Central sensitization associated with a presence of painful TMD, migraine and TMD-attributed headache

Abstract

Temporomandibular disorder (TMD) is one of the most prevalent conditions of pain in the orofacial region and its pathophysiology frequently involves peripheral and central sensitization processes. This condition is often accompanied by other comorbidities, as migraine and headache attributed to TMD. The central sensitization (SC) process, which can be assessed through the quantitative sensory testing (QST), is frequently involved in the pathophysiological mechanisms of the comorbidity. Aims: To investigate the presence of CS in patients presenting painful TMD associated or not with migraine and headache attributed to TMD, after correct identification and correction by the confounding factors. Material and methods: This is an observational, cross-sectional study to be conducted among a sample of adults aged between 20-65 years. The sample will be stratified into three groups: 1) TMD pain; 2) TMD pain + Migraine and 3) TMD pain + headache attributed to TMD. The TMD will be classified through the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD). CS will be assessed through the Central Sensitization Inventory (CSI), test of temporal summation of pain, pressure pain threshold and the conditioned pain modulation (CPM). Assessment and classification of migraines will be performed according to the International Classification of Headache Disorders (3rd edition - beta version) criteria. The headache attributed to TMD will be assessed using the criteria proposed by Schiffman et al. 2012. For the study of the associations of interest will be carried out multivariate analyzes, and logistic regression models will be constructed. For all analyzes a significance level of 5% (p <0.05) will be considered. (AU)