Self-Reported Migraine and Chronic Fatigue Syndrome Are More Prevalent in People with Myofascial vs Nonmyofascial Temporomandibular Disorders

Aims: To compare the number of comorbidities and the prevalence of five specific comorbidities in people who have temporomandibular disorders (TMD) with or without myofascial pain. Methods: This cross-sectional study included 180 patients seeking TMD treatment in Boston and Montreal hospitals. A self-administered questionnaire was used to collect information on sociodemographic and behavioral factors, as well as the presence of the following five comorbidities: migraine, chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis, and restless leg syndrome. TMD was diagnosed using the Research Diagnostic Criteria for TMD. Chi-square and Student t tests were used for categorical and continuous variables, respectively, to test for differences between myofascial (n = 121) and nonmyofascial (n = 59) TMD groups. Multiple logistic regression analysis was used to compare the type and number of self-reported comorbidities in both groups, controlling for confounding variables. Results: The following were found to be significantly higher in the myofascial TMD group than in the nonmyofascial TMD group: self-reported migraine (55% vs 28%, P = .001), chronic fatigue syndrome (19% vs 5%, P = .01), and the mean total number of comorbidities (1.30 vs 0.83, P = .01). Conclusion: Individuals with myofascial TMD had a higher prevalence of self-reported migraine and chronic fatigue syndrome than those with nonmyofascial TMD.

central sensitivity syndrome; comorbidity; myofascial pain; overlapping conditions; temporomandibular disorders

1. Clark GT. Diagnosis and treatment of painful temporomandibular disorders. Dent Clin North Am 1987;31:645–674.

2. John MT, Miglioretti DL, LeResche L, Von Korff M, Critchlow CW. Widespread pain as a risk factor for dysfunctional temporomandibular disorder pain. Pain 2003;102(3):257–263.

3. Burris JL, Evans DR, Carlson CR. Psychological correlates of medical comorbidities in patients with temporomandibular disorders. J Am Dent Assoc 2010;141:22–31.

4. Plesh O, Wolfe F, Lane N. The relationship between fibromyalgia and temporomandibular disorders: Prevalence and symptom severity. J Rheumatol 1996;23:1948–1952.

5. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 2000; 160:221–227.

6. Yunus MB. Central sensitivity syndromes: An overview. Journal Musculoskelet Pain 2009;17:400–408.

7. Yunus MB. Central sensitivity syndromes: A new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum 2008;37:339–352.

8. Gagné C, Godin G. Improving self-report measures of non-adherence to HIV medications. Psychol Health 2005;20: 803–816.

9. Hawkshead J, Krousel-Wood M. Technique for measuring medication adherence in hypertensive patients in outpatient settings: Advantages and limitations. Disease Management & Health Outcomes 2007;15(2):109–118.

10. Auerbach SM, Laskin DM, Frantsve LM, Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J Oral Maxillofac Surg 2001;59:628–633.

11. Klasser GD, Bassiur J, de Leeuw R. Differences in reported medical conditions between myogenous and arthrogenous TMDpatients and its relevance to the general practitioner. Quintessence Int 2014;45:157–167.

12. Nilsson AM, Dahlström L. Perceived symptoms of psychological distress and salivary cortisol levels in young women with muscular or disk-related temporomandibular disorders. Acta Odontol Scand 2010;68:284–288.

13. Galdon MJ, Dura E, Andreu Y, Ferrando M, Poveda R, Bagan JV. Multidimensional approach to the differences between muscular and articular temporomandibular patients: Coping, distress, and pain characteristics. Oral Surg Oral Med Oral PatholOral Radiol Endod 2006;102:40–46.

14. Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L. The relationship between temporomandibular disorders and stress-associated syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:416–420.

15. Lorduy KM, Liegey-Dougall A, Haggard R, Sanders CN, Gatchel RJ. The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Pract 2013;13:604–613.

16. Turk DC, Rudy TE. IASP taxonomy of chronic pain syndromes: Preliminary assessment of reliability. Pain 1987;30:177–189.

17. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6: 301–355.

18. Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med 2005;37:360–363.

19. Lipton RB, Dodick D, Sadovsky R, et al. A self-administered screener for migraine in primary care: The ID Migraine validation study. Neurology 2003;61:375–382.

20. Hadzi-Pavlovic D, Hickie IB, Wilson AJ, Davenport TA, Lloyd AR, Wakefield D. Screening for prolonged fatigue syndromes: Validation of the SOFA scale. Soc Psychiatry Psychiatr Epidemiol 2000;35:471–479.

21. Whitehead WE, Drossman DA. Validation of symptom-based diagnostic criteria for irritable bowel syndrome: A critical review. Am J Gastroenterol 2010;105:814–820.

22. Kushner L, Moldwin RM. Efficiency of questionnaires used to screen for interstitial cystitis. J Urol 2006;176:587–592.

23. Allen RP, Burchell BJ, MacDonald B, Hening WA, Earley CJ. Validation of the self-completed Cambridge-Hopkins questionnaire (CH-RLSq) for ascertainment of restless legs syndrome (RLS) in a population survey. Sleep Med 2009;10:1097–1100.

24. Fillingim RB, Ohrbach R, Greenspan JD, et al. Potential psychosocial risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case-control study. J Pain 2011;12(11, suppl):T46–T60.

25. Slade GD, Bair E, By K, et al. Study methods, recruitment, sociodemographic findings, and demographic representativenessin the OPPERA study. J Pain 2011;12(11, suppl):T12–T26.

26. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Predictors of outcome for orofacial pain in the generalpopulation: A four-year follow-up study. J Dent Res 2004; 83:712–717.

27. Aggarwal VR, Macfarlane GJ, Farragher TM, McBeth J. Risk factors for onset of chronic oro-facial pain--Results of the North Cheshire oro-facial pain prospective population study. Pain 2010;149:354–359.

28. Hosmer DW, Lemeshow S., Sturdivant RX. Applied Logistic Regression, ed 3. Hoboken: John Wiley & Sons, 2013.

29. Velly AM, Philippe P, Gornitsky M. Heterogeneity of temporomandibular disorders: Cluster and case-control analyses. J Oral Rehabil 2002;29:969–979.

30. Franco AL, Gonçalves DA, Castanharo SM, Speciali JG, Bigal ME, Camparis CM. Migraine is the most prevalent primary headache in individuals with temporomandibular disorders. J Orofac Pain 2010;24:287–292.

31. Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME. Temporomandibular disorders are differentially associated with headache diagnoses: A controlled study. Clin J Pain 2011;27:611–615.

32. Lorduy KM, Liegey-Dougall A, Haggard R, Sanders CN, Gatchel RJ. The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Pract 2013;13:604–613.

33. Fernández-de-las-Peñas C, Galán-del-Rio F, Fernández-Carnero J, Pesquera J, Arendt-Nielsen L, Svensson P. Bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder: Evidence of impairment in central nociceptive processing. J Pain 2009;10:1170–1178.

34. Sarlani E, Grace EG, Reynolds MA, Greenspan JD. Evidence for up-regulated central nociceptive processing in patients with masticatory myofascial pain. J Orofac Pain 2004;18:41–55.

35. Maixner W, Fillingim R, Booker D, Sigurdsson A. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 1995;63:341–351.

36. Bradfield JW. A pathologist’s perspective of the somatoform disorders. J Psychosom Res 2006;60:327–330.

37. Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW Jr. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain 2011;27:268–274.

38. Natvig B, Rutle O, Bruusgaard D, Eriksen WB. The association between functional status and the number of areas in the body with musculoskeletal symptoms. International Journal of Rehabilitation Research. Int J Rehabil Res 2000;23:49–53.

39. Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D. Change in the number of musculoskeletal pain sites: A 14-year prospective study. Pain 2009;141:25–30.

40. Kamaleri Y, Natvig B, Ihlebaek CM, Bruusgaard D. Does the number of musculoskeletal pain sites predict work disability?A 14-year prospective study. Eur J Pain 2009;13:426–430.

41. Kamaleri Y, Natvig B, Ihlebaek CM, Bruusgaard D. Localized or widespread musculoskeletal pain: Does it matter? Pain 2008; 138:41–46.

42. Kang JK, Ryu JW, Choi JH, Merrill RL, Kim ST. Application of ICHD-II criteria for headaches in a TMJ and orofacial pain clinic. Cephalalgia 2010;30:37–41.

43. Gonçalves DA, Bigal ME, Jales LC, Camparis CM, Speciali JG. Headache and symptoms of temporomandibular disorder: An epidemiological study. Headache 2010;50:231–241.

44. Winkelman JW, Gagnon A, Clair AG. Sensory symptoms in restless legs syndrome: The enigma of pain. Sleep Med 2013; 14:934–942.

45. Earley CJ, Silber MH. Restless legs syndrome: Understanding its consequences and the need for better treatment. Sleep Med 2010;11:807–815.

46. Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013;14:438–445.

47. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: Diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101–119.

48. Yunus MB, Aldag JC. Restless legs syndrome and leg cramps in fibromyalgia syndrome: A controlled study. BMJ 1996; 312:1339.

49. Chen PK, Fuh JL, Chen SP, Wang SJ. Association between restless legs syndrome and migraine. J Neurol Neurosurg Pyschiatry 2010;81:524–528.

50. Pannucci CJ, Wilkins EG. Identifying and avoiding bias in research. Plast Reconstr Surg 2010;126:619–625.

51. Vazquez-Delgado E, Schmidt JE, Carlson CR, DeLeeuw R, Okeson JP. Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients. Cephalalgia 2004;24:446–454.