评估头痛患者的颞下颌关节紊乱。

Evaluation of temporomandibular joint disorder in headache patients.

机构信息

T.R. Health Sciences University Istanbul Training and Research Hospital Neurology Clinic, Istanbul, Turkey.

T.R. Health Sciences University Istanbul Training and Research Hospital Dentistry Clinic, Istanbul, Turkey.

出版信息

Neurol Sci. 2021 Nov;42(11):4503-4509. doi: 10.1007/s10072-021-05119-z. Epub 2021 Feb 18.

DOI:10.1007/s10072-021-05119-z

PMID:33604763

Abstract

OBJECTIVE

The present study is aimed at determining the percentage of temporomandibular joint disorder (TMD) in patients admitted to the neurology outpatient clinic with a headache complaint and to evaluate the association of TMD with the presence of bruxism and headache traits.

MATERIALS AND METHODS

A total of 349 headache patients were included in the study. The headache type, characteristics of the headache (incidence, duration, and severity of attacks), and the scores of the migraine disability scale (MIDAS) and Allodynia Symptom Scale (ASC-12T) were examined considering the presence of sleep bruxism. The International Classification of Headache Disorders (ICHD-3 Beta) criteria were used for diagnosing headaches. The presence of TMD was evaluated by using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients diagnosed with TMD and/or bruxism were evaluated by a dentist.

RESULTS

A total of 349 patients, 259 females and 90 males, were included in the study. The mean age of the patients was 36 years. Primary and secondary headaches were diagnosed in 317 (90.80%) and 32 (9.20%) patients, respectively. In the primary headache group, there were 227 migraines (182 females, 45 males), 74 tension-type headaches (TTH) (48 females, 26 males), and 15 trigeminal autonomic cephalalgias (TACs) (7 females, 8 males) patients. The remaining patients were diagnosed with other types of diagnoses. The rate of patients with chronic headache was 86.50%. TMD was detected in 89 (25.50%) of the patients while sleep bruxism was present in 80 (23.30%) patients. TMD was detected in 68 (30.0%) migraine patients and 13 (17.60%) TTH patients. The rate of TMD was statistically significantly higher in migraine patients compared to the TTH patients (p=0.037).

CONCLUSION

Our cross-sectional outpatient-based study determined the incidence of TMD in headache patients as 25%. Among the primary headaches, the incidence of TMD was higher in migraine patients compared to the other diagnoses. Considering these data, the presence of TMD is a clinical condition that should be considered in the pathophysiology of headache, primarily migraine, and especially in cases of non-response to treatment.

摘要

目的

本研究旨在确定因头痛就诊于神经内科门诊的患者中颞下颌关节紊乱（TMD）的比例，并评估 TMD 与磨牙症和头痛特征的相关性。

材料和方法

共纳入 349 例头痛患者。根据是否存在睡眠磨牙症，检查头痛类型、头痛特征（发作频率、持续时间和严重程度）、偏头痛残疾量表（MIDAS）和感觉异常症状量表（ASC-12T）评分。采用国际头痛疾病分类（ICHD-3 Beta）标准诊断头痛。使用颞下颌关节紊乱研究诊断标准（RDC/TMD）评估 TMD 的存在。所有诊断为 TMD 和/或磨牙症的患者均由牙医进行评估。

结果

共纳入 349 例患者，其中女性 259 例，男性 90 例，平均年龄为 36 岁。原发性和继发性头痛分别诊断为 317 例（90.80%）和 32 例（9.20%）。在原发性头痛组中，偏头痛 227 例（女性 182 例，男性 45 例）、紧张型头痛（TTH）74 例（女性 48 例，男性 26 例）、三叉神经自主神经性头痛（TAC）15 例（女性 7 例，男性 8 例）。其余患者诊断为其他类型的诊断。慢性头痛患者比例为 86.50%。349 例患者中 89 例（25.50%）存在 TMD，80 例（23.30%）存在睡眠磨牙症。68 例（30.0%）偏头痛患者和 13 例（17.60%）TTH 患者存在 TMD。偏头痛患者的 TMD 发生率明显高于 TTH 患者（p=0.037）。