Preclinical signs of a temporomandibular disorder in females with episodic cervicogenic headache vs asymptomatic controls: A cross-sectional study

Abstract

Background: The International Classification of Headache Disorders, 3rd Edition, accepted "headache attributed to temporomandibular disorders" as a valid headache. The neurophysiologic interplay between cervical structures and the temporomandibular joint, however, might also suggest that a temporomandibular disorder could develop in patients with cervicogenic headache.Objective: To compare the presence of preclinical temporomandibular signs between female patients with episodic cervicogenic headache and a control group.Design: Case-controlled cross-sectional design.Setting: Institutional setting: Hasselt University.Participants: Twenty-two women (mean age +/- SD: 20.7 +/- 2.5 years) with episodic cervicogenic headache, without temporomandibular signs and 22 matched (gender, age, level of education, occupation) asymptomatic controls (21 +/- 2.3 years).Methods: (Un)assisted temporomandibular range of motion, pressure pain thresholds, painful palpations were examined and the level of perceived stress was measured.Main Outcome Measurements: Temporomandibular range of motion (mm), pressure pain thresholds (kPa/cm(2)), painful palpations (yes/no), and level of perceived stress (Perceived Stress Scale).Results: Maximal mouth-opening was significantly smaller in the headache group (P < .05; effect size [ES] -0.45). Palpation of the masseter resulted in significantly more positive pain responses in the headache group at the left (P = .009; ES 8) and right (P = .002;ES 17.5) origin, left (P = .004; ES 14.54) and right (P = .03; ES 5.71) body and left (P < .001; ES 12) insertion. Significantly lower pressure pain thresholds on the left and right anterior (P = .03; ES -0.33 resp. P = .02; ES -0.35), central (P = .003; ES 1.02 resp. P = .02; ES 0.79) and right posterior (P = .03; ES 0.62) temporalis and right tibialis anterior (P = .03; ES -0.33) were measured in the headache group. The level of perceived stress was significantly higher (P = .02) in the headache group.Conclusions: Patients with episodic cervicogenic headache present with signs of a preclinical temporomandibular disorder and sensitization. The smaller range of motion, lower pressure pain thresholds, and higher levels of stress accentuate the multidimensionality of the problem.