偏头痛和紧张型头痛患者的颞下颌关节紊乱症:一项荟萃分析的系统评价
Temporomandibular disorders in migraine and tension-type headache patients: a systematic review with meta-analysis.
作者信息
Bizzarri Paolo, Manfredini Daniele, Koutris Michail, Bartolini Marco, Buzzatti Luca, Bagnoli Cecilia, Scafoglieri Aldo
机构信息
Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium.
Department of Human Neuroscience, University of Rome La Sapienza, 00185 Rome, Italy.
出版信息
J Oral Facial Pain Headache. 2024 Jun;38(2):11-24. doi: 10.22514/jofph.2024.011. Epub 2024 Jun 12.
The simultaneous occurrence of primary headaches and temporomandibular disorders can pose a challenge in determining the best clinical management of patients. Therefore, we aimed to summarize evidence regarding the risk and prevalence of temporomandibular disorders (TMDs) in migraine and tension-type headaches (TTH) patients. Cross-sectional studies published in English comparing the presence of TMDs in adults with TTH or migraine to subjects without headaches were included, International Classification of Orofacial Pain, Diagnostic Criteria for Temporomandibular Disorders or Research Diagnostic Criteria for Temporomandibular Disorders, and large epidemiological studies (sensitive diagnostic criteria (SDC)). The methodological quality was assessed by Modified Newcastle-Ottawa Quality Assessment Scale. Odds ratio (OR) and random effects were calculated. 1405 articles were identified in PubMed, Embase and Central databases, and 13 cross-sectional studies were finally included. Overall Risk of TMDs was statistically significantly higher than control groups in both Migraine (SDC: 11 studies; OR: 3.79 (2.43, 5.90); = 99%), with higher values in chronic migraine (OR: 24.27; (95% Confidence interval (CI): 5.84, 100.82); = 0%) and TTH populations (SDC: 8 studies; OR: 4.45 (2.63, 7.53); = 86%). Headache subjects presented a higher risk of muscular TMDs (5 studies; OR: 2.01 (1.62, 2.50); = 0%), Combined TMDs (5 studies; OR: 2.74 (1.40, 5.36); = 63%), or Painful TMDs (8 studies; OR: 5.31 (2.96, 9.54); = 96%). Headache patients didn't show the risk of arthrogenous TMDs (4 studies; OR: 0.96 (0.54, 1.71); = 33%) or nonpainful TMDs (2 studies; OR: 1.10 (0.28, 4.26); = 84%). The high heterogeneity in the results was reduced following subgroup analysis. Migraine and TTH appear to increase the risk of painful, myogenous or combined arthrogenous and myogenous TMDs.
原发性头痛与颞下颌关节紊乱症同时出现,可能给确定患者的最佳临床治疗方案带来挑战。因此,我们旨在总结偏头痛和紧张型头痛(TTH)患者中颞下颌关节紊乱症(TMDs)的风险及患病率相关证据。纳入了以英文发表的横断面研究,这些研究比较了患有TTH或偏头痛的成年人与无头痛受试者中TMDs的存在情况,采用了《口面部疼痛国际分类》《颞下颌关节紊乱症诊断标准》或《颞下颌关节紊乱症研究诊断标准》以及大型流行病学研究(敏感诊断标准(SDC))。通过改良的纽卡斯尔 - 渥太华质量评估量表评估方法学质量。计算比值比(OR)和随机效应。在PubMed、Embase和Central数据库中识别出1405篇文章,最终纳入13项横断面研究。总体而言,偏头痛组(SDC:11项研究;OR:3.79(2.43,5.90);P = 99%)和TTH组(SDC:8项研究;OR:4.45(2.63,7.53);P = 86%)中TMDs的总体风险在统计学上显著高于对照组,慢性偏头痛组中TMDs风险值更高(OR:24.27;(95%置信区间(CI):5.84,100.82);P = 0%)。头痛患者出现肌肉型TMDs的风险更高(5项研究;OR:2.01(1.62,2.50);P = 0%)、混合型TMDs(5项研究;OR:2.74(1.40,5.36);P = 63%)或疼痛型TMDs(8项研究;OR:5.31(2.96,9.54);P = 96%)。头痛患者未显示出关节型TMDs(4项研究;OR:0.96(0.54,1.71);P = 33%)或非疼痛型TMDs(2项研究;OR:1.10(0.28,4.26);P = 84%)的风险。亚组分析后结果中的高异质性有所降低。偏头痛和TTH似乎会增加疼痛型、肌源性或关节源性与肌源性混合型TMDs的风险。