Réus Jéssica Conti, Polmann Helena, Mendes Souza Beatriz Dulcineia, Flores-Mir Carlos, Trevisol Bittencourt Paulo Cesar, Winocur Efraim, Okeson Jeffrey, De Luca Canto Graziela
J Oral Facial Pain Headache. 2021;35(2):129-138. doi: 10.11607/ofph.2745.
To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?
A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria.
Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis.
Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial.
回答以下问题：在观察性研究中，成人原发性头痛与磨牙症之间是否存在关联？
对观察性研究进行系统综述。检索了七个主要数据库和三个灰色文献数据库。纳入样本由成年患者组成的研究。原发性头痛需根据《头痛疾病国际分类》进行诊断。磨牙症的任何诊断方法均可接受。使用乔安娜·布里格斯研究所批判性评价工具和统计评估与综述工具（MAStARI）对偏倚风险进行评估。在Review Manager 5.3软件中通过计算比值比（OR）分析关联。根据推荐分级评估、制定和评价标准筛选证据确定性。
在检索的544篇文章中，5篇符合定性分析的纳入标准。纳入的研究评估了清醒和睡眠磨牙症，以及作为原发性头痛的紧张型头痛和偏头痛。在两项偏头痛研究中，一项显示OR为1.79（95%CI：0.96至3.33），另一项为1.97（95%CI：1.5至2.55）。另一方面，在三项紧张型头痛研究中，仅与清醒磨牙症存在正相关，OR为5.23（95%CI：2.57至10.65）。所有纳入文章对超过60%的偏倚风险问题给出了肯定答案。证据确定性在低和极低之间变化。由于研究间异质性高，无法进行荟萃分析。
清醒磨牙症患者患紧张型头痛的几率高出5至17倍。睡眠磨牙症与紧张型头痛无关联，与偏头痛的关联存在争议。
