TMD (TMJ) is frequntly an undiagnosed cause of Headache and Facial Pain according to an article in the Annals of Allergy, Asthma and Immunology. The article " Temporomandibular dysfunction: an often overlooked cause of chronic headaches. " is found in Ann Allergy Asthma Immunol 2007 Oct;99(4):314-8. states that
"many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy"
I have seen this frequently in patients for years who are constantly taking antibiotics for sinus infections that cause their headaches. I have found that when we place these patients in a neuromuscular diagnostic orthotic that nthe headaches subside, as do the "sinus infections" . There is tremendous danger associated with the unnecessary overuse of antibiotics.
An article in Sleep and Health Journal, "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses in detail how patients frequently have the TMD diagnosis missed leading to years of needless suffering. The article can be found at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
The article states "studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches." I believe this is grossly under-rating the frequency where TMD either causes the headache directly, is a trigger to a secondary cause of headache or is involved in increasing the degree of pain the patient suffers. Nearly all headaches and migraines are trigeminally mediated and these headaches are TMD related.
Many patients do not have joint clicking , noise , locking or pain but have muscular disorders of the stomatognathic system.
Neuromuscular dentists are a small group of highly educated dentists in the field. They are able to deal with more complex issues due to sophisticated tools such as ULF-TENS, EMG, Computerized Mandibular Scans (MKG) and Sonography or JVA.
The article concludes "The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities."
WHAT THIS MEANS IS, IF YOUR HEADACHES ARE NOT CLEARLY IDENTIFIED BY OBJECTIVE STUDIES (MRI, CST SCANS, CULTURE, BLOOD TESTS, ETC ) THAN YOU SHOULD BE EVALUATED FOR TMD.
A Neuromuscular Dentist is probably an excellent starting point for patients with chronic daily headaches, sinus headaches and migraines which do not have objective causes identified by medical testing.
Ann Allergy Asthma Immunol. 2007 Oct;99(4):314-8.
Temporomandibular dysfunction: an often overlooked cause of chronic headaches.
Lupoli TA, Lockey RF.
Source
Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, University of South Florida College of Medicine, James A. Haley Veteran's Hospital, Tampa, Florida 33612, USA. tlupoli@hsc.usf.edu
Abstract
OBJECTIVE:
To review and discuss the role of temporomandibular dysfunction (TMD) as a cause of chronic headaches and facial pain.
DATA SOURCES AND STUDY SELECTION:
A literature review was performed using the PubMed database for English-language articles published between January 1, 1981, and August 31, 2006, using the following keywords: temporomandibular dysfunction, temporomandibular disorder, temporomandibular joint, and chronic headache. Additional information was obtained from a review of current medical texts.
RESULTS:
Allergists and immunologists are frequently called on to evaluate patients with chronic headaches and facial pain. TMD is known to cause recurrent facial discomfort and headaches. Many individuals with the disorder present with headache or facial discomfort as their only chief complaint. They mistakenly think it is a "sinus" headache. Nearly 10 million Americans are affected by the disorder, and early studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches.
CONCLUSIONS:
TMD is a likely underdiagnosed cause of chronic headache and facial discomfort. As such, many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy. TMD can be readily diagnosed by a careful history and physical examination. Patients typically respond well to conservative therapy, which includes behavioral modification and nonsteroidal anti-inflammatory drugs. The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities.
PMID: 17941277 [PubMed - indexed for MEDLINE]
Showing posts with label chronic daily headacahe. Show all posts
Showing posts with label chronic daily headacahe. Show all posts
Saturday, May 28, 2011
Friday, May 20, 2011
Post Traumatic Stress Disorder and Migraine. Is this an example of a neuromusclar Trigeminally mediated headache?
A recent article in "Headache" dated May 17, 2011 (see abstract below) discusses migraines and PTSD. It details how these types of problems are much more common in women and suggests a sex hormonal component to the pain. The statistics are very similar to what is found in MPD (Myofascial Pain and Dysfunction) and TMJ / TMD 9Temporomandibular Dysfunction). These are also found more frequently in women and associated with Migraine, Tension-Type Headache, and Chronic Daily Headache.
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
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]
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]
Saturday, February 5, 2011
New Article ties Joint hypermobility syndrome to migraines. This has long been known to be a factor in TMJ disorders and associated headaches.
Studies have shown that hypermobility syndrome is associated with chronic headache disorders. This new study shows that 75% of study group with the syndrome had migraines compared to only 43% of controls.
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Friday, January 28, 2011
Continuous headache with earache and eye ache.
David: I have had continous Headaches for 3-4 months now. sides and back of head mainly. Earache and eye ache as well
Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.
An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial pain. If stretch and spray gives relief of the headache, earache and eye ache you will confirm the muscular component.
Because almost all Tension Type Headaches are influences by the Trigeminal Nervous system you will probably do well by tring a Diagnostic Neuromuscular Orthotic as a non-invasive safe diagnostic and treatment entity. If yo get complete relief you will confirm that the headache is muscular and trigeminally modulated.
Occasionally trigger point injections are needed to break-up long standing muscle issues.
Dr Shapira: David, you have given me only minimal infformation on what treatment you have received or any special circumstances when the pain started. The good news is the symptoms you describe indicate that you probably have headaches of muscular orgins. Tension-Type Headaches (TTH) are commononly associated with the jaw and neck muscles. Achy type pain as you describe in your ears and eyes is nearly always referred muscualar pain.
An excellent approach is to visit a Neuromuscular Dentist who is also trained in using Vapocoolant spray to treat Myofascial pain. If stretch and spray gives relief of the headache, earache and eye ache you will confirm the muscular component.
Because almost all Tension Type Headaches are influences by the Trigeminal Nervous system you will probably do well by tring a Diagnostic Neuromuscular Orthotic as a non-invasive safe diagnostic and treatment entity. If yo get complete relief you will confirm that the headache is muscular and trigeminally modulated.
Occasionally trigger point injections are needed to break-up long standing muscle issues.
Thursday, November 25, 2010
Sleep Appliance Causes Patient To Develop "TMJ". Is "TMJ" from Somnomed Sleep Appliance or is sleep apnea a symptom of a TMJ problem?
JEFF: I have an oral device (sonomed) for sleep apnea. It gave me TMJ. I haven't been able to tolerate cpap.
Dr Shapira: YOU STATE THAT YOU HAVE A SOMNOMED TO TREAT SLEEP APNEA BECAUSE YOU CANNOT TOLERATE CPAP.
It is excellent that you have chosen to treat the sleep apnea which can cause heart attacks, strokes, memory loss and excessive daytime sleepiness. Morning Headaches and headaches that wake patients from sleep are usually the result of sleep apnea or TMJ disorders ie "TMD"
YOU THEN STATE THAT YOU DEVELOPED TMJ BUT GAVE NO SPECIFICS AS TO SYMPTOMS. TMJ STANDS FOR TEMPOROMANDIBULAR JOINT, NOT A DISEASE. It is important to understand the SPECIFIC problems so they can be addressed. Patients wearing oral appliances for sleep apnea may experience bite changes or tooth movement but damage should not occur to the joints. It is essential to work with a dentist who has training in treating sleep apnea and TMJ disorders.
I frequently see patients whose bite changes but the feel better. Many of the changes that occur when wearing a sleep appliance are actually due to the body healing. The same developmental problems cause both sleep apnea and TMJ disorders, migraines and chronic daily headaches.
Neuromuscular Dentistry is one of the best approaches to treating headaches and TMJ disorders.
ACCORDING TO THE NHLBI SLEEP APNEA IS A TMJ DISORDER. SEE http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf You have actually developed a new symptom from the same disorder but because you didn't specify symptoms I can not specify what to do next.
The American Academy of Sleep Medicine recommends that dentists treating sleep apnea with oral appliances should be well trained in treating TMJ disorders. I SUGGEST THAT THE BEST QUALIFIED DENTISTS FOR TREATING TMJ DISORDERS ARE NEUROMUSCULAR DENTISTS.
IF YOU CAN GIVE ME SPECIFIC INFORMATION I MAY BE OF MORE HELP. Please review www.ihateheadaches.org to learn about Neuromuscular Treatment of TMJ Disorders, headaches and migraines.
The following is the result of a web form submission from:
comments: I have an oral device (sonomed) for sleep apnea. It gave me TMJ
I haven't been able to tolerate cpap
Dr Shapira: YOU STATE THAT YOU HAVE A SOMNOMED TO TREAT SLEEP APNEA BECAUSE YOU CANNOT TOLERATE CPAP.
It is excellent that you have chosen to treat the sleep apnea which can cause heart attacks, strokes, memory loss and excessive daytime sleepiness. Morning Headaches and headaches that wake patients from sleep are usually the result of sleep apnea or TMJ disorders ie "TMD"
YOU THEN STATE THAT YOU DEVELOPED TMJ BUT GAVE NO SPECIFICS AS TO SYMPTOMS. TMJ STANDS FOR TEMPOROMANDIBULAR JOINT, NOT A DISEASE. It is important to understand the SPECIFIC problems so they can be addressed. Patients wearing oral appliances for sleep apnea may experience bite changes or tooth movement but damage should not occur to the joints. It is essential to work with a dentist who has training in treating sleep apnea and TMJ disorders.
I frequently see patients whose bite changes but the feel better. Many of the changes that occur when wearing a sleep appliance are actually due to the body healing. The same developmental problems cause both sleep apnea and TMJ disorders, migraines and chronic daily headaches.
Neuromuscular Dentistry is one of the best approaches to treating headaches and TMJ disorders.
ACCORDING TO THE NHLBI SLEEP APNEA IS A TMJ DISORDER. SEE http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf You have actually developed a new symptom from the same disorder but because you didn't specify symptoms I can not specify what to do next.
The American Academy of Sleep Medicine recommends that dentists treating sleep apnea with oral appliances should be well trained in treating TMJ disorders. I SUGGEST THAT THE BEST QUALIFIED DENTISTS FOR TREATING TMJ DISORDERS ARE NEUROMUSCULAR DENTISTS.
IF YOU CAN GIVE ME SPECIFIC INFORMATION I MAY BE OF MORE HELP. Please review www.ihateheadaches.org to learn about Neuromuscular Treatment of TMJ Disorders, headaches and migraines.
The following is the result of a web form submission from:
comments: I have an oral device (sonomed) for sleep apnea. It gave me TMJ
I haven't been able to tolerate cpap
Sunday, April 4, 2010
NEW STUDY SHOWS TMD COMORBIDITY IN OVER 50% OF CHRONIC HEADACHES AND CHRONIC MIGRAINES
A new study Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study in Headache. 2010 Feb 12 is very revealing. It was evaluating chronic daily headaches, pschiatric disorders and TMD. In the study "Individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH (chronic daily headache) were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2).
Of the 1631 subjects 57 (3.6%) had CDH. Chronic migraine comprised represented 36.8% and Chronic tension-type headache represented 17.5%. Medication overuse headache was also common representing 22.8% and probable medication overuse headache representing another 17.5% were also common combined totaling 40.3% of Chronic daily headaches
There were TMD comorbidities observed in 58.1% of the patients. This is no surprise as the trigeminal nerve is almost universally involved in chronic headaches. If a thorough neuromuscular detistry evaluation was done it is likely the percentage of patients with TMD signs or symptoms would be much higher. There were also psychiatric disorders were observed in a large percentage of these patients but living with chronic pain can frequently manifest itself in secondary psychiatric problems.
I frequently find that patients who are in chronic pain, not sleeping well and overutilizing medications change ramatically after they begin using a diagnostic orthotic. I sometimes feel I don't meet the patients until their second or third visit after significant pain reduction.
It is normal to be depressed when you are in constant non-remiting pain. I have frequently said that patients in constant pain who do not become depressed are "certifiable".
When considering comorbidities it is important to understand that TMD is a causitive comorbidity that helps create the chronic headaches while the psychiatric comorbidity may be a result of the pain or not related to the pain problem.
If one was to consider medication overuse a comorbidity then the data would skew considerably. Is the medication overuse headache a symptom of the underlying TMD or psychiatric disorder. Patients with TMD are prone to seeing a wide variety of health practitioners before being diagnosed with tmd (TMJ) disorders. TMD is know as "The Great Imposter" for that reason. Please see the Sleep and Health article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
TMD IS SUCH A MAJOR COMORBIDITY IN HEADACHES THAT EVERY PATIENT WITH CHRONIC HEADACHES OR MIGRAINES SHOULD BE EVALUATED FOR TMD PRIOR TO INITIATING MEDICATION. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC MAY ELIMINATE THE PAIN PROBLEMS THEREBY AVOIDING FUTURE MEDICATION OVERUSE HEADACHES AND ASSOCIATED PSYCHIATRIC PROBLEMS FROM BOTH PAIN AND MEDICATION OVERUSE.
PUBMED ABSTRACT below
Headache. 2010 Feb 12. [Epub ahead of print]
Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study.
da Silva Jr A, Costa EC, Gomes JB, Leite FM, Gomez RS, Vasconcelos LP, Krymchantowski A, Moreira P, Teixeira AL.
From the UFMG - Headache Clinic, Belo Horizonte, Brazil (A. da Silva Jr, E.C. Costa, J.B. Gomes, and F.M. Leite); University Hospital, Federal University of Minas Gerais - Headache Clinic, Neurology Division, Belo Horizonte, Brazil (R.S. Gomez); Federal University of Minas Gerais (UFMG) - Internal Medicine, Belo Horizonte, Brazil (L.P. Vasconcelos and A.L. Teixeira); Universidade Federal Fluminense - Neurology, Rio de Janeiro, Brazil (A. Krymchantowski); Universidade Federal Fluminense - Headache Clinic, University Hospital, Rio de Janeiro, Brazil (P. Moreira); Federal University of Minas Gerais (UFMG) - Laboratory of Immunopharmacology, Belo Horizonte, Brazil (A.L. Teixeira).
Background.- Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking. Objectives.- To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil. Methods.- This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively. Results.- A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them. Conclusions.- The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers. (Headache 2010;**:**-**).
PMID: 20163479 [PubMed - as supplied by publisher
Of the 1631 subjects 57 (3.6%) had CDH. Chronic migraine comprised represented 36.8% and Chronic tension-type headache represented 17.5%. Medication overuse headache was also common representing 22.8% and probable medication overuse headache representing another 17.5% were also common combined totaling 40.3% of Chronic daily headaches
There were TMD comorbidities observed in 58.1% of the patients. This is no surprise as the trigeminal nerve is almost universally involved in chronic headaches. If a thorough neuromuscular detistry evaluation was done it is likely the percentage of patients with TMD signs or symptoms would be much higher. There were also psychiatric disorders were observed in a large percentage of these patients but living with chronic pain can frequently manifest itself in secondary psychiatric problems.
I frequently find that patients who are in chronic pain, not sleeping well and overutilizing medications change ramatically after they begin using a diagnostic orthotic. I sometimes feel I don't meet the patients until their second or third visit after significant pain reduction.
It is normal to be depressed when you are in constant non-remiting pain. I have frequently said that patients in constant pain who do not become depressed are "certifiable".
When considering comorbidities it is important to understand that TMD is a causitive comorbidity that helps create the chronic headaches while the psychiatric comorbidity may be a result of the pain or not related to the pain problem.
If one was to consider medication overuse a comorbidity then the data would skew considerably. Is the medication overuse headache a symptom of the underlying TMD or psychiatric disorder. Patients with TMD are prone to seeing a wide variety of health practitioners before being diagnosed with tmd (TMJ) disorders. TMD is know as "The Great Imposter" for that reason. Please see the Sleep and Health article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
TMD IS SUCH A MAJOR COMORBIDITY IN HEADACHES THAT EVERY PATIENT WITH CHRONIC HEADACHES OR MIGRAINES SHOULD BE EVALUATED FOR TMD PRIOR TO INITIATING MEDICATION. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC MAY ELIMINATE THE PAIN PROBLEMS THEREBY AVOIDING FUTURE MEDICATION OVERUSE HEADACHES AND ASSOCIATED PSYCHIATRIC PROBLEMS FROM BOTH PAIN AND MEDICATION OVERUSE.
PUBMED ABSTRACT below
Headache. 2010 Feb 12. [Epub ahead of print]
Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study.
da Silva Jr A, Costa EC, Gomes JB, Leite FM, Gomez RS, Vasconcelos LP, Krymchantowski A, Moreira P, Teixeira AL.
From the UFMG - Headache Clinic, Belo Horizonte, Brazil (A. da Silva Jr, E.C. Costa, J.B. Gomes, and F.M. Leite); University Hospital, Federal University of Minas Gerais - Headache Clinic, Neurology Division, Belo Horizonte, Brazil (R.S. Gomez); Federal University of Minas Gerais (UFMG) - Internal Medicine, Belo Horizonte, Brazil (L.P. Vasconcelos and A.L. Teixeira); Universidade Federal Fluminense - Neurology, Rio de Janeiro, Brazil (A. Krymchantowski); Universidade Federal Fluminense - Headache Clinic, University Hospital, Rio de Janeiro, Brazil (P. Moreira); Federal University of Minas Gerais (UFMG) - Laboratory of Immunopharmacology, Belo Horizonte, Brazil (A.L. Teixeira).
Background.- Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking. Objectives.- To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil. Methods.- This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively. Results.- A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them. Conclusions.- The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers. (Headache 2010;**:**-**).
PMID: 20163479 [PubMed - as supplied by publisher
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