Systemic diseases and other painful conditions in patients with temporomandibular disorders and migraine

Abstract Temporomandibular disorders (TMD) are a highly prevalent, painful musculoskeletal condition affecting the masticatory system, and are frequently associated with migraines (M) and other diseases. This study aimed to investigate the association between painful TMD and M with other painful conditions and systemic diseases, such as cervicalgia, body pain (BP), ear-nose-throat disorders, musculoskeletal disorders, diabetes, cardiopulmonary diseases and gastritis/peptic ulcer. Methods: This was a cross-sectional study conducted in a sample of 352 individuals. Participants were stratified into three groups according to the presence of painful TMD and M: controls [individuals free of TMD and any headache (HA)]; TMD only (presence of painful TMD, but free of any HA); and TMD+M (presence of painful TMD and M). TMD was classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I. Nonspecific physical symptoms (NSPS) were assessed by RDC/TMD - Axis II. The International Classification of Headache Disorders - II criteria, second edition, were applied to identify and classify primary HA. Other painful conditions and systemic diseases were assessed by volunteers’ self-report. The prevalence of all assessed conditions was higher in the TMD+M group. Multiple regression models showed that cervicalgia was associated with the TMD only group (p<0.05), whereas gender (p<0.05), cervicalgia (p<0.05), BP (p<0.05) and NSPS (p<0.05) were significantly associated with the TMD+M group. Our results suggest that individuals with a comorbidity (TMD associated with M) have a more severe condition than those presenting only painful TMD.

摘要
颞下颌关节紊乱病（Temporomandibular disorders, TMD）是一类患病率极高的疼痛性肌肉骨骼疾病，累及咀嚼系统，常与偏头痛（migraines, M）及其他疾病伴发。本研究旨在探究疼痛性颞下颌关节紊乱病与偏头痛伴发其他疼痛性疾病及全身性疾病的关联，所涉疾病包括颈痛、躯体痛（body pain, BP）、耳鼻咽喉疾病、肌肉骨骼疾病、糖尿病、心肺疾病以及胃炎/消化性溃疡。
方法：本研究为横断面研究，纳入352名受试者。研究人员根据受试者是否患有疼痛性颞下颌关节紊乱病及偏头痛将其分为三组：对照组[无颞下颌关节紊乱病及任何头痛（headache, HA）者]、仅颞下颌关节紊乱病组（患有疼痛性颞下颌关节紊乱病但无任何头痛者）以及颞下颌关节紊乱病伴偏头痛组（同时患有疼痛性颞下颌关节紊乱病及偏头痛者）。颞下颌关节紊乱病依据《颞下颌关节紊乱病研究诊断标准（Research Diagnostic Criteria for Temporomandibular Disorders, RDC/TMD）》轴I进行分类；非特异性躯体症状（nonspecific physical symptoms, NSPS）采用RDC/TMD轴II进行评估。采用第二版《国际头痛疾病分类（International Classification of Headache Disorders, ICHD-II）》标准对原发性头痛进行识别与分类。其余疼痛性疾病及全身性疾病通过受试者自我报告进行评估。
所有评估疾病的患病率在颞下颌关节紊乱病伴偏头痛组中均更高。多元回归模型结果显示，颈痛与仅颞下颌关节紊乱病组存在关联（p<0.05）；而性别（p<0.05）、颈痛（p<0.05）、躯体痛（p<0.05）及非特异性躯体症状（p<0.05）均与颞下颌关节紊乱病伴偏头痛组存在显著关联。本研究结果提示，同时伴发共病（颞下颌关节紊乱病与偏头痛）的受试者病情较仅患有疼痛性颞下颌关节紊乱病者更为严重。