Prevalence of temporomandibular dysfunction in people experiencing headache and its reciprocal relationship: a systematic review and meta-analysis

Mosselson, Jackie
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Background : Temporomandibular dysfunction (TMD) is a disorder of the temporomandibular joint and associated orofacial structures. It is the second most common musculoskeletal disorder experienced by adults. Headache is one of the most pervasive neurological disorders and can be an extremely disabling condition. TMD and headache are known to frequently occur simultaneously and have a bi-directional relationship. Due to their close anatomical association TMD has been shown to generate headaches and headaches have been shown to cause TMD. The aim of this systematic review was to determine the prevalence of TMD occurring concurrently in people experiencing headache as well as the prevalence of headache occurring concurrently in people experiencing TMD. Method An extensive search of all databases was conducted using the keywords ‘temporomandibular dysfunction’, ‘TMD’, ‘TMJ’, ‘headache’, ‘migraine’, ‘migraine without aura’, tension-type headache’ and ‘cervicogenic headache’. Only studies conducted on adults were included. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess methodological quality of the included studies. Fourteen studies were included for meta-analysis and two studies could not be included in the meta-analysis and were described narratively. The results of all the studies were pooled using MedCalc statistical software. The prevalence of TMD within people experiencing headache was measured as well as within various headache sub-groups namely migraine, migraine without aura, tension-type headache, concurrent migraine and tension-type headache, cervicogenic headache and chronic headache. The prevalence of headache and various headache sub-groups within people experiencing TMD was measured as well. Male and female prevalence of TMD and headache in the various sub-groups was measured too. Due to the variance and differences in study types and number of participants, the random effects model was used for data-analysis to accommodate the expected high heterogeneity for some of the prevalence results. iv Results The total prevalence of TMD in people experiencing headache was 60.72%. The prevalence of TMD in the various headache sub-groups was as follows: 63.36% in people with migraine; 55.56% in people with migraine without aura; 75% in people with concurrent migraine and tension-type headache; 49.26% in people with tension-type headache; 44.67% in people with cervicogenic headache and 70.85% in people with chronic headache. The total prevalence of TMD in females with headache was 49.79% and in males with headache was 11.86%. The total prevalence of headache in people with TMD was 63.90%. The prevalence of the various headache sub-groups in people with TMD were as follows: 45.15% of people had migraine, 69% of people had concurrent migraine and tension-type headache, 28.58% of people had tension-type headache and 7.12% of people had chronic headache. The total prevalence of headache in females with TMD was 47.52% and 14.75% in males. Conclusion TMD was found to be highly prevalent in people experiencing headache, and had the highest prevalence in people with concurrent migraine and tension-type headache. Headache was found to be a prevalent comorbidity in people experiencing TMD, and the most prevalent headache type seen in individuals experiencing TMD was also concurrent migraine and tension-type headache. When treating people with headache it seems pertinent to correctly diagnose the headache type and determine if TMD is present. If headache is present in people diagnosed with TMD, it is imperative to determine if the headache is caused by TMD or is in fact a primary headache such as migraine or tension-type headache. If TMD is present in people experiencing headache, it would be prudent to treat the orofacial structures to maximise the efficacy of headache treatment. Future studies on the prevalence of TMD within people experiencing migraine without aura and cervicogenic headache would be beneficial as there have been limited studies on these headache groups to date
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirrements for the degree of Master of Physiotherapy.
Temporomandibular Joint Disc, Musculoskeletal Diseases, Headache