title: Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania (SHIP).
abstract: OBJECTIVE
  The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated.
  
  
  METHODS
  Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health.
  
  
  RESULTS
  Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders.
  
  
  CONCLUSIONS
  Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential.
authors.affiliation: Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, School of Dentistry, University of Greifswald, 17487 Greifswald, Germany. obernhar@uni-greifswald.de
authors.forename: Olaf
authors.initials: O
authors.lastname: Bernhardt
authors.forename: Dietmar
authors.initials: D
authors.lastname: Gesch
authors.forename: Christian
authors.initials: C
authors.lastname: Schwahn
authors.forename: Florian
authors.initials: F
authors.lastname: Mack
authors.forename: Georg
authors.initials: G
authors.lastname: Meyer
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016021:Epidemiologic Studies; D005157:Facial Pain / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006261:Headache / Q000453:epidemiology* / Q000523:psychology; D006304:Health Status; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D008603:Mental Health; D008875:Middle Aged; D010173:Palpation; D011602:Psychophysiologic Disorders / Q000453:epidemiology; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D013016:Sound; D013705:Temporomandibular Joint Disorders / Q000453:epidemiology* / Q000523:psychology