Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Clinical Characteristics of Headache in Orofacial Pain Patients

구강안면통증 환자에서의 두통 양상의 분류

  • Kang, Jin-Kyu (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Ryu, Ji-Won (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Taek (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Choi, Jong-Hoon (Department of Oral Medicine, College of Dentistry, Yonsei University)
  • 강진규 (연세대학교 치과대학 구강내과학교실) ;
  • 유지원 (조선대학교 치과대학 구강내과학교실) ;
  • 김성택 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실)
  • Published : 2006.12.30
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Abstract

Headache is a common disease which influences not only individually but also socially. Temporomandibular disorders(TMD) refers to pain and dysfunction within the temporomandibular joint(TMJ) and associated muscles. TMD is presented commonly, and 70% of population are found to have one or more related symptom. A number of studies have been conducted to verify the association between headache and TMD, and some authors have proposed that headache and TMD may be related. In this study, we studied the patterns of headache presented by the patients who visited the TMJ and Orofacial pain clinic. Among the patients participated in this study, tension type headache showed the highest prevalence(48.5%), followed by migraine without aura(15.0%), probable migraine(10.6%), migraine with aura(7.1%), probable tension type headache(4.8%), and other primary headaches(1.8%). The high prevalence of tension type headache may be due to the accompaniment of orofacial pain by pericranial muscle tenderness. Comparison of sex showed that the rate of migraine was higher in female than male(female to male ratio 35.8:25.3). In age analysis, the rate of migraine was high in the twenties(42.2%) and the thirties(40.0%). As the age increased, the rate of migraine decreased, and this trend was in accordance with the previous studies. The percentage of the patients who had previously received treatment was only 26.2%, and that of those who were aware of the diagnosis was merely 8.7%. Therefore, it is not common for headache patients to get treatment, however, since orofacial pain is often accompanied by headache, more systematic diagnosis as well as precise treatment would be necessary. Moreover, since TMD could induce and aggravate headache, proper evaluation and management of TMD would be essential for diagnosis and treatment of headache. In the future, more systematic and broad investigation on the influence of causative factors of TMD on headache as well as the change in headache pattern with the treatment of TMD would be required.

두통은 매우 흔한 질환 중 하나로 개인적으로나 사회적으로 미치는 영향이 크다. 측두하악장애는 측두하악관절과 주위 근육의 통증과 기능장애를 통칭하는 용어로 전 인구의 70%에서 하나 이상의 관련된 증상을 호소할만큼 흔한 질환이다. 두통과 측두하악장애의 연관성에 대한 다양한 연구가 이루어지고 있으며, 몇몇 저자들은 일부 두통이 측두하악장애와 관련이 있는 것으로 보고하였다. 본 연구는 구강내과, 턱관절 및 안면통증 클리닉에 내원한 구강안면통증 환자의 두통 양상을 분석해 보았다. 전체 530명의 환자 중 긴장형 두통이 292명(48.5%)으로 가장 높은 비율을 차지하였고, 무전조성 편두통이 90명(15.0%), 개연적 편두통이 64명(10.6%), 유전조성 편두통이 43명(7.1%), 개연적 긴장형 두통이 29명(4.8%), 기타 일차성 두통이 11명(1.8%)으로 나타나 긴장형 두통 군의 비율이 상당히 높게 나타났는데 이는 구강안면통증 환자들이 대부분 근막동통 등 두개안면 근육의 통증을 동반하기 때문인 것으로 추측할 수 있다. 성별에 따른 분류에서 편두통은 남성(25.3%)보다 여성(35.8%)에서 높은 발생율을 나타냈다. 연령에 따른 분류에서는 20대와 30대에서 편두통 군의 비율이 각각 42.2%, 40.0%로 높게 나타났고, 연령이 증가할수록 감소하다가 50대에서 다시 증가추세를 나타내는 양상을 보여 기존의 연구들과 일치하는 결과를 보였다. 이전에 두통 때문에 진료를 받았던 경험이 있는 환자는 139명으로 26.2%에 불과했으며, 자신의 진단명을 알고 있는 경우는 46명으로 전체 환자의 8.7%밖에 되지 않았다. 이와 같이 환자들이 두통으로 인해 병원에서 진단 및 치료를 받는 경우는 드문 실정이지만, 구강안면통증과 두통은 동반되어 나타나는 경우가 많기 때문에 구강안면통증을 주소로 내원한 환자에서 두통이 동반된 경우 이에 대한 정확한 진단과 치료가 필요하리라 사료된다. 또한 측두하악장애는 두통의 유발 및 악화요인이 될 수 있으므로 두통 환자의 진단 및 치료시 측두하악장애의 증상에 대한 평가 및 적절한 관리가 중요하리라 사료되며, 향후 측두하악장애의 원인요소가 두통에 미치는 영향과 측두하악장애의 치료에 따른 두통의 변화 양상을 연구하는 등 보다 체계적이고 다양한 접근이 필요할 것으로 생각되는 바이다.

Keywords

References

  1. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population - a prevalence study. J Clin Epidemiol 1991;44:1147-1157 https://doi.org/10.1016/0895-4356(91)90147-2
  2. Rasmussen BK. Epidemiology of headache. Cephalalgia 2001;21:774-777 https://doi.org/10.1046/j.1468-2982.2001.00248.x
  3. Leonardi M, Steiner TJ, Scher AT, Lipton RB. The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF). J Headache Pain 2005;6:429-440 https://doi.org/10.1007/s10194-005-0252-4
  4. Rasmussen BK, Jensen R, Olesen J. A populationbased analysis of the diagnostic criteria of the International Headache Society. Cephalalgia 1991;11:129-134. https://doi.org/10.1046/j.1468-2982.1991.1103129.x
  5. Takeshima T, Ishizaki K, Fukuhara Y, Ijiri T, Kusumi M, Wakutani Y, Mori M, Kawashima M, Kowa H, Adachi Y, Urakami K, Nakashima K. Population-based door-to-door survey of migraine in Japan: The Daisen study. Headache 2004;44:8-19. https://doi.org/10.1111/j.1526-4610.2004.04004.x
  6. Miranda H, Ortiz G, Figueroa S, Pena D, Guzman J. Prevalence of Headache in Puerto Rico. Headache 2003;43:774-778 https://doi.org/10.1046/j.1526-4610.2003.03135.x
  7. Ashkenazi A, Silberstein SD. Headache management for the pain specialist. Reg Anesth Pain Med 2004;29:462-475 https://doi.org/10.1097/00115550-200409000-00012
  8. Camarda R, Monastero R. Prevalence of primary headaches in Italian elderly: preliminary data from the Zabut Aging Project. Neurol Sci 2003;24:S122-S124
  9. Roh JK, Kim JS, Ahn YO. Epidemiologic and clinical characteristics of migraine and tension-type headache in Korea. Headache 1998;38:356-365 https://doi.org/10.1046/j.1526-4610.1998.3805356.x
  10. Chung CS, Cho HI, Jung KY, Moon HS, Oh KM, Kim TH, Ha HH. Epidemiology of headache disorders in Korea 2004. The Korean Journal of Headache 2005;1:101
  11. Kim BK Bae HJ, Koo JS, Kwon OH, Park JM. Clinical Characteristics of migraine and tension-type headache: The experience in Eulji Hospital. The Korean Journal of Headache 2005;1:103
  12. Okeson JP. Orofacial pain. Guidelines for Assessment, Diagnosis, and Management. 3rd ed. Chicago. 1996, Quintessence Pub Co Inc. pp. 113-141
  13. Hentschel K, Capobianco DJ, Dodick DW. Facial pain. Neurologist 2005;11:244-249 https://doi.org/10.1097/01.nrl.0000164816.56936.71
  14. Glass EG, McGlymm FD, Glaros AG, Melton K, Romans K. Prevalence of temporomandibular disorder symptoms in a major metropolitan area. Cranio 1993;11:217-220 https://doi.org/10.1080/08869634.1993.11677968
  15. Jensen R. Rasmussen BK, Pedersen B, Lous I, Olesen J. Prevalence of oromandibular dysfunction in a general population. J Orofac Pain 1993;7:175-182
  16. Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The prevalence and treatment needs of subjects with temporomandibular disorders. J Am Dent Assoc 1990;120:295-303 https://doi.org/10.14219/jada.archive.1990.0059
  17. Ciancaglini R, Radaelli G. The relationship between headache and symptoms of temporomandibular disorder in the general population. J Dent 2001;29: 93-98 https://doi.org/10.1016/S0300-5712(00)00042-7
  18. Mitrirattanakul S, Merrill RL. A headache impact in temporomandibular disorders (TMD) and orofacial pain patients: MIDAS study. J Dent Res 2002;81(SpecIss A):A-130
  19. Lous I, Olesen J. Evaluation of pericranial tenderness and oral function in patients with common migraine, muscle contraction headache and 'combination headache'. Pain 1982;12:385-393 https://doi.org/10.1016/0304-3959(82)90183-X
  20. Lipchik GL, Holroyd KA, Talbot F, Greer M. Pericranial muscle tenderness and exteroceptive suppression of temporalis muscle activity: a blind study of chronic tension-type headache. Headache 1997;37:368-376 https://doi.org/10.1046/j.1526-4610.1997.3706368.x
  21. Jensen R. Diagnosis, epidemiology, and impact of tension-type headache. Curr Pain Headache Rep 2003;7:455-459 https://doi.org/10.1007/s11916-003-0061-x
  22. Jensen R, Olesen J. Tension-type headache: An update on mechanisms and treatment. Curr Opin Neurol 2000;13:285-289 https://doi.org/10.1097/00019052-200006000-00009
  23. Kemper JT Jr, Okeson JP. Craniomandibular disorders and headaches. J Prosthet Dent 1983;49:702-705 https://doi.org/10.1016/0022-3913(83)90400-6
  24. Molina OF, dos Santos J Jr, Nelson SJ, Grossman E. Prevalence of modalities of headaches and bruxism among patients with craniomandibular disorder. Cranio 1997;15:314-325 https://doi.org/10.1080/08869634.1997.11746026
  25. Nakamura T, Okamoto K, Maruyama T. Facial asymmetry in patients with cervicobrachial pain and headache. J Oral Rehabil 2001;28:1009-1014 https://doi.org/10.1046/j.1365-2842.2001.00766.x
  26. Headache Classification Subcommittee of the International Headache Society. The International classification of headache disorders. 2nd Ed. Cephalalgia 2004;24(S1):1-160
  27. Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993;53:65-72. https://doi.org/10.1016/0304-3959(93)90057-V
  28. Jensen R. Peripheral and central mechanisms in tension-type headache: An update. Cephalalgia 2003;23(Suppl 1):49-52 https://doi.org/10.1046/j.1468-2982.2003.00574.x
  29. Silberstein SD. Migraine. Lancet 2004;363:381-391 https://doi.org/10.1016/S0140-6736(04)15440-8
  30. Tfelt-Hansen P, Lous I, Olesen J. Prevalence and significance of muscle tenderness during common migraine attacks. Headache 1981;21:49-54 https://doi.org/10.1111/j.1526-4610.1981.hed2102049.x
  31. Jensen R, Rasmussen BK. Muscular disorders in tension-type headache. Cephalalgia 1996;16:97-103 https://doi.org/10.1046/j.1468-2982.1996.1602097.x
  32. Yoly M. Gonzalez, Norman D. Mohl. Masticatory muscle pain and dysfunction. In Laskin DM, Greene CS, Hylander WL(Ed). TMDs: An evidence-based approach to diagnosis and treatment. Chicago, 2006, Quintessence Pub Co Inc., pp. 255-258
  33. Seligman DA, Pullinger AG. The role of functional occlusal relationships in temporomandibular disorders: a review. J Craniomandib Disord 1991; 5:265-279
  34. Pettengill C. A comparison of headache symptoms between two groups: a TMD group and a general dental practice group. Cranio 1999;17:65-69
  35. Magnusson T, Carlsson GE. Recurrent headaches in relation to temporomandibular joint pain-dysfunction. Acta Odontol Scand 1978;36:333-338 https://doi.org/10.3109/00016357809029084
  36. Bernhardt O, Gesch D, Schwahn C, Mack F, Meyer G, John U, Kocher T. Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania(SHIP). Quintessence Int 2005;36: 55-64
  37. Freund BJ, Schwartz M: Relief of tension-type headache symptoms in subjects with temporomandibular disorders treated with botulinum toxin-A. Headache 2002;42:1033-1037 https://doi.org/10.1046/j.1526-4610.2002.02234.x
  38. Silberstein S, Gobel H, Jensen R, Elkind A, Degryse R, Walcott J, Turkel C. Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study. Cephalalgia 2006;26:790-800 https://doi.org/10.1111/j.1468-2982.2006.01114.x
  39. Porta M, Camerlingo M. Headache and botulinum toxin. J Headache Pain 2005;6:325-327 https://doi.org/10.1007/s10194-005-0222-x
  40. Silberstein S, Mathew N, Saper J, Jenkins S. Botulinum toxin type A as a migraine preventive treatment. For the BOTOX Migraine Clinical Research Group. Headache 2000;40:445-450 https://doi.org/10.1046/j.1526-4610.2000.00066.x