Lee Soo Haeng, Jo Jung Hwan, Park Ji Woon
Department of Oral Medicine, Seoul National University Dental Hospital, 03080 Seoul, Republic of Korea.
Department of Oral Medicine and Oral Diagnosis, Seoul National University School of Dentistry, 03080 Seoul, Republic of Korea.
J Oral Facial Pain Headache. 2025 Mar;39(1):70-80. doi: 10.22514/jofph.2025.006. Epub 2025 Mar 12.
Various studies have demonstrated a close link between headaches and temporomandibular disorders (TMD). However, the results are often limited to certain clinical aspects and are based on a cross-sectional study design. This study aimed to examine the clinical characteristics of patients with both TMD and migraine symptoms and to assess the long-term treatment outcomes compared to TMD patients without migraine.
Sixty-four TMD patients were evaluated using the Diagnostic Criteria for TMD protocol and validated questionnaires, including Generalized Anxiety Disorder-7, Patient Health Questionnaire (PHQ)-9, PHQ-15, the Graded Chronic Pain Scale, and the Symptom Checklist-90-Revision (SCL-90-R). Patients were divided into two groups based on the presence of migraine symptoms requiring medication. The study compared psychological and clinical profiles, as well as long-term treatment outcomes.
The migraine group exhibited greater psychological distress, as indicated by higher scores in the SCL-90-R subscales for somatization ( = 0.035), obsessive-compulsive behavior ( = 0.015), interpersonal sensitivity ( = 0.002), depression ( = 0.035), anxiety ( = 0.042), hostility ( = 0.004), paranoid ideation ( = 0.016), and psychoticism ( = 0.044). Additionally, they scored higher on the PHQ-9 ( = 0.023) and PHQ-15 ( = 0.016). Pain levels were higher in the migraine group at 3 months post-treatment ( = 0.023) but the difference with the non-migraine group disappeared 6 months post-treatment. Younger age (odds ratio (OR) = 0.844, = 0.001), female (OR = 0.001, = 0.011), and more positive sites on masticatory muscle palpation (OR = 2.580, = 0.011) were associated with a higher likelihood of experiencing migraine. Mental illness history (β = -0.465, = 0.002), tongue ridging (β = -0.683, < 0.001), and Oral Behavior Checklist scores (β = 0.483, = 0.002) were associated with TMD pain intensity in the migraine group.
TMD patients using sumatriptan for migraine symptoms had higher levels of disability and psychological distress, leading to an increased disease burden. Although the migraine group had worse short-term TMD treatment outcomes, these differences resolved after six months of treatment.
多项研究表明头痛与颞下颌关节紊乱病（TMD）之间存在密切联系。然而，研究结果往往局限于某些临床方面，且基于横断面研究设计。本研究旨在探讨同时患有TMD和偏头痛症状的患者的临床特征，并评估与无偏头痛的TMD患者相比的长期治疗效果。
采用TMD诊断标准方案和经过验证的问卷对64例TMD患者进行评估，这些问卷包括广泛性焦虑障碍-7、患者健康问卷（PHQ）-9、PHQ-15、慢性疼痛分级量表和症状自评量表-90修订版（SCL-90-R）。根据是否存在需要药物治疗的偏头痛症状将患者分为两组。该研究比较了心理和临床特征以及长期治疗效果。
偏头痛组表现出更大的心理困扰，SCL-90-R量表中躯体化（P = 0.035）、强迫行为（P = 0.015）、人际敏感（P = 0.002）、抑郁（P = 0.035）、焦虑（P = 0.042）、敌对（P = 0.004）、偏执观念（P = 0.016）和精神质（P = 0.044）分量表得分更高。此外，他们在PHQ-9（P = 0.023）和PHQ-15（P = 0.016）上的得分也更高。治疗后3个月偏头痛组的疼痛水平更高（P = 0.023），但与非偏头痛组的差异在治疗后6个月消失。年龄较小（优势比（OR）= 0.844，P = 0.001）、女性（OR = 0.001，P = 0.011）以及咀嚼肌触诊阳性部位更多（OR = 2.580，P = 0.011）与发生偏头痛的可能性更高相关。精神疾病史（β = -0.465，P = 0.002）、舌沟纹（β = -0.683，P < 0.001）和口腔行为检查表得分（β = 0.483，P = 0.002）与偏头痛组的TMD疼痛强度相关。
使用舒马曲坦治疗偏头痛症状的TMD患者残疾水平和心理困扰程度更高，导致疾病负担增加。虽然偏头痛组的TMD短期治疗效果较差，但这些差异在治疗6个月后消失。
