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Monday, March 7, 2011

CHRONIC DAILY HEADACHES AND MIGRAINE ASSOCIATED WITH TMD ACCORDING TO NEW ARTICLE IN CLINICAL JOURNAL OF PAIN.

THIS NEW ARTICLE SHOWS THAT ALL TYPES OF HEADACHES ARE ASSOCIATED WITH TMD . THE ABSTRACT OF "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." IS REPRINTED BELOW. WHILE IT IS GENERALLY ACCEPTED THAT TENSION HEADACHES, EPISODIC TENSION-TYPE HEADACHES ARE COMMONLY CAUSED BY SORE MUSCLES IN TMD PATIENTS IT IS ACTUALLY THE CHRONIC NATURE OF TMD THAT IS SO DANGEROUS.

CHRONIC PAIN CAN CAUSE CENTRAL SENSITIZATION. THIS CAN LEAD PROBLEMS LIKE ALLODYNIA, AND HYPERALGESIA BUT THE CENTRAL SENSITIZATION IS NOT NECESSARILLY PERMANENT . UNTREATED IT IS ALSO MAY RESULT IN COMPLEX REGIONAL PAIN SYNDROME. TMD WHEN UNTREATED FREQUENTLY BECOMES CHRONIC. THERE ARE SOME RESEARCHERS WHO BELIEVE THAT TMD PROBLEMS ARE MENTAL NOT MEDICAL AND "EXPERTS" SOMETIMES PRESCRIBE BIOSOCIAL THERAPY OR PSYCHOTHERAPY BUT IGNORE THE UNDERLYING PHYSICAL CAUSES AND TRIGGERS . MANY PATIENTS WITH CHRONIC PAIN DO HAVE DEPRESSION AND OTHER PSYCHOLOGICAL DISABILITIES BUT THEY ARE USUALLY CAUSED BY PATIENTS LIVING WITH PAIN.

IT CAN BE VERY DIFFICULT TO FIND PRACTITIONERS WHO SEE THAT HEADACHES, TMD, AND OTHER PROBLEMS ARE REAL DISORDERS. MANY PATIENTS FEEL THAT THEIR DOCTORS DON'T BELIEVE THEM OR UNDERSTAND THE SEVERITY OF THEIR PROBLEMS.

I FREQUENTLY SEE PATIENTS WHO RESPOND TO VERY SIMPLE TECHNIQUES ADDRESSED AT RELIEVING PAIN FROM MASTICATORY MUSCLES. THE PATIENTS ARE QUITE OPEN AND TELL ME THAT THEY WERE TOLD THAT THEY DID NOT HAVE TMJ BECAUSE THEY DID NOT HAVE CLICKING OR LOCKING.

MANY PATIENTS HAVE MASTICATORY DISORDERS AND MUSCLE PAIN THAT REPSONDS BEAUTIFULLY TO A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS.

Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.
Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.

*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract
OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.

METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.

RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.

DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.

PMID: 21368664 [PubMed - as supplied by publisher]

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posted by Dr Shapira at 7:30 PM

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