title: Signs of temporomandibular disorders in migraine patients: a prospective, controlled study.
abstract: OBJECTIVE
  To identify signs of temporomandibular disorders and cervical pain in individuals with episodic and chronic (transformed) migraine (CM), relative to controls without headaches.
  
  
  METHODS
  In this prospective, controlled, double-blind study, we examined 93 individuals divided in 3 groups: episodic migraine EM, (n=31), CM chronic migraine (n=34), and controls without migraine (n=28). We recorded signs of temporomandibular disorders, and of pain in the neck, after the protocol of Helkimo (1974). We calculated the odds ratio (OR) and confidence intervals (CI) of symptoms as a function of headache status. Data from all groups were paired and compared using the chi test. The level of significance was 5% in 2-tailed tests.
  
  
  RESULTS
  Relative to controls, participants with EM and CM were significantly more likely to have tenderness in the masticatory muscles [controls=28%, migraine=54%, (OR=3.0, 95% CI=1.1-8.9), CM=73% (OR=6.9, 95% CI=2.3-21.2)], and in the temporomandibular joint [controls=25%, migraine=61%, (OR=4.7, 95% CI=1.5-14.5), CM=61% (OR=4.8, 95% CI=1.6-14.5)]. They were numerically (but nonsignificantly) more likely to have limited lateral jaw movements (CM=34%; EM=26%; NP=18%), joint sounds (CM=44%; EM=29%; NP=28%), and tenderness in neck muscles (CM=64%; EM=51%; NP=35%).
  
  
  CONCLUSIONS
  In a tertiary care population, individuals with EM and CM are more likely to have tenderness at the temporomandibular joint and on the masticatory muscles, relative to controls. Studies are needed to investigate whether treatment of 1 disorder will improve the other.
authors.affiliation: Department of Neurology, School of Medicine at Ribeirão Preto, São Paulo, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Stuginski-Barbosa
authors.forename: Henrique R
authors.initials: HR
authors.lastname: Macedo
authors.forename: Marcelo Eduardo
authors.initials: ME
authors.lastname: Bigal
authors.forename: José Geraldo
authors.initials: JG
authors.lastname: Speciali
mesh_terms: D000328:Adult; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000175:diagnosis; D019547:Neck Pain / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D010147:Pain Measurement; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D013705:Temporomandibular Joint Disorders / Q000150:complications* / Q000175:diagnosis