Introduction. Tension-Type Headache (TTH) is the most prevalent headache often associated with impaired function and quality of life. Temporomandibular Disorders (TMD) and TTH frequently coexist; characterized by pericranial tenderness and impact on daily life. We aim to apply a standardized questionnaire for TMD to characterize and analyse an eventual relation between sleep and oral health in TTH in a controlled design. Material and Methods. 58 consecutive TTH patients and 58 healthy controls were included. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire, Oral Health Impact profile (OHIP) and questionnaires for sleep were applied. Results. TTH-patients had significantly higher pain scores ( ), decreased quality of life ( ), and higher total sleep scores ( ) compared to controls. Conclusion. For the first time we have identified a clear relation between TTH and TMD symptoms, depression, anxiety, poor sleep, and impairments of oral function in carefully classified patients. These findings indicate a close, but incomplete, overlap between TTH and TMD. Their underlying pathophysiological mechanisms need further research. 1. Introduction Epidemiological studies of sleep and headache disorders point to a close connection, but the causal relations are unclear [1]. Sleep is thus reported to be the most important alleviating factor in migraine and tension-type headache (TTH) and in contrast also a trigger factor in cluster headache [1]. Likewise, disturbed sleep and lack of sleep are reported to be important trigger factors for TTH and other headaches [1]. TTH is the most prevalent headache in the adult population affecting functional and psychosocial quality of life of the patients [2]. The socioeconomic burden of TTH is thus enormous, but very little scientific attention is directed to the underlying pathophysiology and treatment strategies. In a large Danish longitudinal epidemiological study, we have identified disturbed sleep as a very important risk factor for poor prognosis of TTH [2], but detailed analysis of the specific relations have not yet been conducted. We haves also addressed the issue of overlaps between headaches and Temporomandibular Disorders (TMD) [2, 3] in accordance with other studies [4]. More than half of the headache patients from our tertiary headache center also had TMD diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) [5] and ICHD-II [6], indicating a close relationship, at least in some of the clinical manifestations of the painful conditions.
References
[1]
J. C. Rains, J. S. Poceta, and D. B. Penzien, “Sleep and headaches,” Current Neurology and Neuroscience Reports, vol. 8, no. 2, pp. 167–175, 2008.
[2]
A. C. Lyngberg, B. K. Rasmussen, T. J？rgensen, and R. Jensen, “Incidence of primary headache: a Danish epidemiologic follow-up study,” American Journal of Epidemiology, vol. 161, no. 11, pp. 1066–1073, 2005.
[3]
A. G. Glaros, D. Urban, and J. Locke, “Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap,” Cephalalgia, vol. 27, no. 6, pp. 542–549, 2007.
[4]
G. C. Anderson, M. T. John, R. Ohrbach et al., “Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain,” Pain, vol. 152, no. 4, pp. 765–771, 2011.
[5]
L. LeResche, S. F. Dworkin, L. Wilson, and K. J. Ehrlich, “Effect of temporomandibular disorder pain duration on facial expressions and verbal report of pain,” Pain, vol. 51, no. 3, pp. 289–295, 1992.
[6]
V. Ballegaard, P. Thede-Schmidt-Hansen, P. Svensson, and R. Jensen, “Are headache and temporomandibular disorders related? A blinded study,” Cephalalgia, vol. 28, no. 8, pp. 832–841, 2008.
[7]
D. A. G. Gon？alves, M. E. Bigal, L. C. F. Jales, C. M. Camparis, and J. G. Speciali, “Headache and symptoms of temporomandibular disorder: an epidemiological study: research submission,” Headache, vol. 50, no. 2, pp. 231–241, 2010.
[8]
P. F. Allen, A. S. McMillan, D. Walshaw, and D. Locker, “A comparison of the validity of generic- and disease-specific measures in the assessment of oral health-related quality of life,” Community Dentistry and Oral Epidemiology, vol. 27, no. 5, pp. 344–352, 1999.
[9]
S. F. Dworkin, J. Sherman, L. Mancl, R. Ohrbach, L. LeResche, and E. Truelove, “Reliability, validity, and clinical utility of the research diagnostic criteria for temporomandibular disorders axis II scales: depression, non-specific physical symptoms, and graded chronic pain,” Journal of Orofacial Pain, vol. 16, no. 3, pp. 207–220, 2002.
[10]
The International Classification of Headache Disorders, vol. 24, supplement 1, Cephalalgia, 2nd edition, 2004.
[11]
S. F. Dworkin and L. LeResche, “Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique,” Journal of Craniomandibular Disorders, vol. 6, no. 4, pp. 301–355, 1992.
[12]
A. M. C. Fransson, A. Tegelberg, L. Leissner, B. Wenneberg, and G. Isacsson, “Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: a 2-year follow-up,” Sleep & Breathing, vol. 7, no. 3, pp. 131–141, 2003.
[13]
D. Locker, “Measuring oral health: a conceptual framework,” Community Dental Health, vol. 5, no. 1, pp. 3–18, 1988.
[14]
Hans Gj？rup and P. Svensson, “OHIP-(D), en danskversion af Oral Health Impact Profile,” pp. 304–311, 2011, TANDL？GEBLADET 2006, 110, NR. 4.
[15]
F. Jadidi, O. N？rregaard, L. Baad-Hansen, L. Arendt-Nielsen, and P. Svensson, “Assessment of sleep parameters during contingent electrical stimulation in subjects with jaw muscle activity during sleep: a polysomnographic study,” European Journal of Oral Sciences, vol. 119, no. 3, pp. 211–218, 2011.
[16]
B. M. Laibovitz, Temporomandibular Disorders and Headache: A Review of the Literature, 2006.
[17]
R. Jensen and J. Olesen, “Initiating mechanisms of experimentally induced tension-type headache,” Cephalalgia, vol. 16, no. 3, pp. 175–182, 1996.
[18]
J. G. Steele, P. J. Lamey, S. W. Sharkey, and G. M. Smith, “Occlusal abnormalities, pericranial muscle and joint tenderness and tooth wear in a group of migraine patients,” Journal of Oral Rehabilitation, vol. 18, no. 5, pp. 453–458, 1991.
[19]
M. A. Moufti, R. W. Wassell, J. G. Meechan, P. F. Allen, M. T. John, and J. G. Steele, “The Oral Health Impact Profile: ranking of items for temporomandibular disorders,” European Journal of Oral Sciences, vol. 119, no. 2, pp. 169–174, 2011.
[20]
S. Mitrirattanakul and R. L. Merrill, “Headache impact in patients with orofacial pain,” Journal of the American Dental Association, vol. 137, no. 9, pp. 1267–1274, 2006.
[21]
E. Vazquez-Delgado, J. E. Schmidt, C. R. Carlson, R. DeLeeuw, and J. P. Okeson, “Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients,” Cephalalgia, vol. 24, no. 6, pp. 446–454, 2004.
