Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs

Abstract – The experiment was performed in order to study the effect of acupuncture on headache by comparing the number of attacks during a 2-month period after acupuncture with the number of attacks during a similar period before treatment. Twenty-nine students (age: 19–24 years) all suffering from headache filled out questionnaires noting the days with attacks of headache and the amount and type of drugs used for 60 consecutive days. After acupuncture this observation procedure was repeated. One group of 10 students, however, received a placebo treatment instead of acupuncture but followed the identical questionnaire procedure. After 120 days acupuncture was given to this second group without revealing that the first treatment was a placebo. This treatment was again followed by a 60-day observation period. Comparison of the questionnaires before and after acupuncture showed a significant reduction in the number of days with headache. The placebo treatment resulted in a nonsignificant reduction in attacks of headache. A reduction in the amount of drugs used, especially the acetylsalicylate type, was noted following the acupuncture treatment. It is concluded that acupuncture is a relevant therapy for headache with a definite symptomatic effect.     

Effect of acupuncture on tension headache and urinary catecholamine excretion

Abstract – Sixteen patients with tension headaches were treated with acupuncture, needles being inserted in the hand and foot and then electrostimulated. All patients were seen at four 2-h sessions with intervals of 1 week between each. The first two sessions were used for clinical examination only, thus serving as control, while acupuncture was administered during the last two sessions. Urine samples were collected immediately before and after each session and later analyzed for catecholamine content. During the 1-week intervals between sessions, records were kept of headache attacks and medicine intake. Following acupuncture two-thirds of the patients showed reduction in number of headache attacks, and about one half of the patients reduced their use of pain relieving drugs considerably. Urinary excretion of adrenaline and noradrenaline was always higher in samples collected before sessions than after sessions. However, this reduction in catecholamine excretion was significantly greater when acupuncture had been administered.     

Prevalence of recurrent headache and mandibular dysfunction in patients with unsatisfactory complete dentures

The prevalence of headache and mandibular dysfunction was studied in 43 patients with unsatisfactory complete dentures waiting for prosthodontic treatment at the Dental Clinic of the National Dental Service in Jokkmokk, Sweden. In addition to answering a questionnaire, all patients underwent a clinical-functional examination of the masticatory system. Seventeen patients (40%), 15 women and two men, reported recurrent headache. 63% of the men and 83% of the women showed marked clinical signs of mandibular dysfunction. A significant correlation between headache and mandibular dysfunction was found. The low representation of complete denture wearers in clinical series of patients referred for treatment of mandibular dysfunction may be due to a reduced propensity to seek help and a greater willingness to accept a certain degree of dysfunction compared with other people.     

Headaches and myofascial temporomandibular disorders: overlapping entities,separate managements?

There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non‐systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro‐facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.     

Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.     

High serum procalcitonin levels in patients with periodontitis and chronic migraine

1 Background

To evaluate the contribution of chronic periodontitis (CP) to serum procalcitonin (proCT) levels in chronic migraine (CM) patients in a cross‐sectional study.

2 Methods

We included 138 subjects divided into 4 groups based on clinical features of CM and periodontal parameters: systemically and periodontally healthy individuals (n = 37), systemically healthy and CP patients (n = 19), CM and periodontally healthy patients (n = 34), and CM+CP patients (n = 48). Demographic, neurological, clinical data as well as full‐mouth periodontal records were obtained. ProCT and high sensitive C‐reactive protein (hs‐CRP) serum levels were determined from blood samples taken during migraine interictal period.

3 Results

Patients from the CP+CM group (0.056±0.006 ng/mL) had significantly higher serum proCT levels in comparison with the systemically and periodontally healthy group (0.029±0.019 ng/mL), CM group (0.041±0.002 ng/mL), or CP group (0.034±0.014 ng/mL) (p < 0.001). There were no significant differences in hs‐CRP between groups (p = 0.081). Multiple linear regression analysis showed that CP was associated with increased proCT levels in CM patients (R² = 0.293, p < 0.001).

4 Conclusions

CP independently contributes to elevated serum proCT levels in CM patients. These findings suggest that CP could play a role in migraine chronification.     

Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Västerbotten,Sweden

Objective. The aim of this study was to analyze and compare prevalence of signs and frequently occurring symptoms indicative of temporomandibular disorder (TMD) and headaches in 35-, 50-, 65- and 75-year-old men and women in Västerbotten County, Sweden. Materials and methods. From a total target population of 11 324 subjects living in Västerbotten County in the year 2002, 300 individuals in each age group were randomly selected. Of these, 998 (82% response rate) answered and returned a postal questionnaire and 779 (65% response rate) individuals accepted a clinical examination. Results. The prevalence of frequent TMD symptoms peaked among 50-year-old women and then declined. Women at this age reported significantly higher prevalence compared to men for all TMD symptoms except temporomandibular joint locking. In the 65- and 75-year-olds, the prevalence was practically equal between men and women as well as between these ages. Frequent headaches showed the highest prevalence among 35- and 50-year-old women, with a statistically significant difference between men and women of 50 years of age (p < 0.05). Fifty-year-old women had statistically significantly higher prevalence of muscle pain to palpation (p < 0.001), temporomandibular joint sounds (p < 0.01) and impaired maximal jaw opening capacity (p < 0.01), compared to 50-year-old men. Conclusions. The different symptoms indicative of TMD and headaches showed a similar pattern, with higher prevalence among the 35- and 50-year-old, as compared to the 65- and 75-year-old, participants. The pattern may be related to biological, psychosocial or generation-related factors.     

The emerging role of botulinum toxin in the treatment of temporomandibular disorders

The objective of this review was to discuss the emerging role of botulinum toxin in the treatment of temporomandibular disorders (TMD), to review the current literature, recent clinical trials, as well as preliminary data from our own clinical study, and to formulate an algorithm for the work-up and treatment of TMD.     

Recurrent headaches in relation to temporomandibular joint pain-dysfunction

Magnusson, T. Carlsson, G.E. Recurrent headache in relation to temporomandibular joint paindysfunction.

Two groups of 80 patients, one referred because of mandibular dysfunction and one seeking dental treatment, completed questionnaires concerning recurrent headaches. The function of the masticatory system of all patients was afterwards examined clinically.

The investigation showed that clenching of teeth was correlated to the severity of headache. The frequency and severity of headache varied also with the severity of mandibular dysfunction. Of the variables included in the dysfunction index, only masticatory musculature painful to palpation was found to have a distinct relationship to headaches. This implies that functional treatment is indicated in patients with headaches and tenderness of the masticatory musculature. Functional examination of the masticatory system should therefore be included in investigations of recurrent headaches.     

Dental erosion and aspirin headache powders: A clinical report

The causes of tooth erosion are varied, but all are associated with a chemical attack on the teeth and resulting loss of tooth structure. Etiologic factors related to erosion cited in the literature include bulimia, eating acidic foods, soft drink consumption, acid reflux, and swimming, among others. This clinical report suggests that chronic use of headache powders can also be a factor leading to tooth erosion.     

A Survey of the Support Given by the Oslo Health Insurance Office for Social Dental Service in the Years 1942–47

Consultative and Controlling Dentist of the Oslo Insurance office Oslo     

Association of volume and voxel intensity of the articular disc and lateral pterygoid muscle in migraine patients: a study with magnetic resonance imaging

Abstract

Objectives: To compare the volume and voxel intensity of articular disc and lateral pterygoid muscle (LPM) between a group of migraine patients and a control group (those without history of headache) by using magnetic resonance imaging (MRI).

Patients and methods: MRI scans of 17 migraine patients and 15 healthy controls subjects were analysed and processed, using ITK-SNAP software, by a single investigator, for calculation of volumes and voxel intensity of articular disc and superior and inferior head of LPM.

Results: There were statistically significant differences between migraine patients and controls regarding the volume and voxel intensity of articular disc and inferior head of LPM, increasing in migraine patients. Intra-rater was highly consistent and reproducible (intra-class correlation coefficient [ICC] = 1).

Conclusions: Higher voxel intensity in disc and inferior head of LPM of MRI scans was linked to the increased volume of articular disc, inferior head of LPM and migraine.     

Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population

Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, Lavigne GJ. Prevalence and risk factors of sleep bruxism and wake‐time tooth clenching in a 7‐ to 17‐yr‐old population.
Eur J Oral Sci 2011; 119: 386–394. © 2011 Eur J Oral Sci Sleep‐related bruxism (SB) and wake‐time tooth clenching (TC) have been associated with temporomandibular disorders (TMDs), headache, and sleep and behavioral complaints. This study aimed to assess the prevalence and risk factors of these signs and symptoms in a 7‐ to 17‐yr‐old population (n = 604) seeking orthodontic treatment. Data were collected by questionnaire and by a clinical examination assessing craniofacial morphology and dental status. Sleep‐related bruxism was reported by 15% of the population and TC was reported by 12.4%. The SB group (n = 58) was mainly composed of children (67.3% were ≤12 yr of age) and the TC group (n = 42) was mainly composed of adolescents (78.6% were ≥13 yr of age). The craniofacial morphology of over 60% of SB subjects was dental class II and 28.1% were a brachyfacial type. Compared with controls (n = 220), SB subjects were more at risk of experiencing jaw muscle fatigue [adjusted OR (AOR) = 10.5], headache (AOR = 4.3), and loud breathing during sleep (AOR = 3.1). Compared with controls, TC subjects reported more temporomandibular joint clicking (AOR = 5), jaw muscle fatigue (AOR = 13.5), and several sleep and behavioral complaints. Sleep‐ and wake‐time parafunctions are frequently associated with signs and symptoms suggestive of TMDs, and with sleep and behavioral problems. Their clinical assessment during the planning of orthodontic treatment is recommended.     

Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache

The aim was to compare the short- and long-term effect of a stabilization appliance with a control appliance in myofascial pain patients suffering from episodic or chronic tension-type headache. Sixty patients (mean age 29 +/- 12 years) with temporomandibular disorders (TMD) of myogenous origin and headache were studied in this prospective controlled study. Seventy-seven per cent of the patients reported episodic and 23% chronic tension-type headache at the start of the study. The 60 patients were randomly assigned to a treatment group (stabilization appliance) or to a control group (control appliance). The patients were interviewed regarding symptoms of headache and myofascial pain and clinically examined for masticatory muscle tenderness. At the 10-week and the 6- and 12-month evaluations of appliance therapy, the treatment outcome of tension-type headache was studied. At the 10-week evaluation, 17 patients dropped-out from the control group by requesting another appliance and receiving a stabilization appliance. Another patient in the control group dropped out later during the trial. In an intent-to-treat analysis, significant differences in improvement of headache between treatment and control groups were found at the follow-ups. A 30% reduction of muscles tender to palpation correlated significantly to improvement of headache at all follow-ups. The stabilization appliance seems to have a positive effect on tension-type headache, both in a short- and in a long-term perspective in patients with TMD with pain of myogenous origin.     

Effect of acupuncture on myogenic headache

abstract – The purpose of the investigation was to study the effect of acupuncture on myogenic headache and to examine whether electromyographic recordings of jaw muscle activity would provide objective evidence of the effect of such treatment. In 21 dental students, 14 males and seven females, with a history of 2–10 years of headache, acupuncture was performed unilaterally in the foot between the 4th and 5th metatarsal bones (G 41). The needle was inserted to a depth of 10–15 mm and moved continuously by hand for 15–20 min. Electromyographic recordings of postural activity in the right and left anterior temporal and masseter muscles were obtained in the same sitting before, during and after acupuncture treatment. In clinical controls 24 h, 1 month and 4 months after the treatment, 12 subjects reported considerable improvement, two variable results, and seven no change. The electromyographic recordings showed an average decrease in postural activity during acupuncture, particularly of the temporalis muscles, and a further decrease after completed treatment. However, marked individual variations in muscular response were noted. The results indicate that acupuncture treatment can relieve headache, and that electromyographic recordings may provide objective evidence of the effect of acupuncture.