Temporomandibular disorders in migraine and tension-type headache patients: a systematic review with meta-analysis

The simultaneous occurrence of primary headaches and temporomandibular disorders can pose a challenge in determining the best clinical management of patients. Therefore, we aimed to summarize evidence regarding the risk and prevalence of temporomandibular disorders (TMDs) in migraine and tension-type headaches (TTH) patients. Cross-sectional studies published in English comparing the presence of TMDs in adults with TTH or migraine to subjects without headaches were included, International Classification of Orofacial Pain, Diagnostic Criteria for Temporomandibular Disorders or Research Diagnostic Criteria for Temporomandibular Disorders, and large epidemiological studies (sensitive diagnostic criteria (SDC)). The methodological quality was assessed by Modified Newcastle-Ottawa Quality Assessment Scale. Odds ratio (OR) and random effects were calculated. 1405 articles were identified in PubMed, Embase and Central databases, and 13 cross-sectional studies were finally included. Overall Risk of TMDs was statistically significantly higher than control groups in both Migraine (SDC: 11 studies; OR: 3.79 (2.43, 5.90); I² = 99%), with higher values in chronic migraine (OR: 24.27; (95% Confidence interval (CI): 5.84, 100.82); I² = 0%) and TTH populations (SDC: 8 studies; OR: 4.45 (2.63, 7.53); I² = 86%). Headache subjects presented a higher risk of muscular TMDs (5 studies; OR: 2.01 (1.62, 2.50); I² = 0%), Combined TMDs (5 studies; OR: 2.74 (1.40, 5.36); I² = 63%), or Painful TMDs (8 studies; OR: 5.31 (2.96, 9.54); I² = 96%). Headache patients didn't show the risk of arthrogenous TMDs (4 studies; OR: 0.96 (0.54, 1.71); I² = 33%) or nonpainful TMDs (2 studies; OR: 1.10 (0.28, 4.26); I² = 84%). The high heterogeneity in the results was reduced following subgroup analysis. Migraine and TTH appear to increase the risk of painful, myogenous or combined arthrogenous and myogenous TMDs.