Freund Brian J, Schwartz Marvin
Headache. 2002 Nov-Dec;42(10):1033-7. doi: 10.1046/j.1526-4610.2002.02234.x.
Temporomandibular disorder (TMD) and chronic tension headaches clinically coexist in many individuals. Generally considered as separate pathological entities, they have been clinically treated by different means.
To determine the utility of treatment with botulinum toxin for patients with coexisting TMD and chronic tension type headache.
In this open-label study of 60 subjects with chronic TMD, 46 subjects also met the diagnostic criteria for chronic tension headache. All 60 subjects were treated with 150 units of botulinum toxin-A injected into the masticatory muscles, specifically 50 units into each masseter and 25 units into each temporalis muscle.
Thirty-eight of 60 subjects (63%) reported a 50% improvement in their facial pain during the follow-up period. The subset of 46 subjects with chronic tension headache and TMD symptoms reported a 50% or greater improvement in headache pain as well. The number of headache free days also improved postinjection.
These results suggest that the masticatory muscles, specifically the temporalis, may be involved in the pathogenesis of this form of chronic tension headache found in association with TMD.
颞下颌关节紊乱病（TMD）和慢性紧张性头痛在临床上常共存于许多个体中。它们通常被视为独立的病理实体，临床上采用不同的方法进行治疗。
确定肉毒杆菌毒素治疗共存TMD和慢性紧张型头痛患者的效用。
在这项对60例慢性TMD患者的开放标签研究中，46例患者也符合慢性紧张性头痛的诊断标准。所有60例患者均接受150单位A型肉毒杆菌毒素注射到咀嚼肌中，具体为每侧咬肌注射50单位，每侧颞肌注射25单位。
60例患者中有38例（63%）在随访期间报告面部疼痛改善了50%。46例患有慢性紧张性头痛和TMD症状的患者亚组也报告头痛疼痛改善了50%或更多。注射后无头痛天数也有所改善。
这些结果表明，咀嚼肌，特别是颞肌，可能参与了与TMD相关的这种慢性紧张性头痛的发病机制。
