Investigation of the association between temporomandibular disorders and migraine: clinical, psychosocial and pathophysiological aspects

Abstract

Temporomandibular disorder (TMD) are often associated with migraine in a comorbid relationship. Several factors seem to interfere in this association, with emphasis on the involvement of the Trigeminal System and the participation of Calcitonin Gene-Related Peptide (CGRP) in both conditions. Psychosocial factors also seem to interfere in this association. Also, referred pain/sensations are commonly found in painful conditions such as TMD, which can hinder the differential diagnosis with primary headaches. The aim of the present study will be to evaluate the pain characteristics, psychosocial aspects, and the salivary CGRP levels of patients with painful TMD and migraine isolated or in combination. The presence of pain/referred sensations will also be assessed through standardized palpation in trigeminal (T) and extratrigeminal (ET) areas. For this, an observational, cross-sectional clinical study will be conducted involving women aged 18 to 50 years. The sample will be stratified into 4 groups: CG: Control Group (Individuals without any painful condition), TMD (individuals diagnosed with myalgia), MIG: Migraine (participants with episodic migraine), TMD+MIG: participants presenting TMD and Migraine. To characterize the sample, sociodemographic information will be collected. TMD classification and psychosocial assessments will be performed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). For the identification of primary headaches, the criteria of the International Classification of Headache Disorders - Third Edition (ICHD-3) will be adopted. The assessment of the symptoms of depression, anxiety and physical symptoms will be performed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Questionnaire (GAD-7) and the Patient Health Questionnaire-15 (PHQ-15). Central sensitization symptoms (CS) will be accessed by the CS inventory (CSI). The pressure pain threshold (PPT) will also be evaluated, and standardized palpation will be performed using a palpometer with different intensities (0.5; 1; 2 kg) in the trigeminal and extra-trigeminal areas. The analysis of salivary CGRP level will be performed using the ELISA test. Numerical data will be evaluated for normal distribution and the homogeneity of variances of the groups will be compared to apply the most appropriate statistical test. Correlation analysis will be performed to assess the association between salivary CGRP levels in patients with Migraine and/or TMD. All statistical analyzes will be performed at a significance level of 5% (± = 0.05). (AU)