Temporo-mandibular disorders are an important comorbidity of
          migraine and may be clinically difficult to distinguish them from tension-type
          headache

Silva Júnior, Ariovaldo Alberto da; Brandão, Karina Viana; Faleiros, Bruno Engler; Tavares, Rafael Mattos; Lara, Rodrigo Pinto; Januzzi, Eduardo; Carvalho, Anísio Bueno de; Carvalho, Eliane Maria Duarte de; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betania Mara Franco; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

doi:10.1590/0004-282X20130221

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Arquivos de Neuro-Psiquiatria

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Sumário

Articles • ANPArq. Neuro-Psiquiatr. 72 (2) • Feb 2014 • https://doi.org/10.1590/0004-282X20130221 copy

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

Desordens temporomandibulares são comorbidade importante da migrânea e podem ser clinicamente difíceis de distinguir da cefaleia tipo tensional

Authorship SCIMAGO INSTITUTIONS RANKINGS

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging.

Objectives

: To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center.

Method

: Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD.

Results

: Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001).

Conclusion

: TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

primary headache; temporomandibular disorders; migraine

	Headache center (n=289)	Oral clinic (n=78)	p-value
Sex
Women	86.9% (251)	75.6% (59)	0.015**
Men	13.1% (38)	24.4% (19)
Years of school
< 8 years	52.3% (136)	23.2% (16)	<0.001*
8-15 years	35.0% (91)	59.4% (41)
> 15 years	12.7% (33)	17.4% (12)

	Headache center (n=289)		Oral clinic (n=78)		p-value
	%	95%CI	%	95%CI
Migraine	79.89	[74.16; 83.63]	25.64	[15.73; 35.55]	<0.001*
Tension-type headache	20.42	[15.74; 25.09]	46.15	[34.84; 57.47]	<0.001*
Chronic daily headache	16.61	[12.29; 20.93]	3.85	[0.52; 8.21]	0.004*

	Headache center (n=289)	Oral clinic (n=78)	p-value
No TDM	32.9% (95)	2.6% (2)	<0.001*
Muscular	49.5% (143)	23.1% (18)
Articular	1.4% (4)	15.4% (12)
Muscular and articular	16.3% (47)	59.0% (46)

	Headache center		Oral clinic		p-value

	Prevalence	95%CI	Prevalence	95%CI
Disc dislocation with reduction	3.46%	[1.34; 5.58]	28.21%	[17.99; 38.42]	<0.001*
Disc dislocation without reduction	0.35%	[0.34; 1.03]	10.26%	[3.37; 17.14]	<0.001*
Spontaneous dislocation	0.69%	[0.27; 1.65]	7.69%	[1.65; 13,74]	0.002**
Synovitis/ capsulitis	17.65%	[9.24; 26.06]	42.31%	[31.10; 53.52]	<0.001*
Myofascial pain	48.10%	[42.30; 53.89]	70.51%	[60.17; 80.86]	<0.001*
Local muscle soreness	18.34%	[13.85; 22.83]	8.97%	[2.49; 15.46]	0.047*
Myospasm	0%	–	8.97%	[2.49; 15.46]	<0.001**

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[1] Correspondence
: Ariovaldo Alberto da Silva Jr. Núcleo de Apoio à Pesquisa, Unifenas-BH, Rua Líbano, 66 / Bairro Itapoã; 31710-030 Belo Horizonte MG - Brasil.