Preclinical Temporomandibular Dysfunction in Episodic Cervicogenic Headaches

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In an observational study, researchers found that young women with cervicogenic headaches were susceptible to stress, which they believed was a factor and predictor for the first-onset of temporomandibular dysfunction.

Patients with episodic cervicogenic headaches displayed preclinical symptoms for temporomandibular dysfunction (TMD), with significant differences in the range of motion for the temporomandibular joint (TMJ) and pressure pain threshold of the temporal muscle when compared with a control group, according to a study published in PM&R.

Researchers of this cross-sectional study examined the differences in the range of motion of the TMJ, pressure pain thresholds of the extra-trigeminal nerve, levels of perceived stress, and preclinical signs of TMD between patients with episodic cervicogenic headaches and healthy control patients. The study arm (n=22) included women with a diagnosis of episodic cervicogenic headaches based on the International Classification of Headache Disorders-3 criteria of episodic cervicogenic headaches without symptoms of TMD. The control arm (n=22) included asymptomatic women matched for age and socioeconomic background. Procedures to evaluate the TMJ range of motion, temporomandibular palpation pain, pressure pain thresholds, and levels of perceived stress were completed on the entire study population. Headache diaries were used to collect data on headache intensity, frequency, and duration of patients in the study arm.

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The study arm had a significantly reduced range of motion in the TMJ (unassisted P =.003; assisted P =.002) and significantly more positive local pain responses to palpitation in the masseter muscle when compared with the control arm. The study arm also had significantly lower pressure pain thresholds for the left temporal muscle (P =.009) and right temporal muscle (P =.01), and significantly higher perceived stress when compared with the study group (P =.02). Spearman’s rho calculations indicated a significant association between headache frequency and range of motion of the TMJ (unassisted ρ -.55; assisted ρ -.64).

Limitations of this study include selection bias and low generalization due to only including women, inability to assess the impact of psychosocial and lifestyle factors, and being unable to analyze a potential causational relationship between episodic cervicogenic headache and TMD.

The researchers concluded that “[p]atients with episodic [cervicogenic headache] clearly present with signs of a preclinical [temporomandibular dysfunction]. Knowledge of a possible multidimensional association between [cervicogenic headache] and [temporomandibular dysfunction] could influence the treatment.”

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Mingels S, Dankaerts W, Granitzer M. Preclinical signs of a temporomandibular disorder in females with episodic cervicogenic headache vs asymptomatic controls: A cross-sectional study [published online March 12, 2019]. PM R. doi: 10.1002/pmrj.12156

This article originally appeared on Neurology Advisor