Symptomatic Connection Between Chronic Migraine, Temporomandibular Disorder
Patients with chronic migraine experience TMD symptoms such as tenderness in the masticatory muscles, and a type of secondary headache attributed to TMD.
Patients with chronic migraine share features with individuals with temporomandibular disorders that include kinesiophobia and neck disability, according to a cross-sectional study recently published in Pain Medicine.1
A growing body of research indicates a number of shared features between chronic migraine and TMD. For example, patients with chronic migraine, but not headache-free individuals, commonly experience TMD symptoms such as tenderness in the masticatory muscles, and a type of secondary headache attributed to TMD is included in the International Classification of Headache Disorders 3 Beta.2-4
Patients with chronic migraine and TMD have both been found to have high levels of catastrophizing and kinesiophobia, which have been linked with increased disability.5,6 However, few studies have investigated the relationship between catastrophizing and kinesiophobia, and chronic migraine and TMD. In the current study, investigators hypothesized that these disorders may be comorbid and share underlying pathophysiology. They compared adult patients with chronic migraine (n=50) and TMD (n=51) on measures of disability and psychological factors, and examined potential predictors of pain, and disability. The sample consisted of 85.1% women, and the mean age of participants was 47.3±12.4.
Significant differences were observed between groups for the novel Craniofacial Pain and Disability Inventory to measure pain, disability, and functional status (t = 3.93, P <.001), the pain catastrophizing scale (t = 2.12, P =.03), and the Headache Impact Test (t = 5.57, P <.001). Analysis of correlations between variables revealed that the largest association in the TMD group was between the Neck Disability Index and the Pain Catastrophizing Scale (r = 0.61, P <.001), and the largest associations in the chronic migraine group were between the Neck Disability Index scores and the Craniofacial Pain and Disability Inventory scores (r = 0.75, P <.001) and between the Neck Disability Index and the Visual Analogue Scale to measure pain (r = 0.59, P <.001). Regression models showed that in patients with TMD, the Neck Disability Index and the Tampa Scale of Kinesiophobia to measure fear of movement and re-injury were covariates of the Craniofacial Pain and Disability Inventory (adjusted R2 = 0.34), while in the chronic migraine group, the Neck Disability Index was a predictive factor for the Headache Impact Test (adjusted R2 = 0.19).
In summary, the findings demonstrate that cervical disability was positively correlated with “orofacial pain and disability and kinesiophobia for both groups, a positive correlation with pain catastrophizing in the TMD group, and a positive correlation with headache impact in the [chronic migraine] group,” wrote the authors. “Therefore, it appears necessary to consider cervical disability as a good predictive factor for several variables in the evaluation and management” of patients in both groups, they concluded.
One limitation that may have influenced results is the difference in symptom duration between groups. Also, the cross-sectional design of the study precluded the examination of certain variables and associations.
- Gil-Martínez A, Navarro-Fernández G, Mangas-Guijarro MÁ, et al. [published online May 29, 2017]. Pain Med. doi:10.1093/pm/pnx127
- Gonçalves DA, Bigal ME, Jales LCF, Camparis CM, Speciali JG. Headache and symptoms of temporomandibular disorder: an epidemiological study. Headache. 2010; 50:231–241. doi:10.1111/j.1526-4610.2009.01511.x
- Stuginski-Barbosa J, Macedo HR, Bigal ME, Speciali JG. Signs of temporomandibular disorders in migraine patients: A prospective, controlled study Clin J Pain. 2010;26:418-421. doi:10.1097/AJP.0b013e3181d10691
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia. 2013; 33:629-808.
- GilMartınez A, Grande-Alonso M, La Touche R, Lara-Lara M, López-López A, Fernández-Carnero J. Psychosocial and somatosensory factors in women with chronic migraine and painful temporomandibular disorders. Pain Res Manag. 2016;2016:9. doi:10.1155/2016/3945673
- Martins IP, Gouveia RG, Parreira E. Kinesiophobia in migraine. J Pain. 2006;7:445-451. doi:10.1016/j.jpain.2006.01.449