Journal of Oral & Facial Pain and Headache最新文献

Calcitonin gene-related peptide (CGRP) monoclonal antibodies in the treatment of episodic and chronic migraine was invetigated. A comprehensive literature search was conducted in Ovid Medline, Web of Science and Embase databases from their inception until April 2024 for randomized controlled trials comparing CGRP monoclonal antibodies with placebo or other active treatments in adults with episodic or chronic migraine. The primary outcome assessed was the incidence of hypertension, and secondary outcomes were tolerability, acceptability and adverse events. Data analysis was performed using a random-effects model, and the strength of evidence was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A total of eleven studies involving 9729 participants were found eligible and included for data analysis. The results revealed that the pooled odds ratio for the incidence of hypertension in patients receiving CGRP monoclonal antibodies compared to placebo was (95% confidence interval (CI): 0.60, 2.21; I² = 32%), suggesting no significant increase in hypertension risk. Moreover, no significant differences were observed in tolerability or acceptability between the CGRP monoclonal antibody and placebo groups. However, the overall risk of total adverse events was significantly higher in the CGRP monoclonal antibody group (odds ratio (OR): 1.13; 95% CI: 0.97, 1.33; I² = 56%; p = 0.01). These findings indicate that CGRP monoclonal antibodies are well-tolerated and present a generally safe option for treating episodic and chronic migraine. Although there was no significant increase in the incidence of hypertension, a slight rise in overall adverse events was observed. Consequently, CGRP monoclonal antibodies may be considered a viable treatment option for patients who have not found other treatments effective or tolerable, or who have contraindications to alternative therapies. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (http://www.crd.york.ac.uk, registration number: CRD42024554897).

Tension-type headache (TTH) is a common primary headache disorder, and recent research has focused on various treatment options. However, studies evaluating acupuncture for TTH from the perspective of Traditional Chinese Medicine (TCM) and its mechanisms are limited. This literature review synthesizes findings from twelve clinical studies that investigated acupuncture for TTH treatment. Data analysis was conducted for acupoint selection, types of acupuncture, treatment duration and needle retention time in these studies considering TCM principles. Our results indicate that acupuncture practitioners should select acupoints based on TCM syndrome differentiation and patient-specific factors. The optimal treatment duration is at least four weeks, with each session lasting a minimum of 20 minutes, and 30 minutes per session is recommended for enhanced efficacy. Additionally, the therapeutic effects of acupuncture on TTH may involve mechanisms such as the inhibition of myofascial trigger points and the modulation of central sensitization.

Orofacial migraine (OFM) and neurovascular orofacial pain (NVOP) are both recognized as migraine-related entities affecting the facial and orofacial regions, according to the International Classification of Orofacial Pain (ICOP). However, the distinction between these two conditions and the question of whether NVOP should be considered a separate entity remain subjects of ongoing debate. The aim of this study is to compare the diagnostic characteristics of OFM and NVOP to reassess whether they should continue to be classified as two distinct diagnoses. The cohort comprised 75 patients, 12 males and 63 females, 40 were diagnosed as NVOP and 35 as OFM according to ICOP criteria. Patients were recruited from the tertiary orofacial pain clinic in Hadassah Medical Center between the years 2016 to 2023. NVOP and OFM patients did not differ in age, sex, pain intensity and other pain characteristics. However, OFM patients have significantly more cranial autonomic signs (36.4%) than NVOP patients (10.3%), and also more migraine symptoms such as nausea and photophobia. (68.6% vs. 41%) OFM patients reported significantly more awakening from sleep (52.9%) than NVOP patients (26.3%). Also, OFM pain was concomitant with headache in about two third of cases (66.7%), compared to only a third (30.8%) of NVOP cases. Most NVOP patients have pain that mimics toothache (85%), rarely detected in OFM (11.4%). The diagnostic features of OFM and NVOP indicate that there are many similarities between the two. But also, unique features that allows for separating OFM and NVOP into two distinct diagnostic entities, in accordance with the ICOP classification. Inclusion of patients with associated headaches enhanced this separation, and suggests expanding the definition of ICOP and include it under OFM and NVOP. At present there is justification to maintain the separate ICOP classifications of NVOP and OFM, particularly for research purposes.

To assess the correlation between awake bruxism (AB) behaviors and psychological status in a group of healthy young adults. Participants were recruited at the University of Siena, Siena, Italy, by advertising the initiative. The reported frequency of AB behaviors was evaluated through the Oral Behavior Checklist (OBC). The 4-item Patient Health Questionnaire-4 (PHQ-4) was adopted to evaluate the participants' psychological status. Student's t-test was used to detect differences between genders. The Pearson correlation test was performed to assess the correlation between the two questionnaires. Mandible bracing showed the strongest correlation with anxiety and depression traits (r = 0.62), followed by teeth clenching (r = 0.54). Teeth contact (r = 0.33) and teeth grinding (r = 0.32) had the lowest level of correlation. In a sample of healthy young individuals, there is a moderate-to-high correlation between the reported teeth clenching and mandible bracing frequency and the degree of anxiety and depression symptoms. Such findings suggest the importance of the psychological assessment in awake bruxers.

A scoping review was carried out with the aim of mapping the existing literature on the association between sleep/awake bruxism and primary headache (migraine and tension headache) in children and adolescents. This scoping review followed the method proposed by Arksey & O'Malley and the Joanna Briggs Institute Manual for Evidence Synthesis and was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR). The methods were registered in the Open Science Framework (). The following was the guiding question: "What does the literature say about the association between bruxism (sleep and awake) and primary headache (migraine and tension headache) in children and adolescents?". Two independent researchers performed searches of the Cochrane Library, Embase, PubMed/Medline, Scopus and Web of Science electronic databases. Searches were conducted in August and September 2022 and updated in July 2023, leading to the retrieval of 6089 articles, 11 of which were selected for inclusion in the review. Sleep bruxism was associated with migraine as well as the frequency, duration, and intensity of migraine. Patients with tension headache are at increased risk for sleep bruxism and girls are more affected by both migraine and tension headache. In this scoping review, an association was found between primary headache (tension headache and migraine) and sleep bruxism. Awake bruxism was not investigated separately, making it difficult to determine its association with headache. The interaction between these variables is a complex phenomenon of unknown nature that merits further research.

The role of sedentary behaviors in temporomandibular disorders (TMD) has not been thoroughly investigated. This study aims to investigate the potential association between sedentary behaviors and TMD using Mendelian randomization (MR) analysis. The MR method was employed to assess the causal association between sedentary behaviors and the risk of TMD. Genetic variants associated with sedentary behaviors, such as watching TV (Television), using computers and driving, were used as instrumental variables (IVs). MR analysis was performed using inverse variance-weighted (IVW) and weighted median methods, alongside MR-Egger regression to assess pleiotropy and statistical heterogeneity. Furthermore, leave-one-out analyses were conducted to assess whether any single SNP (single nucleotide polymorphism) or subset of SNPs influenced the results. Our analysis identified a significant association between driving time and the risk of temporomandibular disorders (IVW: OR (Odd ratio) = 2.797, 95% CI (Confidence interval) = 1.148-6.811, p = 0.024; weighted median OR = 4.271, 95% CI = 1.226-14.871, p = 0.023). In contrast, no significant associations were observed between time spent watching TV and using a computer and TMD risk. The robustness of the findings was confirmed through sensitivity analyses, including leave-one-out analysis. This study provides evidence of a potential genetic link between prolonged driving and TMD risk, suggesting that individuals frequently engaged in long-duration driving should be monitored for TMD symptoms. Further research is warranted to explore the complex interactions between sedentary behaviors and TMD, incorporating longitudinal and comprehensive assessments.

Temporomandibular disorders (TMD) comprise a group of conditions affecting the masticatory muscles, the temporomandibular joints and associated structures, often manifesting as orofacial pain and functional limitations of the mandible. Central sensitization (CS) is gaining increasing attention in research focused on pain syndromes and somatization, playing a significant role in the pain experience. This study investigates the prevalence of CS and somatization among TMD patients, analyzing their relationships with TMD diagnoses and the intensity of chronic masticatory muscle pain (MMP). A prospective observational study was conducted with 214 adult participants diagnosed with TMD, based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The Central Sensitization Inventory (CSI) and the Somatic Symptom Scale-8 (SSS-8) were utilized to assess CS and the burden of somatic symptoms, respectively. Furthermore, the patients were assessed for MMP, and the average pain in these muscles was calculated. Statistical analysis investigated correlations between CSI and SSS-8 scores, specific TMD diagnoses and MMP intensity. Most participants did not surpass the subclinical level for CS as assessed by the CSI. Women reported higher SSS-8 scores than men, suggesting sex differences in somatic symptom reporting. No significant relationship was found between specific TMD diagnoses and levels of CS or the SSS-8. However, a significant correlation was observed between SSS-8 scores and the intensity of chronic MMP, underscoring the impact of the intensity of chronic MMP on the perception of somatic symptoms among TMD patients. Additionally, the group with subclinical levels of CS presented significantly lower SSS-8 scores than other groups. This study highlights a lower-than-expected prevalence of CS among TMD patients. Higher levels of somatization were related to higher levels of CS and greater MMP. The findings suggest that TMD management should not only address specific pain sources but also consider the broader psychosocial aspects of the disorders, especially in chronic types.

Temporomandibular disorder (TMD) is considered a complex disorder that follows the biopsychosocial model. The current study aimed to explore the effect of clinic location and referring physicians on the distribution of Axis I diagnoses according to the Diagnostic Criteria for TMD (DC/TMD). Eighty-eight patients from a dental school Orofacial Pain Clinic (DentalOFP) and 104 patients from a hospital Orofacial Pain Clinic (HospitalOFP) were examined by the same dentist who was certified as a DC/TMD examiner and compared. Significant differences between the two clinics were noted, including age (p = 0.002), gender (p = 0.019), symptom duration (p < 0.001), and referring physician's profile (p < 0.001). While 55.7% of referring physicians were dentists in the DentalOFP clinic, only 13.5% of referring physicians were dentists in the HospitalOFP clinic. DentalOFP clinic presented with characteristics of a tertiary clinic, as to female: male ratio and longer symptom duration. Significant differences were found as to intra-articular disorders (IAD) (p = 0.019), degenerative joint disorder (DJD) (p = 0.041), and subluxation (p = 0.015). There were no significant differences as to local myalgia (p = 0.128), myofascial pain with referral (p = 0.389), and arthralgia (p = 0.096). Multiple parameters, such as age, gender, symptom duration, primary vs. tertiary clinic, clinic location, and referring physicians may affect the overall DC/TMD Axis I profile. This study supports abandoning the term TMD. It is suggested to assess each Axis I diagnosis separately, and for each Axis I diagnosis, to follow the International Classification of Orofacial Pain (ICOP), as to primary vs. secondary etiologies, and acute vs. chronic conditions, to provide appropriate treatment.

Bruxism is a significant phenomenon that should not be underestimated, given its prevalence and consequences. The major symptoms associated with bruxism include myalgia, decreased quality of life, and limited mandibular movements. This study aimed to evaluate and compare the effectiveness of four treatment methods for managing bruxism-related symptoms: botulinum toxin (BoNT-A), dry needling (DN), pharmacological therapy (PT), and manual therapy (MT). Eighty patients with bruxism (44 female, 36 male) were randomly assigned to four groups of 20 patients each. All therapies were administered by the same maxillofacial surgeon. Measurements were recorded at baseline (pre-treatment) and at 2, 4 and 12 weeks post-treatment. The metrics assessed included the visual analog scale (VAS) for pain, maximum painless mouth opening (MMO), and the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis was performed using a mixed-design repeated measures two-way analysis of variance (ANOVA) to compare changes within and among the groups over time. Tukey's multiple comparison test was applied for further analysis. The results indicated that both objective and subjective clinical outcomes were similar across all treatment groups. Considering their competitive efficiency, non-invasiveness or minimal invasiveness, and cost-effectiveness, DN, MT and PT appear to be promising alternatives for managing bruxism and its symptoms, especially in the early stages. ClinicalTrials ID: NCT06583551.

This study aimed to investigate the metabolic mechanisms underlying the combination of patent foramen ovale (PFO) and migraine by assessing metabolite expression before and after interventional occlusion surgery. The study included 11 PFO patients from the Heart Center of Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, who underwent transcatheter PFO intervention and occlusion surgery between January 2018 and February 2023, and 11 healthy controls. Blood samples were collected pre-surgery, 3 days post-surgery, and 30 days post-surgery for metabolomics analysis. The goal was to identify differentially expressed metabolites between groups. Statistical analyses were performed to evaluate these metabolites alongside migraine disability, assessed using the Migraine Disability Assessment (MIDAS) score. Preliminary analysis of metabolic pathways was also conducted. Results showed significant differences in serum metabolites, including dopamine, L-proline, L-tyrosine, D-proline, acetylcarnitine, and dulcitol, between PFO migraine patients and healthy controls based on Liquid Chromatography-Mass Spectrometry (LC-MS) non-targeted metabolomics analysis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of these metabolites revealed enrichment in protein digestion, absorption, and metabolic signaling pathways, highlighting the role of metabolism in the disease process. Elevated levels of dopamine and other metabolites were found in migraine patients, with differential metabolites primarily associated with the arginine metabolic pathway, suggesting its importance in the condition's progression. Additionally, patients with PFO and migraine showed significant improvements in headache frequency, duration, and severity post-treatment (p < 0.05), though accompanying symptoms did not show statistically significant changes (p > 0.05). Overall, interventional closure surgery for PFO significantly alleviates headache symptoms in patients.