Migraine, tension-type headache (TTH) and headaches attributed to temporomandibular disorders (TMD) are prevalent in patients with TMD-pain. The objective was to describe the course of headache complaints as compared to the course of TMD complaints in TMD-pain patients with headache during usual care multidisciplinary treatment for TMD. This was a 12-week longitudinal observational study following adults with TMD-pain and headache during a usual-care multidisciplinary TMD-treatment. The Graded Chronic Pain Scale was used for both TMD and headache to measure pain-related disability (primary outcome measure), pain intensity, days with pain and days experiencing disability (secondary outcome measures). Stratified for the headache type, general linear modelling for repeated measures was used to analyze changes over time in the TMD complaints and the headache complaints. TMD-pain patients with migraine (n = 22) showed significant decrease of pain-related disability for both TMD and headache complaints over time. No difference in the effect over time was found between the two complaints. Patients with TMD-pain and TTH (n = 21) or headache attributed to TMD (n = 17) did not improve in disability over time. For the secondary outcome measures, the results were equivocal. In conclusion, TMD-pain patients with migraine, improvement in TMD-related disability was comparable to headache-related disability for TMD-pain patients with TTH or with headache attributed to TMD, no improvements in disability were found.
AIM: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms.DESIGN: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument.RESULTS: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire - Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91).DISCUSSION: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple 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.
Dit project exploreert de potentie van een eHealth-gebaseerde hoofdpijnapp ‘Hoofdpunt’ voor fysiotherapeuten en hoofdpijnverpleegkundigen die patiënten met hardnekkige hoofdpijn of ernstige migraine ondersteunen bij het (weer) optimaal kunnen functioneren in hun dagelijkse leven. Het concept is gebaseerd op een recent ontwikkelde interactieve app die fysiotherapeuten ondersteunt bij blended coaching van rugpijnpatiënten naar eigen regie over leven met lage rugpijn. De inhoud van deze app is gestoeld op een cognitieve gedragstherapeutische benadering (de Acceptance and Commitment Therapy: ACT) die de persoonlijke situatie, wensen en klachten van de patiënten als uitgangspunt neemt bij blended coaching naar eigen regie. Eerstelijns fysiotherapeuten en hoofdpijnverpleegkundigen van hoofdpijncentra willen het potentieel van bovenstaand concept exploreren voor hun ondersteuning van patiënten met hardnekkige hoofdpijn of ernstige migraine. Een optimale benutting van app-technologie in combinatie met het ACT-concept draagt naar verwachting bij aan hun mogelijkheden om patiënten inzicht te verschaffen in factoren die de ‘uitlokkers’ van hoofdpijn en de hevigheid van symptomen beïnvloeden. Het belang daarvan is gelegen in de forse aanslag van ernstige hoofdpijn op de kwaliteit van leven. Migraine staat bijvoorbeeld op de tweede plaats van de Global Burden of Disease Study. De met hoofdpijn en migraine gemoeide kosten zijn hoog als gevolg van veelvuldig medicatiegebruik en hoog ziekteverzuim. Inzicht in beïnvloedende factoren stelt patiënten in staat om eigen regie en verantwoordelijkheid te nemen over het dagelijkse functioneren en kan aanvallen van hoofdpijn/migraine voorkomen en/of verzachten. De verwachting is dat medicatiegebruik en ziekteverzuim daardoor zullen afnemen. In dit project exploreren wij aan de hand van actieonderzoek de wensen en mogelijkheden van de ‘Hoofdpunt-app’ bij zorgprofessionals en patiënten. Het project is een voorbereiding op de evaluatie van de doelmatigheid van deze ondersteuning bij hoofdpijninterventie.
