Nazeri Masoud, Ghahrechahi Hamid-Reza, Pourzare Amin, Abareghi Fatemeh, Samiee-Rad Sahand, Shabani Mohammad, Arjmand Shokouh, Abazarpour Ramin
Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Neuroscience Research Center, Neuropharmacology Institute, Kerman Medical Sciences University, Kerman, Iran.
Indian J Dent Res. 2018 Sep-Oct;29(5):583-587. doi: 10.4103/0970-9290.244932.
Previous studies have demonstrated a strong association between primary headaches (HAs) and temporomandibular disorders (TMDs), specifically the myofascial pain subtype of TMD (MP TMD). The role of anxiety and depression in presentation and maintenance of MP TMD and migraine is previously demonstrated. Therefore, the objective of the current study was to evaluate the modification effect of anxiety and depression on the possible association of MP TMD and migraine.
In this retrospective case-control study, individuals between 15 and 45 years old who were diagnosed with migraine HA according to the international classification of headache disorder-II (ICHD-II) were selected as case subjects (n = 65). Non-HA control subjects were matched by sex and age (n = 63). Research diagnostic criteria (RDC/TMD) (Axis I) was used to diagnose patients with MP TMD; other subtypes of RDC/TMD Axis I were excluded from the study. Subjects' anxiety and depression were screened using Persian version of Hospital Anxiety and Depression Scale-14. Chi-square and Mantel-Haenszel tests were used to analyze the data. P < 0.05 was considered statistically significant.
A significant association was found between migraine and MP TMD so that subjects with MP TMD had a five times chance of developing HA (P < 0.001). Further analysis using stratification method revealed that anxiety and depression have a modification effect in the association of MP TMD and HA and MP TMD patients with anxiety or depression had more chance of developing migraine HA (P = 0.003).
Association between HA and TMD was observed in this study. Besides, we depicted that anxiety and depression interact in this association so that patients who did not have anxiety or depression did not demonstrate an association between TMD and HA. We suggest further studies to confirm the modifying effects of anxiety and depression.
既往研究表明原发性头痛（HA）与颞下颌关节紊乱病（TMD）之间存在密切关联，特别是TMD的肌筋膜疼痛亚型（MP TMD）。焦虑和抑郁在MP TMD和偏头痛的发生及持续存在中的作用已得到证实。因此，本研究的目的是评估焦虑和抑郁对MP TMD与偏头痛可能关联的调节作用。
在这项回顾性病例对照研究中，根据国际头痛疾病分类第二版（ICHD-II）被诊断为偏头痛性HA的15至45岁个体被选为病例组（n = 65）。非HA对照受试者按性别和年龄匹配（n = 63）。采用研究诊断标准（RDC/TMD）（轴I）诊断MP TMD患者；RDC/TMD轴I的其他亚型被排除在研究之外。使用医院焦虑抑郁量表-14的波斯语版本筛查受试者的焦虑和抑郁情况。采用卡方检验和Mantel-Haenszel检验分析数据。P < 0.05被认为具有统计学意义。
偏头痛与MP TMD之间存在显著关联，使得患有MP TMD的受试者发生HA的几率为五倍（P < 0.001）。使用分层方法的进一步分析表明，焦虑和抑郁在MP TMD与HA的关联中具有调节作用，患有焦虑或抑郁的MP TMD患者发生偏头痛性HA的几率更高（P = 0.003）。
本研究观察到HA与TMD之间存在关联。此外，我们描述了焦虑和抑郁在这种关联中相互作用，即没有焦虑或抑郁的患者未表现出TMD与HA之间的关联。我们建议进一步研究以证实焦虑和抑郁的调节作用。
