Influence of temple headache frequency on physical functioning and emotional functioning in subjects with temporomandibular disorder pain.

Temporomandibular disorders (TMD) occur in about 10% of the population, whereas the prevalence of frequent episodic tension-type headache (FETTH) ranges from 24% to 43%, and the prevalence of chronic tension-type headache (CTTH) ranges from 3% to 5%.1–3 Several studies have demonstrated many shared signs and symptoms of tension-type headache (TTH) and TMD.4 In studies of TMD patients, TTHs are very common5,6 and TMD is common in studies of TTH patients.7–11 The International Classification of Headaches Disorders, second edition (ICHD–II) has recognized this relationship of headache and TMD with the inclusion of the secondary headache, “11.7 Headache or facial pain attributed to temporomandibular joint (TMJ) disorders,” which includes a criterion of headache associated with jaw activity.12 The ICHD–II also made a general request for investigation of secondary headaches so that their diagnostic criteria “can be much more clearly defined.”12 In addition, the dental literature has recently encouraged dialog between the dental and medical communities regarding these disorders.13 An important feature of TTH in the ICHD–II is frequency of occurrence, which is used to divide TTH into subtypes of infrequent episodic (IETTH), frequent episodic (FETTH), and chronic (CTTH) tension-type headaches.12 IETTH has little impact on the individual, while FETTH may result in more pain-related disability and economic costs. CTTH is a serious condition with considerable impact on quality of life and disability of affected individuals.12,14,15 Pain, depression, anxiety, psychological distress, and impaired sleep are also common in patients with TMD and have been reported to result in reduced quality of life.16–18 Although the criteria for secondary TMD-related headache do not include subtypes of frequency as used in primary TTH, the effect of TTH frequency suggests that headache frequency should be considered in the investigation of TMD-related secondary headaches. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has suggested that six domains should be considered in the assessment of clinical trials to permit meaningful comparisons between intervention studies in chronic pain conditions such as headache.19 Although intended for clinical trials, the use of this set of standardized domains is also applicable to other study designs. It allows patient-centered effects to be compared across pain conditions such as TMD and headache. In a previous study, the authors observed that subjects with painful TMD showed significant trends for increased signs and symptoms of TMD associated with patient report of increased frequency of temple headaches, suggestive of secondary TMD-related headaches.20 The present study investigated the effects of temple headache frequency on physical functioning and emotional functioning in the same study sample. The authors hypothesized that psychological and emotional functioning would be decreased in association with increased frequency of temple headache. Therefore, the aim of this study was to investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in TMD subjects and concurrent temple headache. A secondary objective was to assess the association between patient report of jaw activities aggravating temple headache and headache frequency.