A Study to Determine the Frequency of Headache Disorders in Patients Attending an Orofacial Pain Clinic.
Citation:
Moodley, Tashia, A Study to Determine the Frequency of Headache Disorders in Patients Attending an Orofacial Pain Clinic., Trinity College Dublin.School of Dental Sciences, 2023Download Item:
Abstract:
Introduction: The multifactorial origin of headache and temporomandibular disorders (TMD) coupled with the fact that they exhibit similar and overlapping signs and symptoms make differential diagnosis and treatment planning challenging. The purpose of this study was to evaluate the association between patient complaints and perceptions relative to the definitive diagnosis of Headache Disorders or TMD in a population referred to an Orofacial Pain Clinic for the management of possible TMD.
Methods: The descriptive cross-sectional study involved a sample of convenience utilising a questionnaire given to 150 patients prior to clinical examination. The questionnaire, completed by the participants, recorded their pain history and location which was then compared to the definitive diagnosis reached by a single Orofacial Pain Specialist. Cross tabulations were completed between categorical variables like gender, age, location of pain, and occurrence of TMD pain, headache, and other orofacial pain. Associations were subjected to the Chi-square test and Fischer?s Exact Test. The odds ratio and 95% confidence interval (CI) were calculated. A significance level of 0.05 was used and all the statistical tests were two-tailed which followed data analysis using SPSS version 26 (SPSS Inc., Chicago, USA) and Excel (Microsoft, USA).
Results: Of the participants, 115 (76.7%) were female and 35 (23.3%) were male. In this study, 55 (36.7%) of patients were in the 50+ age group. Twenty-nine participants (19.3%) were between 19 and 29 years of age. TMD diagnosis was most common with 68 diagnoses (45.4%). In decreasing order, the other diagnoses were headache in 33 patients (22%), neuropathic pain in 33 (15.3%), and muscular pain in 9 patients (6%). TMD combined with headache was recorded in 8 patients (5.3%), TMD and odontogenic pain in 5 patients (3.3%), and TMD together with muscular pain was observed in two patients (1.5%). The patient?s location of the pain showed that pain arising in the TMJ area was the most frequently selected area of pain with 127 of the 150 participants (84.6%). Of these patients that indicated pain in the TMJ area, 50% of the patients were accurate in locating the pain and had a definitive diagnosis of TMD. Of the
patients that located pain in the frontal head zone, 67% were accurate in locating the head as the area of pain relative to the definitive diagnosis of headache. Of the group of patients who had dental pain, 47% were diagnosed with neuropathic pain, 35% had headaches and 18% were diagnosed with TMD. A total of 33 patients were diagnosed with headache disorders. Of these patients that presented with symptoms associated with the TMJ, 21 patients (63.3%) had a definitive diagnosis of headaches and did not have a diagnosis of TMD. The findings from this study showed that there was a relationship between TMD symptoms and the diagnosis of TMD. The odds ratio with a 95% confidence interval showed that those patients with TMD symptoms were 2.2 times more likely to have a diagnosis of TMD, with statistical significance using a Pearson Chi-square test (P< 0.001). From a patient perspective, jaw joint pain was the most frequently self-reported pain with 90 of the 150 participants (60%) perceiving it as the source of their pain. For patients diagnosed with TMD, 80.9% of the patients perceived their pain to be TMJ related. Of those patients diagnosed with TMD, 13.2% of patients perceived their pain as odontogenic. In patients diagnosed with headache disorders, 54.4% of these patients perceived their pain originated from the jaw joint and 39.4% of these headache patients believed their pain was of odontogenic origin.
Conclusion: This study demonstrated that the majority of patients referred to the Orofacial Pain Clinic were female. The majority of patients were in the 50+ age group. The most common diagnosis amongst the patients attending the clinic was TMD. In patients attending the Orofacial Pain Clinic, TMD patients were accurate in locating and identifying the area of pain relative to the definitive diagnosis. This study highlighted that patients attending this clinic were often unable to differentiate between headache and TMD pain as well as the pain of non-odontogenetic origin, often confusing it for odontogenic pain. This study proposed the use of a facial diagram for the patient to more accurately illustrate their location of pain, thereby assisting the referring clinician in making a more accurate distinction between the various types of Orofacial pain.
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https://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:MOODLEYTDescription:
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Author: Moodley, Tashia
Advisor:
Osullivan, MichaelPublisher:
Trinity College Dublin. School of Dental Sciences. Discipline of Dental ScienceType of material:
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