J Oral Facial Pain Headache. 2017;31(1):55-60. doi: 10.11607/ofph.1654.
To assess the association between chronic tension-type headache coexistent with chronic temporomandibular disorder (TMD) pain and severe limitations in physical and emotional functioning.
Sample size estimation was used to determine that this case-control study should include 126 subjects. Subjects suffering from chronic TMD who were aged between 18 and 68 were recruited in routine clinical practice. Of the 126 included subjects, 63 had TMD pain associated with chronic tension-type headache (cases) and 63 had TMD pain without a history of tension-type headache (controls). Clinical diagnosis of TMD was made according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I criteria, and clinical diagnosis of headache was made according to the International Classification of Headache (ICHD-II). RDC/TMD Axis II criteria were applied to record the scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90-Revised Depression (SCL-DEP) and Somatization (SCL-SOM) scales. A logistic regression analysis was used to assess the relationship between TMD pain with chronic tension-type headache and high levels of depression and somatization severity as scored on the SCLDEP and SCL-SOM scales, respectively, and high pain-related disability (GCPS grade III or IV). Data were adjusted to take into account age, gender, time since TMD pain onset, chronic TMD pain intensity, and characteristic pain intensity.
The presence of chronic tension-type headache was significantly associated with severe SCL-DEP (odds ratio [OR] = 7.2; P < .001), severe SCLSOM (OR = 13.8; P < .001), and high pain-related disability (OR = 9.7; P < .001).
This study provides evidence of associations between the clinical diagnosis of chronic tension-type headache coexistent with chronic TMD pain and key aspects of physical and emotional functioning reflected in severe depression, severe somatization, and high pain-related disability.
评估共存慢性紧张型头痛和慢性颞下颌关节紊乱（TMD）疼痛与身体和情绪功能严重受限之间的关联。
采用样本量估计来确定这项病例对照研究应纳入 126 名受试者。在常规临床实践中招募了年龄在 18 至 68 岁之间患有慢性 TMD 的患者。在纳入的 126 名受试者中，63 名患有 TMD 疼痛伴慢性紧张型头痛（病例），63 名患有 TMD 疼痛而无紧张型头痛病史（对照）。TMD 的临床诊断依据 RDC/TMD 轴 I 标准，头痛的临床诊断依据 ICHD-II 标准。应用 RDC/TMD 轴 II 标准记录 Graded Chronic Pain Scale（GCPS）和 Symptoms Checklist-90-Revised Depression（SCL-DEP）及 Somatization（SCL-SOM）量表的评分。采用 logistic 回归分析评估 TMD 疼痛伴慢性紧张型头痛与 SCL-DEP 和 SCL-SOM 量表上的抑郁严重程度和躯体化严重程度高分、高疼痛相关残疾（GCPS 分级 III 或 IV）之间的关系。数据经过调整，以考虑年龄、性别、TMD 疼痛发作时间、慢性 TMD 疼痛强度和特征性疼痛强度。
慢性紧张型头痛的存在与 SCL-DEP 严重程度显著相关（比值比 [OR] = 7.2；P <.001）、SCL-SOM 严重程度（OR = 13.8；P <.001）和高疼痛相关残疾（OR = 9.7；P <.001）。
本研究提供了证据，表明共存慢性紧张型头痛和慢性 TMD 疼痛的临床诊断与严重抑郁、严重躯体化和高疼痛相关残疾等身体和情绪功能的关键方面有关。
