Journal of Oral & Facial Pain and Headache最新文献

Background: Calcium pyrophosphate dihydrate deposition disease (CPPD) is a metabolic disease resulting in acute arthritis. CPPD often affects joints containing fibrocartilage. The purpose of this review is to examine the clinical presentations, prevalence, and treatment modalities associated with CPPD when it affects the temporomandibular joint (TMJ).

Methods: A search, following PRISMA guideline, was conducted in various electronic databases (PubMed, Scopus, Web of Science) to find relevant studies about CPPD in the temporomandibular joint. The search spanned from 01 January 1980, to 31 January 2024. A case report was also presented.

Results: A systematic review of literature identified 64 papers, reaching a total of 74 cases of CPPD of the temporomandibular joint TMJ. CPPD is a condition that typically affects middle-aged or older patients, with an average age of around 60 at the time of diagnosis. Females are affected more frequently than males. Most cases involve unilateral TMJ involvement, and common symptoms include pain, reduced mouth opening, and swelling. Different papers also describe severe stages of the invasion of muscles, parotid gland, and even brain structure. Surgery has the preferred treatment option for most Authors and is mandatory for late-stage lesions. The recurrence rate is extremely low.

Conclusions: CPPD is an uncommon, locally invasive, and typically benign condition that rarely affects the TMJ. Distinguishing CPDD in the TMJ from other neoplasms poses diagnostic challenges. A definitive diagnosis necessitates histological examination and quantitative microanalysis. In our patient, successful excision of CPDD in the TMJ was achieved using an external approach.

The prospero registration: PROSPERO number is CRD42024558402.

Background: Misdiagnoses often lead to suboptimal therapeutic approaches, making early and accurate diagnoses by experts crucial for effective headache management. This study primarily aims to investigate the referred patient profiles with headaches to optimize diagnostic and referral approaches.

Methods: In this cross-sectional multicenter international study, sixty-nine neurologists from 13 countries evaluated headache patients referred to neurology clinics (NCs). Researchers recruited patients on different weekdays selected by the research randomizer program for five consecutive weeks in April and May 2022. The clinicians collected data on various factors such as age, sex, headache characteristics and accompanying symptoms using the Head-MENAA study questionnaire and the International Classification of Headache Disorders-3 (ICHD-3) criteria. Patients were grouped according to the settings as emergency services (ESs), other specialty clinics (OSCs) and private offices (POs) in which they were evaluated.

Results: A total of 3722 individuals out of 12043 evaluated in NCs had headache complaints. Among them, 15.07% consisted of patients referred to neurology by these three different settings. 14.8% of them were referred from ESs, 16.58% from OSCs, and 68.64% were applied to POs. While there was not a significant difference between groups regarding the mean age, the proportion of male patients in the ESs (49.4%) was higher than those in OSCs (26.9%) and POs (23.1%) (p < 0.001). Headache severity was higher in the ESs and POs than in the OSCs and Neurology Outpatient Clinics (NOCs) (p < 0.001). Primary headaches were the reason for consultation in 89.2% of patients in the ESs, 90.3% of patients in OSCs and 93.5% of patients in POs, migraine without aura being the most common headache type in all groups.

Conclusions: This study suggests that preferences for admission and referral may vary based on demographic characteristics, types and severity of the headache, as well as accessibility and availability of different settings.

Background: Various studies have demonstrated a close link between headaches and temporomandibular disorders (TMD). However, the results are often limited to certain clinical aspects and are based on a cross-sectional study design. This study aimed to examine the clinical characteristics of patients with both TMD and migraine symptoms and to assess the long-term treatment outcomes compared to TMD patients without migraine.

Methods: Sixty-four TMD patients were evaluated using the Diagnostic Criteria for TMD protocol and validated questionnaires, including Generalized Anxiety Disorder-7, Patient Health Questionnaire (PHQ)-9, PHQ-15, the Graded Chronic Pain Scale, and the Symptom Checklist-90-Revision (SCL-90-R). Patients were divided into two groups based on the presence of migraine symptoms requiring medication. The study compared psychological and clinical profiles, as well as long-term treatment outcomes.

Results: The migraine group exhibited greater psychological distress, as indicated by higher scores in the SCL-90-R subscales for somatization (p = 0.035), obsessive-compulsive behavior (p = 0.015), interpersonal sensitivity (p = 0.002), depression (p = 0.035), anxiety (p = 0.042), hostility (p = 0.004), paranoid ideation (p = 0.016), and psychoticism (p = 0.044). Additionally, they scored higher on the PHQ-9 (p = 0.023) and PHQ-15 (p = 0.016). Pain levels were higher in the migraine group at 3 months post-treatment (p = 0.023) but the difference with the non-migraine group disappeared 6 months post-treatment. Younger age (odds ratio (OR) = 0.844, p = 0.001), female (OR = 0.001, p = 0.011), and more positive sites on masticatory muscle palpation (OR = 2.580, p = 0.011) were associated with a higher likelihood of experiencing migraine. Mental illness history (β = -0.465, p = 0.002), tongue ridging (β = -0.683, p < 0.001), and Oral Behavior Checklist scores (β = 0.483, p = 0.002) were associated with TMD pain intensity in the migraine group.

Conclusions: TMD patients using sumatriptan for migraine symptoms had higher levels of disability and psychological distress, leading to an increased disease burden. Although the migraine group had worse short-term TMD treatment outcomes, these differences resolved after six months of treatment.

Background: Motor vehicle accidents (MVA) are associated with the onset of temporomandibular disorder (TMD) symptoms. However, diagnosing TMD-related pain is challenging due to various entities that can refer pain to the region. This study aims to identify prevalent radiographic confounders to pain diagnosis in MVA patients who were subsequently referred for temporomandibular joint imaging using cone-beam computed tomography (CBCT) by comparing these patients to a cohort of patients without MVA history.

Methods: CBCTs of 738 temporomandibular joints were reviewed, with cases stratified by MVA history. This research explored the demographics and calculated the prevalence of radiographic confounders (RC) in each category, comparing the findings for both groups. The chi-square test was used to assess statistical significance.

Results: Patients in the MVA cohort (n = 151, mean age = 41.3 years, S.D (Standard Deviation) = 13.3 years) averaged 1.10 confounders/patient compared to a significantly lower 0.68 confounders/patient in the non-MVA cohort (n = 218, mean age = 33.6 years, S.D = 18.2 years). The most frequently identified RCs include sinus pathologies (39.1% (MVA) vs. 28.0% (non-MVA), p = 0.025) and endodontic lesions (22.5% (MVA) vs.10.1% (non-MVA), p = 0.001).

Conclusions: Clinicians must be vigilant about confounders when managing patients suspected of TMD. We recommend patients undergo a complete dental evaluation before being referred to a specialist to avoid unnecessary medical costs and treatment delays.

Background: Although pharmacologic therapies are considered the first choice for the treatment of chronic tension-type headache (CTTH), physiotherapy and rehabilitation approaches are also used in the management of patients with CTTH. This study aimed to investigate the efficacy of physiotherapy approaches in CTTH through a systematic review and meta-analysis.

Methods: The following electronic databases were searched, PubMed and Web of Science databases. Common primary outcomes from randomized controlled trials (RCTs) were changes in the intensity and duration of headaches, headache frequency, disability and headache impact. The methodologic quality (completeness of reporting and risk of bias) of trial reports included in systematic reviews was assessed using the Physiotherapy Evidence Database scale ratings. We also performed data synthesis and quantitative analysis of the eligible data.

Results: Nine RCTs were included in the review. Seven studies related to intensity of headache (IH), three on headache frequency (HF), three on headache duration (HD), and two on headache impact were eligible for quantitative analysis. Analysis of the data showed that neck-shoulder strength exercises, electroacupuncture, and approaches targeting muscle relaxation improved the IH (-1.17 (-1.86, -0.49) p < 0.01) and reduced the HD (-0.71 (-1.31, -0.12), p = 0.02); the approaches targeting muscle relaxation and neck-shoulder strength exercises induced a significant decrease in the HF (-1.36 (-2.47, -0.26), p = 0.02) in patients with CTTH in comparison with the control groups.

Conclusions: Neck-shoulder strength exercises and muscle relaxation are effective in reducing the intensity, duration, and frequency of headaches and electroacupuncture causes significant improvement in the duration and intensity of headaches in patients with CTTH.

The prospero registration: PROSPERO number is CRD42023457085.

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.

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.

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.

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).

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.