Comparison of clinical signs in patients with episodic and chronic tension-type headache attributed to temporomandibular disorders. Preliminary results

Aim: This study assessed (1) the sensitivity at trigeminal and non-trigeminal site in TMD patients with episodic (ETTH) and chronic tension type headache (CTTH) compared with healthy controls and (2) the relationship between familiar headache in the temples and provocation tests of the masticatory system in TMD patients with ETTH and CTTH. Materials and Methods: 153 TMD pain subjects and 84 healthy controls were enrolled in the study. Inclusion criterion for the TMD subjects was a RDC/TMD pain diagnosis (group I and III) and ETTH or CTTH diagnosed according to IHS criteria. Assessment variables were mandibular range of motion, masticatory muscle and TMJ tenderness, referred pain, pressure pain threshold (PPT), and provocation tests of the jaw. Results: PPT differed significantly between controls and TMD (ETTH and CTTH) patients at trigeminal and non-trigeminal sites (p < 0.001). Number of painful muscle sites increased significantly with headache frequency (p < 0.001). CTTH patients had significantly more sites with referred pain in the temples than ETTH patients (p < 0.03). Overall, 31% of ETTH and 57% of CTTH patients reported familiar headache in one or more of the provocation tests. Conclusion: TMD patients with ETTH and CTTH had increased sensitivity at trigeminal and non-trigeminal sites and more muscle tenderness compared with controls, which suggests involvement of peripheral and central sensitization. Overall, one-third of ETTH and over half of CTTH patients exhibited a causal temporal relationship with familiar headache in the temples following provocation tests