title: Temporomandibular disorders and chronic daily headaches in the community and in specialty care.
abstract: BACKGROUND
  Chronic daily headaches (CDHs) are often associated with temporomandibular disorders (TMDs). However, large studies assessing the relationship were conducted in general, and not clinical, populations. Thus, clinical exams were not completed. Clinic-based studies with expert diagnosis are, in turn, often small and may not be representative.
  
  
  OBJECTIVE
  To contrast the demographic and clinical symptoms of CDH and TMD in participants within the general population relative to patients seen in a headache clinic.
  
  
  METHODS
  All inhabitants 10 years and older of a small city in Brazil were interviewed. Those with more than 15 days of headache per month were examined by a team consisting of a neurologist, a dentist, and a physical therapist. Headaches were classified as per the Second Edition of the International Classification of Headache Disorders and TMD as per the Research Diagnostic Criteria. The procedure was repeated (by the same team) with CDH sufferers consecutively seen in a headache center.
  
  
  RESULTS
  Of 1605 inhabitants interviewed, 57 (3.6%) had CDH, and 43 completed all physical assessments. For specialty care group, of 289 patients, 92 had CDH, and 85 completed all assessments. No significant differences were seen for gender and age, but education level was significantly higher among those recruited at specialty care. Muscular TMD happened in 30.2% of CDH patients from the community vs 55.3% in the headache center (difference of -25.1%, 95% confidence interval of difference=-40.8% to -9.4%). No TMD happened in 41.9% of those recruited from the population relative to 20% of those in the headache center (21.9%, 95% confidence interval=6.7-37.1%).
  
  
  CONCLUSIONS
  Individuals with CDH recruited from the general population are significantly less likely to have CDH relative to those selected from the headache center. Issues of generalizability are of concern when conducting clinic-based studies on the topic.
authors.affiliation: Headache Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ariovaldo Alberto
authors.initials: AA
authors.lastname: da Silva Junior
authors.forename: Abouch Valenty
authors.initials: AV
authors.lastname: Krymchantowski
authors.forename: João Bosco Lima
authors.initials: JB
authors.lastname: Gomes
authors.forename: Frederico Mota Gonçalves
authors.initials: FM
authors.lastname: Leite
authors.forename: Betânia Mara Franco
authors.initials: BM
authors.lastname: Alves
authors.forename: Rodrigo Pinto
authors.initials: RP
authors.lastname: Lara
authors.forename: Rodrigo Santiago
authors.initials: RS
authors.lastname: Gómez
authors.forename: Antônio Lúcio
authors.initials: AL
authors.lastname: Teixeira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001938:Brazil / Q000453:epidemiology; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
keywords: chronic daily headache; prevalence; temporomandibular disorder