Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University, São Paulo, Brazil.
Clin J Pain. 2011 Sep;27(7):611-5. doi: 10.1097/AJP.0b013e31820e12f5.
Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.
The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.
Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.
TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.
颞下颌关节紊乱（TMD）被认为与头痛并存。早期的人群研究表明，TMD 也可能是偏头痛进展的一个危险因素。如果这是真的，TMD 应该与特定的头痛综合征（例如偏头痛和慢性偏头痛）相关，而不是与头痛总体相关。因此，我们的目的是在一项对照临床研究中探讨 TMD 亚型和严重程度与原发性头痛之间的关系。
样本由 300 人组成。使用颞下颌关节紊乱研究诊断标准评估 TMD，根据国际头痛疾病分类-2 对原发性头痛进行分类。单变量和多变量模型评估 TMD 参数与头痛诊断和频率的关系。
与没有 TMD 的人相比，患有肌筋膜 TMD 的人患有慢性每日头痛（CDH）的可能性显著更高[相对风险（RR）=7.8；95%置信区间（CI），3.1-19.6]、偏头痛（RR=4.4；95% CI，1.7-11.7）和发作性紧张型头痛（RR=4.4；95% CI，1.5-12.6）。TMD 疼痛程度与 CDH（P<0.0001）、偏头痛（P<0.0001）和发作性紧张型头痛（P<0.05）的可能性增加相关。TMD 严重程度也与头痛频率相关。在多变量分析中，TMD 与偏头痛和 CDH 相关（P=0.001）。疼痛性 TMD（P=0.0034）和 TMD 疼痛程度（P<0.001）与头痛频率相关。
TMD、TMD 亚型和 TMD 严重程度与特定的头痛综合征和头痛频率独立相关。这种差异关联表明，疼痛传入的中枢易化可能很重要，因为只有在涉及肌肉 TMD 疼痛时才观察到阳性关联。
