Background & Aims
There is a significant overlap between painful temporomandibular disorders (p-TMD) and primary headaches, with 56.1% of headache patients having p-TMD [1, 2] and 82.8% of p-TMD patients experiencing headaches [3]. p-TMD has been identified as a risk factor for headache development, and headaches predict the development of p-TMD [4, 5]. Migraine is commonly reported to be the predominant primary headache associated with p-TMD [6, 7]. However, clinical experience and close literature analysis suggest this overwhelming predominance is likely inflated. Possible reasons include the bias of questionnaires favoring migraine diagnosis and restricting to one diagnosis per patient [7], along with the challenge of accurately diagnosing p-TMD, potentially complicated by interictal allodynia more common in migraine than tension-type headache patients [8]. This study aims to determine the prevalence of p-TMD and headaches in a tertiary care center as assessed by clinical interview and examination.
Methods
This retrospective study was conducted at the Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University. Clinical records of all patients attending initial consultations, and seen by a specialist in orofacial pain and headache disorders, between August 2017 and November 2022 were analyzed (n=201). Diagnosis of p-TMD followed the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) [9], while headache diagnosis adhered to ICHD-3 criteria [10]. Patients with available records meeting these criteria were included, while those with other orofacial pain conditions were excluded. This study focused on specific outcomes: 1) p-TMD status, categorized as non-painful TMD and/or no-TMD, arthralgia, myalgia, or both arthralgia and myalgia; 2) primary headache diagnosis, including episodic migraine, chronic migraine, TTH, and both migraine with TTH (patients experiencing < 8 migraine days per month alongside diagnosed TTH).
Results
Among the total 201 patients, 73.6% (n=148) were females, and 26.4% (n=53) were males, with a mean age of 33.3 years (SD=15.6). In addition, among the total patient population 71.6% (n=144) were diagnosed with p-TMD, and 52.7% (n=106) experienced headaches. In addition, 21.3% (n=43) of patients had neither headache nor p-TMD. Within the p-TMD population (n=144), the prevalence of headaches was as follows: TTH 42.4% (n=61), episodic migraine 13.2% (n=19), migraine with TTH 5.6% (n=8), and chronic migraine: 2.8% (n=4). The total number of patients suffering from migraine (episodic, chronic and migraine + TTH) was 21.6% (n= 31).
Conclusions
This study reports a more prevalent coexistence of p-TMD and tension type headache, compared to migraine. It is the first clinical study to utilize the DC/TMD to identify p-TMD patients and concurrently assess headache prevalence by patient interview instead of self-administered questionnaire.
References
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Presenting Author
Fernando Gustavo Exposto
Poster Authors
Cristina Exposto
PhD Student
Aarhus University
Lead Author
Lene Baad-Hansen
Aarhus University
Lead Author
Peter Svensson
DDS
Department of Dentistry and Oral Health, Aarhus University
Lead Author
Fernando Exposto
Section of Orofacial Pain and Jaw Function, Aarhus University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Headache