J Oral Facial Pain Headache. 2018;32(2):137-150. doi: 10.11607/ofph.1912.
To investigate the effects of adding orofacial treatment to cervical physical therapy in patients with chronic migraine and temporomandibular disorders (TMD).
A total of 45 participants with chronic migraine and TMD aged 18 to 65 years were randomized into two groups: a cervical group (CG) and a cervical and orofacial group (COG). Both groups continued their medication regimens for migraine treatment and received physical therapy. The CG received physical therapy only in the cervical region, and the COG received physical therapy in both the cervical and orofacial regions. Both groups received six sessions of treatment that consisted of manual therapy and therapeutic exercise in the cervical region or the cervical and orofacial regions. Scores on the Craniofacial Pain and Disability Inventory (CF-PDI) and the Headache Impact Test (HIT-6) were primary outcome variables, and the secondary outcome variables were scores on the Tampa Scale for Kinesiophobia (TSK-11), pain intensity measured on a visual analog scale (VAS), pressure pain thresholds (PPTs) in the temporal, masseter (2 points, M1 and M2) and extratrigeminal (wrist) regions, and maximal mouth opening (MMO). Data were recorded at baseline, posttreatment, and after 12 weeks of follow-up. The α level was set at .05 for all tests and two-way repeated-measures analysis of variance (ANOVA) for within- and between-group interactions.
There were 22 CG participants (13.6% men and 86.4% women) and 23 COG participants (13% men and 87% women). The ANOVA analysis revealed statistically significant differences for group × time interaction in CF-PDI, HIT-6 in the last follow-up, pain intensity, PPTs in the trigeminal region, and MMO (P < .05), with a medium-large magnitude of effect. No statistically significant differences were found in the PPTs of the extratrigeminal region or in the TSK-11 (P > .05).
Both groups reported a significant improvement in CF-PDI, HIT-6, and pain intensity. Cervical and orofacial treatment was more effective than cervical treatment alone for increasing PPTs in the trigeminal region and producing pain-free MMO. Physical therapy alone was not effective for increasing the PPTs in the extratrigeminal region (wrist) or decreasing the level of TSK-11.
探讨在慢性偏头痛和颞下颌关节紊乱病（TMD）患者中，附加口面治疗对颈部物理治疗的影响。
将 45 名年龄在 18 至 65 岁之间的慢性偏头痛和 TMD 患者随机分为两组：颈部组（CG）和颈部与口面组（COG）。两组均继续接受偏头痛治疗的药物治疗方案，并接受物理治疗。CG 仅在颈部区域接受物理治疗，COG 在颈部和口面区域均接受物理治疗。两组均接受六次治疗，包括颈部区域的手动治疗和治疗性运动，或颈部和口面区域的手动治疗和治疗性运动。颅面部疼痛和残疾量表（CF-PDI）和头痛影响测试（HIT-6）的评分是主要结局变量，次要结局变量是 Tampa 运动恐惧量表（TSK-11）的评分、视觉模拟评分（VAS）上的疼痛强度、颞部（2 点，M1 和 M2）、咬肌（2 点，M1 和 M2）和颅外（腕部）区域的压力疼痛阈值（PPT）以及最大张口度（MMO）。在基线、治疗后和 12 周随访时记录数据。所有检验的α水平均设定为.05，采用组内和组间双向重复测量方差分析（ANOVA）。
CG 组有 22 名参与者（13.6%为男性，86.4%为女性），COG 组有 23 名参与者（13%为男性，87%为女性）。方差分析显示，在 CF-PDI、最后一次随访时的 HIT-6、疼痛强度、三叉神经区域的 PPTs 和 MMO 方面，组间×时间交互作用有统计学意义（P<.05），效应量为中到大。颅外区域的 PPTs 或 TSK-11 无统计学差异（P>.05）。
两组患者在 CF-PDI、HIT-6 和疼痛强度方面均有显著改善。与单独的颈部治疗相比，颈部和口面治疗更能有效提高三叉神经区域的 PPTs，并产生无痛的 MMO。单独的物理治疗对增加颅外区域（腕部）的 PPTs 或降低 TSK-11 水平没有效果。
