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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Conservative, non invasive and reversible treatment is possible and highly successful for most temporomandibular disorder patients. Unfortunately, at this time it is not possible to provide preventive therapy or predict an 'at risk' group. Perpetuating and aggravating factors can sometimes be identified and eliminated in patients suffering from a TMD. TMD treatment can also be of benefit for chronic headache patients. A logical approach to the management of TMJ disorders has been outlined that emphasises the principle of 'escalation of therapy'. This has the advantage of avoiding overtreatment and maintaining patient confidence if initial attempts fail.
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PMID:A management approach for temporomandibular disorders. 141 56

This is a descriptive study to establish the profile of 120 consecutive patients seeking relief from symptoms and dysfunction of the masticatory system at the Dental Clinic, Singapore General Hospital from February 1988-September 1988. The mean age of the patients was 29.4 years and females outnumber males by 2:1. The patients complained of TMJ clicking (66%), TMJ pain (55%), painful chewing (47%), headaches (42%), painful opening (37%), jaw locking (33%), and jaw muscle pain (23%). The possible etiological factors were recorded: macrotrauma (27%), stressful episodes (24%), unilateral mastication (53%), clenching (28%), grinding (26%) and excessive chewing habits (10%). Unilateral chewing was significantly associated with pain on opening (p less than 0.05) and joint pain (p less than 0.05). A statistical relationship was found between night grinding and laterotrusive wear of teeth (p less than 0.001). There was evidence that tension headache reported by TMD sufferers was related to temporalis muscle/tendon dysfunction (p less than 0.001).
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PMID:A profile of patients with temporomandibular disorders in Singapore--a descriptive study. 262 16

Clinical investigations of temporomandibular disorders require objective, repeatable methods for screening diseased subjects from non-diseased control subjects. This study evaluated whether information gathered from a short, public domain questionnaire was useful in distinguishing temporomandibular disorder subjects (n = 216) from non-temporomandibular disorder controls (n = 69) and tension-type headache subjects (n = 22). The questionnaire consisted of eight questions relating to jaw pain (i.e., location of pain, precipitating factors, and temporal pattern of pain) and five questions relating to jaw function (i.e., joint noises, locking, and difficulty in opening). There were five possible answers to each question which ranged from 0 (no symptoms) to 4 (unbearable or constant symptoms). The total scores for the eight pain questions and the five jaw function questions were used to determine the questionnaire's sensitivity and specificity in each group, and ROC curves were plotted to identify the best cutoff point for disease presence or absence. Results showed that the questionnaire reliably distinguished between the control group and temporomandibular disorder group with 90.3%-97.7% sensitivity and 95.7%-100% specificity at cutoff values between 5 and 9. These results support the use of the questionnaire as a primary screening tool for general practice and as a supplementary screening tool for clinical temporomandibular disorder studies. However, results also showed that the questionnaire was unable to distinguish easily between TMD subjects and temporalis region tension-type headache subjects.
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PMID:Validity of a brief questionnaire in screening asymptomatic subjects from subjects with tension-type headaches or temporomandibular disorders. 792 38

General agreement has emerged in the scientific literature that behavioral and educational modalities are useful and effective in the management of chronic pain conditions. Behavioral and educational treatment modalities constitute a component of virtually every established chronic pain treatment program. It has been demonstrated that management of temporomandibular disorders has benefited from such behavioral interventions as well. The label "biobehavioral" refers to proven, safe methods that emphasize self-management and acquisition of self-control over not only pain symptoms but also their cognitive attributions or meanings and maintaining a productive level of psychosocial function, even if pain is not totally absent. A large collection of treatment modalities is subsumed under the label of biobehavioral treatments; the most commonly studied of these include biofeedback, stress management, relaxation, hypnosis, and education. An NIH Technology and Assessment Conference held in 1995 comprises the best available summary of the state of the art concerning the suitability of biobehavioral methods as useful approaches to ameliorate chronic pain, including TMD. Educational methods have also been demonstrated to be efficacious in the self-management of headache and back pain, but only limited data are available for TMD. By and large, when biobehavioral treatments are used in the management of TMD, effects are virtually always positive and in the hypothesized beneficial direction. While effects are often moderate in size, these methods show the potential for producing long-lasting benefits when compared with usual clinical treatment for TMD. Research has as yet failed to establish one biobehavioral modality as superior to another. It is important to note that much the same situation is present with regard to the scientifically established validity of many biomedically based TMD treatments.
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PMID:Behavioral and educational modalities. 900 36

Forty-three patients who underwent arthroscopic surgery for arthrogenous TMD were polled concerning the effect of surgery on the symptoms of headache, neck pain, shoulder pain, dizziness and tinnitus. Statistically significant levels of symptom reduction were recorded for all symptoms polled. This indicates that a substantial number of significant symptoms are produced by the influence of temporomandibular joint pathology on central neural processes. A model for the affect of temporomandibular joint pathology on cervical and masticatory musculature is proposed. This data implies that we cannot use muscle tenderness, hypertonicity and/or pain to differentiate arthrogenous from myogenous temporomandibular disorders. The characteristics of a population of whiplash onset TMD patients were compared to other TMD populations. The results indicate that whiplash induced TMD may differ from insidious onset TMD and even other trauma onset TMDs by prevalence of neck pain, intensity of neck pain and probability of concurrence of neck pain, shoulder pain, headache and jaw pain. These symptoms resolved within 24 hours of arthroscopic temporomandibular joint surgery indicating that the temporomandibular joint pathology was the perpetuating force behind, if not the cause of, these symptoms.
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PMID:A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus. 908 76

The dental profession faces educational, scientific, and ethical challenges in orofacial pain and headache. Past educational deficiencies are being addressed with guidance and recommendations from the AADS, the ADA, and the AAOP. With education and further research, many dental ethical questions in TMD will be resolved. The educational process must continue with a solid foundation in scientific basis provided in university settings. The appropriate use of TMD diagnostic machines, treatment modalities, and management of perpetuating factors such as sleep will evolve with the new knowledge of scientific discovery. These are some of the many challenges of orofacial pain and headache disorders that warrant special consideration.
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PMID:Special considerations in orofacial pain and headache. 914 87

Seventy-five patients suffering from myofascial pain, headaches and anterior disc displacement were assessed clinically and with a kinesiograph. Twenty-eight asymptomatic dental staff served as a control group. The prevalence of awareness of bruxism was significantly greater in our TMD patients than the controls. Bruxism patients recorded a higher prevalence of incisor dentine wear suggestive of a forward mandible posture. Class II, Division 1 malocclusions formed a significantly higher proportion of the TMD patient group than the controls. Kinesiographic recordings showed that the vertical and lateral components of movement from postural position to intercuspal were significantly greater in the patient group.
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PMID:Occlusal variables, bruxism and temporomandibular disorders: a clinical and kinesiographic assessment. 921 96

For many years researchers and clinicians have been aware of the varying presenting signs and symptoms common in the TMD patient. The symptom-complex frequently includes preauricular pain; cephalgia (predominantly frontal, temporal, occipital, vertex, retro- and periorbital); cervicalgia (immobility/stiffness); otalgia (congestion, vertigo, tinnitus). The most prominent signs are those of joint sounds (popping, click and crepitus due to disc displacement with reduction and/or osseous breakdown); restricted mandibular excursion (disc displacement without reduction); and mandibular deviation/deflection (disc(s) displacement).
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PMID:Facial asymmetry: recognition of TMD. 961 Feb 80

The purpose of this study was to investigate the effectiveness of repositioning splint therapy as a conservative treatment modality for TMD patients. The treatment sequence of 160 randomly sampled TMD patients was monitored in order to assess different aspects of the patients' response to splint therapy. Included among these aspects were the pretreatment symptoms; the treatment duration required for initial and final alleviation of symptoms; the number of patients requiring surgery; and the particular appliance and its wear pattern utilized to maintain the treatment results. The treatment success was based on the remission of symptoms including but not limited to pain to palpation, headaches, earaches, jaw locking, and joint noises. Eighty-nine and four tenths percent (89.4%) of the patients experienced a complete remission of symptoms and did not require any surgical intervention. The average time for initial improvement was 22.3 days, while the average time for complete remission of symptoms was 4.3 months. The results of the study indicate that repositioning splint therapy is an effective treatment modality for the conservative treatment of temporomandibular disorders.
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PMID:The treatment of temporomandibular disorders through repositioning splint therapy: a follow-up study. 1002 48

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes.
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PMID:Chronic pain conditions in women. 1032 86


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