Headache. 2010 Sep 1;50(8):1306-1312. Epub 2010 Feb 12.

Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study.

da Silva Jr A, Costa EC, Gomes JB, Leite FM, Gomez RS, Vasconcelos LP, Krymchantowski A, Moreira P, Teixeira AL.

From the UFMG – Headache Clinic, Belo Horizonte, Brazil (A. da Silva Jr, E.C. Costa, J.B. Gomes, and F.M. Leite); University Hospital, Federal University of Minas Gerais – Headache Clinic, Neurology Division, Belo Horizonte, Brazil (R.S. Gomez); Federal University of Minas Gerais (UFMG) – Internal Medicine, Belo Horizonte, Brazil (L.P. Vasconcelos and A.L. Teixeira); Universidade Federal Fluminense – Neurology, Rio de Janeiro, Brazil (A. Krymchantowski); Universidade Federal Fluminense – Headache Clinic, University Hospital, Rio de Janeiro, Brazil (P. Moreira); Federal University of Minas Gerais (UFMG) – Laboratory of Immunopharmacology, Belo Horizonte, Brazil (A.L. Teixeira).

Abstract

Background.- Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking.
Objectives.- To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil.
Methods.- This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively.
Results.- A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1%) of them.
Conclusions.- The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers. (Headache 2010;50:1306-1312).

As for the individuals with TMD, trigger points were detected in the masticatory or accessory system (myofacial pain) and 36% had also articular dysfunctions.

Through much of our research here at AZ TMJ, we have found that once our patients TMD symptoms are treated, many find relief of their Chronic Daily Headache / Migraines and psychiatric disorders. Future studies are needed to clarify the nature of these relationships. Dr. Stan Farrell is focused on finding new and innovative ways to treat CDH, CM, Headache and TMD disorders. http://www.az-tmj.com/