Influence of temporomandibular disorders treatment on the frequency and intensity of migrane attack: a double-blind, randomized placebo controlled study.

Abstract

Temporomandibular disorder (TMD), according to American Academy of Orofacial Pain, is a collective term that encloses some clinical problems involving masticatory muscles, temporomandibular joint (TMJ) and associated structures or both. The signals and symptoms can include pain in the involved structures, limited or deviant jaw opening and chewing difficulties and articular sounds during mandibular movements. According to literature in general TMD affect women more than the men. The chronic headache is a symptom that frequently appears associated to the TMD and available international literature presents research corroborating these findings. According to Okeson some studies has shown recurrent chronic headaches in 70% to 85% of patients with TMD. In accordance with 2nd. Edition of the International Classification of Headache Disorders, migraine is a type of common, disabling and recurrent primary chronic headache (it does not present clear and definite structural injuries) manifesting in attacks lasting 4-72 hours. The typical characteristics are the unilateral localization of pulsating pain, moderate or strong intensity, aggravation by or causing avoidance of routine physical activity and associated with nausea and/or vomiting, photophobia and phonophobia. It can be divided in two major sub-types, Migraine without Aura and Migraine with Aura. Epidemiologic researches have registered raised prevalence of the migraine. The migraine can be aggravated or precipitating by some factors. Thus, in a person who fills the criteria for migraine, aggravating factors like psicossocial stress, frequent alcoholic beverage consumption and other extrinsic factors, can be associated with an increase in the intensity or frequency of attacks. The trigger or precipitating factors are conditions that can increase the probability of occurrence of a migraine attack in person with migraine, as the menstruation and the aspartame. Our hypothesis is that the TMD could be a trigger factor since the physiopathology of both are close associated with caudate nucleus of the trigeminal nerve. A clarification of the paper of the musculoeskeletal system in the physiopathology of the headache is not still available. Therefore, is important to study the relation between masticatory system dysfunction with TMD. In this fact is the relevance of the study considered here that intends to investigate the hypothesis of that TMD can be one more trigger factor for migraine attack in person with migraine. Then the objectives of this study are to determine the prevalence of migraine without aura between the patients that are looking for treatment for TMD; to investigate the influence of the TMD treatment in the frequency and intensity of the migraine attacks and evaluate the quality of life of the individuals before and after therapy procedures, relating it with the results of the treatment. The sample will be composed by women with 18 to 65 years old with migraine without aura and TMD. The size of the sample will be determined after pilot study to be executed. The exclusion and inclusion criteria are the recommended by Guideline elaborated for the Subcommittee of Clinical Trials of the International Headaches Society. The study will be made in three distinct phases: 1st. Phase will have duration of one month and 2nd. and 3rd. phases, three months each one. This will be a double-blind, placebo controlled study. To the end of the seven months all individuals of the randomized selected sample and took place in one of the three groups (TMD treatment, migraine without aura treatment and placebo group), will have received the adequate treatment for TMD and migraine without aura. Some migraine characteristics before and after treatment will be compared: frequency and intensity of the migraine attacks and quality of life. We will compare before and after migra (AU)