Study Suggests Tension Headache May Actually Be
TMJD
05/12/06
| BUFFALO, N.Y. -- People whose recurrent headaches have
been diagnosed as tension-related actually may be suffering
from temporomandibular muscle and joint disorder, or TMJD,
a study headed by a researcher from the University at
Buffalo's School of Dental Medicine has
shown.
Results
showed that examiners could replicate tension-headache
symptoms in 82 percent of subjects by performing the
clinical examination of the temporalis muscle, which is
involved in TMJD.
Richard
Ohrbach, D.D.S., Ph.D., UB associate professor in the
Department of Oral Diagnostic Sciences, presented the study
results at the American Association of Dental Research
meeting held recently in Orlando, Fla.
The
temporalis muscle is responsible for closing the jaw and is
involved in chewing, but these core functions of that pair
of muscles often are ignored when the presenting complaint
is "headache," as opposed to jaw pain, Ohrbach
said.
"Because
headache is so incredibly common, it often is regarded as
inevitable, and if sufferers label the pain as 'headache,'
they may not seek help," he said. "Or if they do seek help,
the label of 'headache' typically will propel the
individual to a physician or neurologist for
consultation.
"Knowledge
about the intersection between jaw pain and headache is not
well established, and consequently, jaw pain may be ignored
in the differential diagnosis," Ohrbach added. "This can be
most unfortunate for the individual, because TMJD can be
very treatable, but if a jaw disorder is ignored, then
treatment for the headache may not address all of the
factors contributing to the headache."
The
current study is part of an $8 million project to establish
valid and reliable TMJD diagnostic criteria. Results will
advance the field of TMJD research and aid clinicians in
their practices.
Researchers
at the University of Minnesota and the University of
Washington, in addition to UB, are involved in the
project.
An
estimated 5-10 percent of the U.S. population suffer from
TMJD severe enough to warrant treatment. These patients
experience debilitating pain that can destroy quality of
life. Diagnosing the disorder is problematic, however, due
to overlap with other conditions, Ohrbach
said.
TMJD
usually involves more than a single symptom, rarely has a
single cause and frequently involves multiple factors,
including behavioral and emotional responses. Lacking a
firm set of diagnostic tools, physicians and dentists often
depend on their individual judgment to decide if a patient
does or does not have the disorder, he
noted.
The
diagnostic criteria for TMJD being tested in this project
are part of the established Research Diagnostic Criteria
for Temporomandibular Disorders (RDC/TMD). Headache
diagnosis is based on the International Headache Society
(IHS) guidelines. All examiners were been trained to use
the "gold-standard" criteria for tension-type headache
established by the IHS.
The
study compared the diagnostic procedures for pain and the
reproduction of "pain" vs. "headache" during the clinical
examination. Procedures included a range of functional and
orthopedic tests and standard pain sensitivity to pressure
applied to the muscles associated with headache. The types
of headaches considered included sub-clinical headaches,
tension-type headaches and headaches exhibiting more
symptoms than are accepted for tension-type headaches, such
as the "mixed headache," migraine or "migraine-type"
headaches
The
study involved 583 participants -- 82.3 percent female and
17.7 percent male -- who were recruited as cases from the
community based on the presence of symptoms clearly
associated with TMJD. Based on IHS criteria, 31.5 percent,
or 152 participants, were diagnosed with tension-type
headache by the examiners.
Additional
researchers on the study were Yoly Gondalez, D.D.S., from
UB; John O. Look, D.D.S., Ph.D., Eric L. Schiffman, D.D.S.,
and Wei Pan, Ph.D., from the University of Minnesota, and
Edmond L. Truelove, D.D.S., from the University of
Washington.
The
study was funded by the National Institute of Dental and
Craniofacial Research.
The
University at Buffalo is a premier research-intensive
public university, the largest and most comprehensive
campus in the State University of New
York.
Contact
Lois
Baker
ljbaker@
buffalo.edu
716-645-5000
ext 1417
Source:
http://www.buffalo.edu/