Headache Disorders, Tension-Type Headache
Conditions
Keywords
Bite force, Temporomandibular disorder, Neck pain
Brief summary
Patients with tension-type headache (TTH) and migraine often experience musculoskeletal complaints, like neck pain and/or jaw pain. Earlier studies have revealed an association between different headache types and neck pain and discussed the possible role of the cervical muscles. Furthermore, patients with neck pain show a decrease in motor control of the jaw, without having any other signs of TMD. Similarly, studies in patients with TMD have only found an indication for poorer neck muscle function. Patients with TMD also show a decrease in bite force and force steadiness compared to healthy controls. It is however, unknown if bite force and force steadiness are similarly impaired in patients with headache and/or neck pain. The current study will take a closer look at the jaw muscle function of in patients with TTH, with and without neck pain.
Detailed description
Tension-type headache (TTH) and migraine has been found to coincide with cervical pain, musculoskeletal dysfunction and/or temporomandibular disorders (TMD). The possible interplay between these three symptoms/disorders, headache, neck pain and TMD, have not been studied completely, only in sections. Earlier studies have revealed an association between different headache types and neck pain and discussed the possible role of the cervical muscles. Patients with TTH and (chronic) migraine exhibit lower muscle strength in the neck extensor muscles compared to healthy controls. Patients with neck pain show a decrease in motor control of the jaw, without having any other signs of TMD. Similarly, studies in patients with TMD have only found an indication for poorer neck muscle function while patients with TMD also show a decrease in bite force and force steadiness compared to healthy controls. It is however, unknown if bite force and force steadiness are similarly impaired in patients with headache and/or neck pain. Muscle tenderness increases with increasing headache frequency and intensity in TTH while this association is not present in migraine patients. Tenderness has a significant influence on the neck muscle function in TTH patients and there is a negative correlation between Total Tenderness (TTS) and muscle force. There is currently, however, no clear understanding of the influence of tenderness on the function of jaw muscles in TTH patients. The current project will increase the investigator's understanding of the interplay or dependency between the function of the jaw and neck muscles in TTH patients. If a comorbidity of TMD or neck pain make TTH patients more prone to dysfunction of jaw and neck muscles, this may lead to a subgrouping of these TTH patients. Together with the muscle function deficits discovered in the current case control study, this may suggest a targeted treatment for TTH to be tested in a follow up randomized control study.
Interventions
OTHERBite force testing
Maximum bite force examination with a force intra-oral measuring device
Sponsors
UMC Utrecht
Academic Centre for Dentistry in Amsterdam
Danish Headache Center
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
* Age between 18 and 55 years old. * Diagnosed Frequent episodic TTH (1-14 headache days / month) or chronic TTH (≥15 headache days/ month) based on the ICHD-3. * Maximum 3 days of migraine per month. * Signed informed acceptance of participation.
Exclusion criteria
* medication overuse headache (ICHD-3) * missing more than 1 molar, * previous whiplash or head trauma, * other major physical or neurological diseases, * diagnosed depression, other mental illness * unable to understand and speak Danish. * Pregnant or lactating women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Bite Force | baseline | Maximum bite force in Newton, best out of three tests |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bite Force Steadiness | baseline | 30% of maximum bite force held for 30 seconds, expressed as mean and standard deviation |
| Neck muscle function | baseline | Ratio of flexion/extension strength |
| Total Tenderness Score | baseline | Overall total tenderness score (range 0 - 48; higher score means higher tenderness of the muscles). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale | baseline | Pain intensity for headache, neck pain and jaw complaints (range 0 - 10; higher means more pain) |
| Prevalence of temporomandibular disorders | baseline | The prevalence of the different diagnoses of temporomandibular disorders, based on the diagnostic criteria for temporomandibular disorders. |
Countries
Denmark
Contacts
Primary ContactBjarne Kjeldgaard Madsen, PT, PhD
Backup ContactDianna Bartolin Christiansen
Outcome results
None listed