Kocaman Gülşen, Kahraman Neşe, Köseoğlu Banu Gürkan, Bilgiç Başar, Matur Zeliha, Ertaş Mustafa, Gülşen Yeşim, Baykan Baykal Betül
Department of Neurology, Bezmialem Vakıf University, Faculty of Medicine, İstanbul, Turkey.
Department of Maxillofacial Surgery, İstanbul University, İstanbul Faculty of Dentistry, İstanbul, Turkey.
Noro Psikiyatr Ars. 2018 Dec;55(4):330-336. doi: 10.5152/npa.2017.19257. Epub 2018 Jul 6.
Migraine and temporomandibular disorders (TMD) are both common diseases and TMD are reported as a risk factor in migraine progression. OnabotulinumtoxinA is used in the treatment of chronic migraine (CM), and also has a potential role in TMD treatment. In this study, it is aimed to compare the efficacy of onabotulinumtoxinA treatment in CM patients with and without TMD.
In this retrospective study, 30 CM patients (age range: 18-65 years), satisfying the inclusion and follow-up criteria in their medical records were investigated. The PREEMPT injection protocol was taken as reference and onabotulinumtoxinA 155-195 U with fixed-dose has been administered into 31 specific sites within the head/neck muscles in included subjects. Two cycles of treatment were assessed in all patients at the baseline and 12 weeks later. The headache diaries, which were completed routinely one month before, and during 6 months follow-up after the treatment, were assessed. The effect of onabotulinumtoxinA treatment was compared between CM patients with and without TMD/bruxism.
Of 30 female patients, 17 had concomitant TMD. In week 24, there were significant improvement in the groups with and without TMD regarding to the mean change of frequencies in the days with migraine compared to the initial findings (p<0.001). However, there was no significant difference between the two groups.
OnabotulinumtoxinA is an effective and safe treatment for CM. Its efficacy appears to be similar in CM patients with and without TM, speculating that the comorbidity of TMD did not play a role for the treatment response.
偏头痛和颞下颌关节紊乱病（TMD）都是常见疾病，且TMD被报道为偏头痛进展的一个风险因素。A型肉毒毒素用于治疗慢性偏头痛（CM），在TMD治疗中也具有潜在作用。本研究旨在比较A型肉毒毒素治疗在合并或不合并TMD的CM患者中的疗效。
在这项回顾性研究中，调查了30例符合病历纳入及随访标准的CM患者（年龄范围：18 - 65岁）。以PREEMPT注射方案为参考，向纳入研究的受试者头颈部肌肉内31个特定部位注射固定剂量155 - 195 U的A型肉毒毒素。在基线及12周后对所有患者的两个治疗周期进行评估。评估治疗前1个月及治疗后6个月随访期间常规填写的头痛日记。比较合并或不合并TMD/磨牙症的CM患者中A型肉毒毒素治疗的效果。
30例女性患者中，17例合并TMD。在第24周时，与初始结果相比，合并和不合并TMD的组在偏头痛发作天数频率的平均变化方面均有显著改善（p<0.001）。然而，两组之间无显著差异。
A型肉毒毒素是治疗CM的一种有效且安全的方法。在合并和不合并TM的CM患者中其疗效似乎相似，推测TMD的合并症对治疗反应没有影响。
