Concomitant Headache and Its Association With Worse Psychological and Clinical Status in Temporomandibular Disorders

To analyse clinical features and psychological status according to the presence of concomitant headache in a well-defined group of temporomandibular disorders (TMD).

Graded Chronic Pain Scale and Symptom Checklist-90-Revision were applied to evaluate pain disability and psychological characteristics in a group of 793 TMD patients. The presence of generalised bodily symptoms, sleep disturbance, and general health status was collected. Clinical and psychological variables associated with concomitant headache were statistically identified.

Among the TMD patients, 290 reported headache (37%). Those with headache reported higher levels of TMD pain intensity (p = 0.005) and more frequently reported pain on palpation of the masticatory muscles (p = 0.031) and temporomandibular joint (p = 0.007). Also, clenching (p = 0.016), sleep disturbance (p < 0.001), and insomnia (p < 0.001) were more prevalent. Those with headache experienced pain in other body regions more frequently. Higher levels of somatization (p < 0.001), depression (p = 0.045), anxiety (p = 0.005), and paranoid ideation (p = 0.022) were found in the headache group.

TMD patients when reporting concomitant headache showed higher pain levels, widespread pain, and higher levels of psychological distress. The results indicate the need to appropriately address the issue of headache in TMD patients with an emphasis on psychological issues to improve overall prognosis.