects a syndrome that includes both chronic migraine and chronic tension-type headache, TMD and migraine may be biologically linked," she said. " More studies are needed to clarify the mechanisms involved."
1. Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R. Are headache andtemporomandibular disorders related? A blinded study. Cephalalgia. 2008;28:832-841.
2. Gonçalves DG, Camparis CM, Speciali JG, et al. Temporomandibular disorders are associated with increased headache severity and frequency. Presented at: the International Headache Conference; September 10-13, 2009; Philadelphia. Abstract.