Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes.
OBJECTIVE
To describe the characteristics of headaches attributed to temporomandibular disorders (TMD) and assess the effects of two management strategies used for the management of TMD on headache intensity and frequency.


METHODS
The initial sample (n=60) of this randomized controlled trial comprised patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD (RDC/TMD), and headache. The patients were divided into two groups: group 1 received only counseling for behavioral changes, and group 2 received counseling and an occlusal appliance. A 5-month follow-up period included three assessments. TMD-related headache characteristics, eg, headache intensity (scored on a visual analog scale [VAS]) and frequency were measured by a questionnaire. Two-way analysis of variance, chi-square, Friedman, and Mann-Whitney tests were used to test for differences considering a 5% significance level.


RESULTS
The main clinical features of headache attributed to masticatory myofascial pain were the long duration (≥4 hours), frontotemporal bilateral location, and a pressing/tightening quality. Forty-one subjects (group 1, 17 subjects; group 2, 24 subjects) were included in the final analysis. There was a reduction in headache intensity and frequency, with no significant differences between groups (P>.05). The mean (±SD) baseline VAS was 7.6 (±2.2) for group 1 and 6.5 (±1.6) for group 2; final values were 3.1 (±2.2) (P<.001) and 2.5 (±2.3) (P<.001), respectively.


CONCLUSIONS
Headache attributed to masticatory myofascial pain was mainly characterized by long duration, frontotemporal bilateral location, and a pressing/tightening quality. Also, counseling and behavioral management of masticatory myofascial pain improved headache, regardless of the use of an occlusal appliance.
Yuri Martins
YM
Costa
André Luís
AL
Porporatti
Juliana
J
Stuginski-Barbosa
Leonardo Rigoldi
LR
Bonjardim
José Geraldo
JG
Speciali
Paulo César
PC
Rodrigues Conti
D000293:Adolescent; D000328:Adult; D003376:Counseling; D003769:Dental Occlusion, Traumatic / Q000517:prevention & control; D004032:Diet; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology* / Q000517:prevention & control; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D017090:Occlusal Splints; D010147:Pain Measurement / Q000379:methods; D011795:Surveys and Questionnaires; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000150:complications* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult