Orofacial treatment beneficial for headache plus temporomandibular disorder

By Lucy Piper, Senior medwireNews Reporter

Patients with features of cervicogenic headache (CGH) who also show signs of temporomandibular disorder (TMD) may benefit from receiving orofacial treatment in addition to usual cervical manual therapy care, say researchers in Manual Therapy.

They found that the combined therapy not only significantly improved cervical range of motion in most planes, it also significantly diminished pain and hypomobility compared with manual therapy alone.

Following treatment, the majority (64%) of patients receiving additional orofacial treatment improved more than the smallest detectable change for upper cervical range of motion (ROM) on the flexion-rotation test.

By contrast, this was achieved by none of the study participants receiving cervical manual therapy alone, and "at no point" was there a significant change in ROM in this group, say Harry von Piekartz (University of Applied Science, Osnabrück, Germany) and Toby Hall (Curtin University of Technology, Bentley, Australia).

Given their findings, the researchers recommend that clinicians "examine for features of TMD as part of their examination of patients with headache, particularly when relevant features of cervical impairment do not respond to cervical manual therapy."

In all, 43 patients with CGH for more than 3 months were randomly assigned to receive either cervical manual therapy alone or orofacial treatment plus cervical manual therapy. In total, 44.7% had all four signs of TMD - joint sounds, deviation during mouth opening greater than 2 mm, passive mouth opening range less than 53 mm, and pain during passive mouth opening greater than 32 mm on a visual analog scale - while 65.1% had at least three signs.

There was no significant difference in the cervical range of motion between the two groups at baseline, but at 3 months, after six treatment sessions, there was significant improvement in cervical range of motion in patients receiving combined treatment.

This was most evident in extension and rotation, which increased significantly from an average 56.8 to 76.0 for extension, from 54.0 to 77.4 for left rotation, and 52.2 to 76.5 for right rotation. These improvements persisted to the 6-month follow up, the researchers report.

Scores for these measures in the usual care group had actually declined at 3 months, with only slight improvements at 6 months.

The researchers therefore stress that "failure to include orofacial care for TMD in patients unresponsive to cervical manual therapy, may lead to treatment failure."

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