Migraine headache and temporomandibular disorders show significant overlap in the area or distribution of pain, the gender prevalence and age distribution. 
Temporomandibular disorders may cause headaches per se, worsen existent primary headaches, and add to the burden of headache disorders. 
The patients with combined migraine and tension-type headaches had a higher prevelance of temporomandibular disorders. 
Evidence supporting a close relationship include the increased masticatory muscle tenderness in migrainuers compared and improvement in headache symptoms with traditional TMD treatment.Migrena i temporomandibularni poremećaji imaju mnogo zajedničkog. Obje vrste poremećaja javljaju se u mlađoj životnoj dobi, češće u osoba ženskog spola, a i distribucija boli slična je. 
Temporomandibularni poremećaji mogu biti jedan od uzroka glavobolje ili mogu pogoršati primarnu glavobolju. 
Prevalencija temporomandibularnih poremećaja češće se javlja u bolesnika koji imaju kombinaciju migrenske i tenzijske glavobolje. 
Bolesnici s migrenskom glavoboljom češće imaju napetost mastikatornih mišića, a do poboljšanja dolazi nakon što budu liječeni istim metodama kao i bolesnici s temporomandibularnim poremećajima

Vanja Bašić Kes

Vida Demarin

HRČAK - Portal of Croatian Scientific and Professional Journals

111TEMPOROMANDIBULAR DISORDERS AND MIGRAINE HEADACHEVida Demarin, Vanja Bašić KesDepartment of Neurology, Sestre milosrdnice University Hospital, Zagreb, CroatiaSummaryMigraine headache and temporomandibular disorders show significant overlap in the area or distribution of pain, the gender prevalence and age distribution. Temporomandibular disorders may cause headaches per se, worsen existent pri-mary headaches, and add to the burden of headache disorders. The patients with combined migraine and tension-type headaches had a higher prevelance of  temporomandibular disorders. Evidence supporting a close relationship include the increased masticatory muscle tenderness in migrainuers compared and improvement in headache symptoms with traditional TMD treatment. Key words: temporomandibular disorders; migraine headache. HEADACHEHeadache is the most common neurological symptom encountered in pri-mary care, and also in general neurological practice. In most cases there is no serious underlying cause. Recurring headaches occur in 76% of women and 57% of men [1,2]. The incidence of headache is 39% at age six and increases to 70% by 15 years of age. [1] Headache afflicts a large portion of the population and with its varying severity can result in discomfort, disruption of daily activity, and occasionally debilitating pain. Although about 30% of headache sufferers are periodically functionally impaired, many do not seek medical care [3].Migraine is a familial paroxysmal neurological disorder characterized by spontaneous or triggered attacks of headache that are variably associated with autonomic disturbance like nausea or pallor, heightened sensitivity to external stimuli (scotoma, paraesthesiae, dizziness) and less often signs as hemiparesis or aphasia. The attacks usually last 4-72 hours. Migraine headaches affect 18% of UDK 616.716.1:616.857ReviewReceived: 22 January 2010Accepted: 17 March 2010Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headache112women and 6% of men, although its onset is within the first three decades of life. Migraine greatly affects quality of life. The World Health Organization ranks migraine among the worlds 20 most disabling medical illnesses.Family physicians and specialists in neurology seek to rule out an orga-nic cause of primary and secondary headache. Unfortunately, the difficulties in distinguishing headaches based on clinical presentation rarely lead to the uncovering of an organic etiologic factor, and rarely lead to the diagnosis of co-morbid conditions such as TMD. This results in frequent empiric management of headache without the evaluation of TMD as a potentially treatable comorbid condition [2].Genetic factors play an important role in the development of migraine hea-daches, with 70-90% of patients having a positive family history for migraine. Traditional concepts regarding the pathogenesis of headache crudely separated this disorder into the muscle contraction theory of tension-type headache and the vascular theory of migraine. Current concepts point to both a neurogenic theory and the role of serotonin in migraine. This neurogenic theory of migraine proposes that the pain origi-nates in the structures of the brain, affecting ascending and descending pat-hways. In addition, a primary neuronal event is followed by secondary vascular changes whereby, neuronal activation, vascular dilation, and muscle spasm all promote and propagate head pain. The very core of these disturbances appear to be channel dysfunction leading to neuronal hyperexcitability. Although many forms and variants of migraine headache exist, many of them demonstrate specific phases including a prodrome, aura, headache, and postdrome or recovery. Tension-type headache, including pain generating from the masticatory musculature, can be episodic as well as chronic and may be indistinguishable clinically and therapeutically from migraine. It is likely that some tension-type headaches and correspondingly some TMDs represent a variant form of migra-ine or they have a migrainous component to them. The possibility is expressed more clearly by looking at the difference between tension-type headache and migraine as a continuum of the same pathophysiologic.TEMPOROMANDIBULAR DISORDERSTemporomandibular disorders (TMD) are among the most common orofaci-al pain conditions of nondental origin. The reported prevalence of TMD differs between studies, probably because of variations in methodology and definitions 113Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headacheof TMD. The prevalences of TMD symptoms and signs are apparently also high in non-patient populations. Although there are no racial or ethnic differences in the prevalence of TMD, there is a significant gender predilection. The prevalence of TMD in males has been reported to be 3.2-10% and 6.3-14% in females. The highest association is in women in their reproductive years with a declining prevalence after the age of 45. In addition, women are significantly more likely to experience disability due to TMD and represent over 80% of patients treated for TMD.The most common symptom of TMD is clicking of the TMJ, the prevalence levels varying from 8 to 50 %. In contrast, mouth opening limitations are relati-vely rare, occurring in 5 % or less of the population.Pain in the face and the TMJs is a common symptom of TMD, and supposed to be the most important reason for seeking treatment for. It has been suggested that TMD pain occurs with about the same prevalence as abdominal pain and chest pain, but is less common than back pain and headache [4-7]. There are two distinct disorders affecting the temporo-mandibular complex; temporo-mandibular joint articular disorders including congenital or develo-pmental conditions, disc derangement disorders, dislocations, inflammatory dis-orders, and osteoarthritic disorders and masticatory muscle disorders particularly myofascial pain, myositis, myospasm, and myofibrotic contracture [8-10]. Mechanical stimuli, including bruxism and clenching of the teeth along with myogenic pain of the masticatory muscles may provide the stimulus for the release of serotonin and norepinephrine from the dorsal raphe and locus ce-ruleus of the brain, setting off a cascade of events leading to migraine headache and further muscle tension. Recent papers have suggested that a common fac-tor to migraine and tension-type headaches may be chronic clenching and that dentists may be able to treat headache patients more effectively than previously suspected through the use of a dental appliances [11].The link between migraine headache and TMD can be best proven by com-paring and contrasting these disorders based on the most common parameters to evaluate diseases, namely epidemiologic characteristics, locations of pain, co-morbid diseases, presumed etiologies, clinical manifestations, and therapeutic intervention.MIGRAINE AND TEMPOROMANIBULAR DISORDERSMigraine headache and TMD are both characterized by pain in the head and/or face and both conditions are more common in women, particularly in Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headache114their child-bearing years. Migraine headache affects17-18% of women and 6% of men; while TMD affects up to 10% of men and up to 14% of women. Women represent greater than 80% of all TMD patients and a majority of headache pati-ents partly because of their increased likelihood of seeking care.Due to the close anatomical relationship of the muscles of mastication and TMJ to the head and due to the frequency of referred pain, it is sensible to theo-rize that there is a significant percentage of patients with headache actually have TMD as the major source of their pain. The literature suggests that there is a relationship between both intracapsular articular disorders as well as disorders affecting the masticatory musculature [2,12-14]. Migraine pain often manifests in areas of the head including the TMJ and masticatory muscles [15-21].DeRossi et al. demonstrated the relationship of TMD and headache, showing a significantly higher prevalence of TMD in patients presenting to a neurology clinic for headache than a control population (11/13 of headache patients versus 1/22 of control patients), [5]. These results suggest a subset of patients referred to a neurologist for headache may in fact have a previously undiagnosed TMD as the source of their complaint and a significant subset of patients with migraine headache have TMD as a comorbid disease. Interestingly, for reasons that are not completely understood, a number of coexisting conditions have been linked to migraine, including asthma, chronic fatigue syndrome, hypertension, Raynaud’s phenomena, stroke, anxiety disor-ders, depression, and mood disorders. Although these conditions are more com-mon in individuals with migraine, it is unclear what if any causal relationships exist. A few studies in the literature have demonstrated a relationship between temporo-mandibular disorders (TMD) and various types of headache, including vascular headaches. According to Haley, these studies resulted from the clinical observation that patients with TMD also frequently suffer from headache [18]. The relationship between temporo-mandibular disorders and headache is well recognized in the literature. For instance, some patients diagnosed with either migraine or tension-type headaches, which may be caused by myalgia of the temporalis muscle, will have signs and symptoms consistent with TMD [16,18,22]. Strengthening this relationship between TMD and headache is the fact that treatment of TMD has resulted in a decrease of symptoms of headache in some patients [22]. Despite an obvious lack of a well-designed longitudinal study that irrefutably confirms the relationship between headache and TMD, a clinical correlation can be seen. In addition, recent evidence suggests that patients who have a diagnosis of vascular or migraine headache have a higher prevalence of 115Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headacheTMD, as a contributing cause of their pain, than the general population. In addi-tion, although myalgia of the masticatory muscle accounts for a majority of the TMD, intracapsular disorders are associated with vascular headache compared to controls.There is a growing belief that primary headaches such as tension-type hea-dache and migraine represent a continuum of the same physiologic process. A convergence hypothesis has been proposed suggesting that successive symp-toms experienced clinically actually reflect an escalating pathophysiologic pro-cess, beginning with a premonitory period and progressing into tension-type headache and, if left uninterrupted eventually into migraine. In addition, com-ponents of a TMD, including bruxism, myalgia, or an intraarticular disorder may represent a mechanical trigger, similar to chemical and psychological trig-gers, known to precipitate a migraine headache. THERAPYThe therapy of TMD and migraine usually involves a multidisciplinary approach for maximum benefit. Both conditions have many similarities.Non-specific drugs such as analgetics, non-steroidal anti-inflammatory dru-gs and opioids may control the pain of migraine.Specific drugs such as the triptans and ergots, are effective for the treatment of migraine headache attacks but are not useful for other pain disorders. Tri-patans are usually not recommended during the aura phase of an attack, nor are they used in patients with complex auras (sensory, motor, speech). They are contraindicated in hemiplegic migraine, and should be avoided in patients with coronary heart disease, previous stroke or uncontrolled hypertension. Noninvasive therapies for therapies for headache include physical therapy, relaxation techniques, and diet modifaction and now recently the suggestion of interocclusal orthotic treatment to suppress the nociceptive-trigeminal system.For TMD, pharmacologic and non-pharmacologic therapies are employed. Initial TMD treatment often involves physical and cognitive awareness measu-res, stress reduction, occlusal therapy, and medications including tricyclic an-tidepressants, anxiolytics, and neuroleptic medications commonly used in the treatment of migraine.References[1] Saper JR (Ed). Clinician’s Manual on Headache. Philadelphia: Science Press. 1995.Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headache116  [2] Schiffman E, Halet D, Baker C, Lindgren B. Diagnostic criteria for screening head-ache patients for temporomandibular disorders. Headache. 1995;35:121-4.  [3] Bevilaqua Grossi D, Lipton RB, Bigal ME. Temporomandibular disorders and mi-graine chronification. Curr Pain Headache Rep. 2009 Aug;13(4):314-8.  [4] Lipton JA, Ship JA, Larach-Robinson D. Estimated prevelance and distribution of reported  orofacial pain in the United States. J Am Dent Assoc. 1993;124:115-21.  [5] DeRossi SS, Greenberg MS, Sollecito TP, Detre JA. A prospective study evaluating and analyzing the presence of temporomandibular disorders (TMD) in a cohort of patients referred to a neurology clinic for evaluation and treatment of head-ache. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:443.  [6] DeKanter RJAM, Truin GJ, Burgersdijk RCW, et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorders. J Dent Res. 1993;72:1509-18.  [7] Dworkin SF, Huggins KH, LeResche L, et al. Epidemiology of signs and symptoms in temporomandibular disorders: Clinical signs in cases and controls. J Am Dent Assoc. 1990;120:273-81.  [8] Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular dis-orders: review, criteria, examination and specifications, critique. J Craniomand Disord.1992; 6:301-55.  [9] Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The prevalence and treatment needs of  subjects with temporomandibular disorders. J Am Dent Assoc. 1990;120:295-303.[10] Parker MW. A dynamic model of etiology in temporomandibular disorders. J Am Dent Assoc. 1990;120:283-9.[11] Shankland WE. Nociceptive trigeminal inhibition--tension suppression system: a metho of preventing migraine and tension headaches. Compend Contin Educ Dent. 2002 Feb;23(2):105-8, 110, 112-3; quiz 114.[12] Williamson EH. Interrelationship of internal derangements of the temporoman-dibular joint, headache, vertigo, and tinnitus: a survey of 25 patients. Cranio. 1990;8:301-6.[13] Quayle AA, Gray RJ, Metcalfe RJ, Guthrie E, Wastell D. Soft occlusal splint therapy in the treatment of migraine and other headaches. J Dent. 1990;18:123-9.[14] Steele JG, Lamey PJ, Sharkey SW, Smith GMR. Occlusal abnormalities, pericranial muscle and joint tenderness and tooth wear in a group of migraine patients. J Oral Rehabil. 1991;18:453-8.[15] Schokker RP, Hansson TL, Ansik BJJ. Craniomandibular disorders in patients with different types of headache. J Craniomand Disord Facial Oral Pain. 1990;4:47-51.[16] Schellhas KP, Wilkes CH, Baker CC. Facial pain, headache, and temporomandibu-lar joint inflammation. Headache. 1989;29:228-31.117Rad 507. Medical Sciences, 34(2010):111-117V. Demarin, V. Bašić Kes: Temporomandibular disorders and migraine headache[17] Lapeer GL. Reduction of the painful sequela of migraine headache by use of the occlusal diagnostic splint: an hypothesis. Cranio. 1998:6;82-6. [18] Haley D, Schiffman E, Baker C, Belgrade M. The comparison of patients suf-fering from temporomandibular disorders and a general headache population Headache. 1993;33:210-13.[19] Graff-Radford SB. Oromandibular disorders and headache. A critical appraisal. Neurologic Clinics. 1990;8:929-45. [20] Flaherty TJ. The cyclic nature of TMD, the headache patient, and the functional treatment rationale. Functional Orthodont. 1994;11:36-9. [21] Clifford T, Lamey PJ, Fartash L. Mandibular tori, migraine and temporomandibu-lar disorders. Br Dent J. 1996;180:382-4. [22] Schokker RP, Hansson TL, Ansik BJJ. Differences in headache patients regarding response to treatment of the masticatory system. J Craniomand Disord Facial Oral Pain. 1990;4:228-32. SažetakTemporomandibularni poremećaji i migrenska glavoboljaMigrena i temporomandibularni poremećaji imaju mnogo zajedničkog. Obje vrste poremeća-ja javljaju se u mlađoj životnoj dobi, češće u osoba ženskog spola, a i distribucija boli slična je. Temporomandibularni poremećaji mogu biti jedan od uzroka glavobolje ili mogu pogoršati primarnu glavobolju. Prevalencija temporomandibularnih poremećaja češće se javlja u bolesnika koji imaju kom-binaciju migrenske i tenzijske glavobolje. Bolesnici s migrenskom glavoboljom češće imaju napetost mastikatornih mišića, a do po-boljšanja dolazi nakon što budu liječeni istim metodama kao i bolesnici s temporomandibular-nim poremećajima.Ključne riječi: temporomandibularni poremećaji; migrena.Corresponding author:Vida Demarine-mail: vida.demarin@zg.t-com.hr

Temporomandibularni poremećaji i migrenska glavobolja

Abstract

Similar works

Full text

Available Versions

HRČAK - Portal of Croatian Scientific and Professional Journals

Hrčak - Portal of scientific journals of Croatia