Association Between Headache Attributed to Temporomandibular Disorders and Comorbid Bodily Pain

Individuals with vs without headache attributed to temporomandibular disorder may have a greater number of comorbid bodily pain conditions, a higher number of painful sites in the head and neck, and increased pain intensity, according to a study published in Headache.

This retrospective cross-sectional case-control review of medical records from a university pain clinic was conducted to determine the phenotypic characteristics of chronic temporomandibular disorders with and without headache attributed to temporomandibular disorders. The review included 295 patients diagnosed with myalgia and/or arthralgia who visited the clinic for pain management. A total of 34 patients (29.3%, “cases”) met International Classification of Headache Disorders 3rd edition criteria for headache attributed to temporomandibular disorders, and another 82 individuals (70.7%, “control” patients) met the criteria for temporomandibular disorders without related headache. Demographic characteristics were similar in both cases and controls.

The mean number of painful sites in the head and neck region upon palpation and the mean temporomandibular disorders pain intensity were both  greater in patients with vs without headache (odds ratio [OR], 1.18; P <.0001 and OR, 1.11; P =.04, respectively). In addition, 85.3% of case patients reported the presence of bodily pain conditions compared with 63.4% of control patients (P =.02) and 38% of control patients reported ≥2 comorbid pain conditions vs 56% of case patients (P =.04).

Study limitations include self-report of bodily pain conditions and a selection bias that may affect generalizability of results.

“[I]t seems that the presence of [headache attributed to temporomandibular disorder] in patients ]with temporomandibular disorder] may be associated with a more “severe” form of [temporomandibular disorder] related to greater alterations in central pain processing mechanisms including pain amplification and reduced pain inhibition. Alternatively, this may also be a reflection of increased somatic awareness. Hence, improved phenotyping of [headache attributed to temporomandibular disorder] will lead to better understanding of the etiopathophysiology, resulting in more precise treatment strategies,” noted the study authors.

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Reference

Vivaldi D, Di Giosia M, Tchivileva IE, Jay GW, Slade GD, Lim PF. Headache attributed to TMD is associated with the presence of comorbid bodily pain: A case-control study [published online September 4, 2018] Headache. doi:10.1111/head.13404