Temporomandibular Disorders may Contribute to Primary Headaches

A study published in the Journal of Oral and Facial Pain and Headache reveals that individuals with painful myogenous temporomandibular disorders (TMDs) often experience a concurrent presence of fibromyalgia and chronic widespread pain (CWP).

Fibromyalgia, recognized as a subtype within chronic widespread pain (CWP), is defined by pervasive musculoskeletal pain. The coexistence of temporomandibular disorders (TMD) and fibromyalgia is commonly acknowledged as a duo of chronic overlapping pain conditions (COPCs). Additionally, conditions such as migraine, chronic tension-type headache, chronic lower back pain, chronic fatigue syndrome, and irritable bowel syndrome (IBS) are also classified as COPCs. 

Despite numerous studies exploring the coexistence of fibromyalgia and temporomandibular disorders (TMDs), the connection between these two conditions remains unclear. Clarifying the epidemiological aspect of this association is crucial for the accurate diagnosis and management of patients experiencing these conditions. Hence, this study was conducted with the recognition of this need for understanding.

To ascertain the prevalence of chronic widespread pain and fibromyalgia in individuals with temporomandibular disorders and vice versa, a thorough search was systematically carried out across electronic databases. The quality of the studies was evaluated using the Newcastle-Ottawa Scale, and meta-analyses employing specific diagnostic criteria were employed to assess pooled prevalence estimates.

The assessment incorporated 19 studies of moderate to high quality, comprising 9 studies examining the prevalence of chronic widespread pain or fibromyalgia in individuals with temporomandibular disorders, and 10 studies evaluating the prevalence of TMDs in those with CWP or fibromyalgia. Among these studies, 10 were case-control, 6 were cross-sectional, and 3 were cohort studies. Heterogeneity across the pooled studies was noted, attributed to variations in criteria guidelines, protocols, subjective patient and clinician assessments, and differences in application over time.

The key findings of this study were:

As indicated by the meta-analyses, three-quarters of individuals with fibromyalgia concurrently had temporomandibular disorders (76.8% [69.5% - 83.3%]), and around one-third of those with temporomandibular disorders had comorbid fibromyalgia (32.7%, 4.5% - 71.0%).

In comparison to disc displacement disorders, myogenous temporomandibular disorders were more prevalent in this patient group (63.1% [47.7% - 77.3%] vs. 24.2% [19.4% - 39.5%], respectively). Additionally, comorbid inflammatory degenerative temporomandibular disorders were observed in 41.8% (21.9% - 63.2%) of individuals with fibromyalgia.

The highest percentages of patients with temporomandibular disorders exhibiting symptoms of fibromyalgia were noted in a study of individuals with painful disorders of the masticatory muscles lasting ≥6 months (63.2%) and in a study where patients were referred to a physiatrist for the evaluation of potential fibromyalgia (52.4%).

These results imply that clinicians should take into account the intersection of temporomandibular disorders with chronic widespread pain and fibromyalgia when providing care to affected individuals. Additionally, in suitable cases, adopting multidisciplinary approaches to treatment may be beneficial.

Source:

Dibello, V., Lozupone, M., Sardone, R., Ballini, A., Lafornara, D., Dibello, A., Vertucci, V., Santarcangelo, F., Maiorano, G., Stallone, R., Petruzzi, M., Daniele, A., Solfrizzi, V., & Panza, F. (2023). Temporomandibular Disorders as Contributors to Primary Headaches: A Systematic Review. In Journal of Oral & Facial Pain and Headache (Vol. 37, Issue 2, pp. 91–100). Quintessence Publishing. https://doi.org/10.11607/ofph.3345