Study of quality of life in patients with primary headache and temporomandibular disorders

Temporomandibular disorders (TMD), according to the American Academy of Orofacial Pain (AAOP) is a collective term that embraces several clinical problems that involve the masticatory muscles, the temporomandibular joint (TMJ) and the associated structures. Headaches, especially the primary headache syndromes, are frequently associated with TMD. Studies have shown that these pain conditions can affect different aspects of patient’s quality of life. However, there is a lack of data regarding the impact of primary headache associated with TMD on patient´s quality of life. The present study aimed to evaluate the quality of life of patients presenting painful TMD and primary headache disorders. The sample was composed by 293 individuals (83.6% women) aged between 18 to 76 years old (mean 37.57). The sample was stratified in control group (n = 34), TMD (n = 25), TMD/Headache (n = 203) and Headache only (n=31). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) was applied to confirm the TMD diagnosis. Primary headaches were diagnosed based on the International Classification of Headache Disorders-2nd edition and the criteria proposed by Silberstein and Lipton for chronic daily headaches. The assessment of quality of life was made through the Medical Outcomes Study 36 - Item Short-Form Health Survey SF-36. Differences statistically significant was found among groups in all domains of the SF-36 (p <0.001). Regarding the bodily pain domain, the control group differed significantly (p <0.05) of the other three groups, the group TMD/Headache was significantly different (p <0.05) of the TMD group and of the Headache group. The domains physical functioning, role physical and vitality, presented lower scores on TMD/Headache group when compared to others groups (p<0.05). The mental health, role emotional, social functioning and general health, showed lower scores on TMD/Headache group than among the control group and headache group (p <0.05). When sample was stratified according to headache frequency, it was found that individuals with chronic headache had significantly lower scores when compared with episodic headache individuals in physical functioning (p = 0.001), bodily pain (p <0.001), vitality (p = 0.030) and general health (p = 0.046) domains. In conclusion it was found that the association between primary headache and TMD represents a strong impact on quality of life of individuals and that the chronic headaches affect more significantly the patient than episodic headaches