측두하악장애 환자의 두통 양상의 분류 : 일차성 두통 vs 측두하악장애로 인한 두통

Clinical Characteristics of Headaches in Temporomandibular Disorder Patients : Primary Headache vs Headache Attributed to TMD

  • 유지원 (조선대학교 치과대학 구강내과학교실) ;
  • 배국진 (조선대학교 치과대학 구강내과학교실) ;
  • 홍성주 (조선대학교 치과대학 구강내과학교실) ;
  • 윤창륙 (조선대학교 치과대학 구강내과학교실) ;
  • 안종모 (조선대학교 치과대학 구강내과학교실)
  • Ryu, Ji-Won (Dept. of Oral medicine, College of Dentistry, Chosun University) ;
  • Bae, Kook-Jin (Dept. of Oral medicine, College of Dentistry, Chosun University) ;
  • Hong, Seong-Ju (Dept. of Oral medicine, College of Dentistry, Chosun University) ;
  • Yoon, Chang-Lyuk (Dept. of Oral medicine, College of Dentistry, Chosun University) ;
  • Ahn, Jong-Mo (Dept. of Oral medicine, College of Dentistry, Chosun University)
  • 발행 : 2009.09.30

초록

본 연구는 측두하악장애와 연관된 두통의 유병율을 평가하고 측두하악장애와 연관된 두통의 양상을 평가함으로써 두통과 측두하악장애와의 관계를 평가하기 위하여 시행되었다. 2008년 1월부터 2008년 6월까지 측두하악장애 관련 증상을 주소로 조선대학교 치과병원 구강내과에 내원한 환자 중 일차성 두통을 가지고 있는 환자 66명을 대상으로 하여, 측두하악장애, 두통에 관한 평가를 시행하였다. 연구결과는 다음과 같다. 1. 측두하악장애을 기준으로 분류하였을 경우, 측두하악관절 및 저작근이 동시에 이환된 경우가 66명 중 36명(54.5%)로 가장 많았다. 2. 두통을 기준으로 분류하였을 경우, 긴장성 두통이 66명중 59명(89.39%)로 가장 많았다. 3. 66명 중 36명(54.5%)이 측두하악장애와 연관된 두통을 호소하였다. 4. 측두하악장애와 연관된 두통을 호소한 36명 중 19명(52.78%)이 본래 존재한 일차성 두통과는 다른 양상이 측두하악장애와 연관되어 나타난다고 하였다. 즉 측두하악장애와 일차성 두통을 동시에 가지고 있는 경우, 측두하악장애와 연관된 두통이 상대적으로 흔하게 발생된다고 볼 수 있을 것이다. 또한 그 중 과반수 이상이 기존 두통양상과는 다른 증상을 호소하는 것으로 보아, 측두하악장애와 두통의 연관성을 연구하는데 있어 새로운 두통양상에 대한 연구가 추가적으로 이루어져야 할 것이다. 또한 측두하악장애와 두통과의 연관성을 평가하기 위해서는 보다 많은 모집단을 대상으로, 보다 세분화된 기준을 가지고 대조군을 설정하여 평가하는 것이 추후에 필요할 것으로 사료된다.

The objective of this study was to describe the prevalence of the headache attributed to Temporomandibular disorder(TMD) symptoms and to investigate the relationships of headache and TMD. 66 patients seeking care for signs and symptoms of Temporomandibular disorders(TMD) and Orofacial pain in the department of oral medicine, Dental Hospital, Chosun University, from January, 2008 to June, 2008, were recruited. The obtained results were as follows : 1. A muscle and TMJ origin combined was the most common in study populations(54.55%), grouped as TMD classification. 2. Tension type headache was the most common in study population(89.39%), grouped as headache classification. 3. 36 patients out of 66(54.55%) had headaches which related to TMD. 4. Out of 36 patients who had suffered the headache which were attributed to TMD, 19 patients(52.78%) described that their headache related to TMD was different from their own primary headaches. In conclusion, headache attributed to TMD is relatively common in the patients who had headaches and TMD symptoms together. And the new headache patterns may related to headache and TMD chronification. Larger-scale studies and more specified and controlled comparison study is needed to confirm the relationship between the headache and TMD.

키워드

참고문헌

  1. The American Academy of Orofacial Pain. Differential diagnosis and management considerations of temporomandibular disorders. In: Okenson JP(Ed). Orofacial pain: guidelines for assessment, diagnosis and management.American Academy of Orofacial Pain. Chicago, 1996, Quintessence Publishing Co, Inc, pp. 113-141
  2. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291-305 https://doi.org/10.1177/10454411970080030401
  3. Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R. Are headache and temporomandibular disorders related? A blinded study. Cephalalgia 2008 ;28(8):832-841 https://doi.org/10.1111/j.1468-2982.2008.01597.x
  4. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population-a prevalence study. J Clin Epidemiol 1991;44:1147–1157 https://doi.org/10.1016/0895-4356(91)90147-2
  5. Ciancaglini R, Radaelli G. The relationship between headache and symptoms of temporomandibular disorder in the general population. J Dent 2001;29:93–98 https://doi.org/10.1016/S0300-5712(00)00042-7
  6. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap. Cephalalgia 2007;27:542–549 https://doi.org/10.1111/j.1468-2982.2007.01325.x
  7. Rantala MA, Ahlberg J, Suvinen TI et al. Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patients. Acta Odontol Scand 2003;61: 217-222 https://doi.org/10.1080/00016350310004089
  8. Nassif NJ, Talic YF. Classic symptoms in temporomandibular disorder patients: a comparative study. Cranio 2001;19:33-41 https://doi.org/10.1080/08869634.2001.11746149
  9. Pettengill C. A comparison of headache symptoms between two groups: a TMD group and a general dental practice group. Cranio 1999; 17:64-9 https://doi.org/10.1080/08869634.1999.11746079
  10. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24 (Suppl. 1):1-160
  11. Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache 1998; 38:497-506 https://doi.org/10.1046/j.1526-4610.1998.3807497.x
  12. Stovner L, Hagen K, Jensen R et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210 https://doi.org/10.1111/j.1468-2982.2007.01288.x
  13. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279:381-383 https://doi.org/10.1001/jama.279.5.381
  14. Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence. A review of population-based studies. Neurology 1994;44 (6 Suppl. 4):S17-23
  15. Gesch D, Bernhardt O, Alte D et al. Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based study of health in Pomerania. Quintessence Int 2004;35:143-150
  16. Jensen R, Rasmussen BK, Pedersen B, Lous I, Olesen J. Prevalence of oromandibular dysfunction in a general population. J Orofac Pain 1993;7:175-182
  17. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. JADA 1993;124:115-121
  18. De Kanter RJ, Truin GJ, Burgersdijk RC et al. Prevalence in the Dutch adult population and a metaanalysis of signs and symptoms of temporomandibular disorder. J Dent Res 1993;72:1509–1518 https://doi.org/10.1177/00220345930720110901
  19. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005;20:243-249 https://doi.org/10.1007/s10654-004-6519-2
  20. Holroyd KA, Stensland M, Lipchik GL, Hill KR, O' Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000;40:3–16 https://doi.org/10.1046/j.1526-4610.2000.00001.x
  21. Rasmussen BK, Jensen R, Olesen J. Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Community Health 1992;46:443-446 https://doi.org/10.1136/jech.46.4.443
  22. Leonardi M, Musicco M, Nappi G. Headache as a major public health problem: current status. Cephalalgia 1998;18 (Suppl. 21):66–69 https://doi.org/10.1177/0333102498018S2116
  23. Kemper JT Jr, Okeson JP. Craniomandibular disorders and headaches. J Prosthet Dent 1983;49:702–705 https://doi.org/10.1016/0022-3913(83)90400-6
  24. Molina OF, dos Santos J Jr, Nelson SJ, Grossman E. Prevalence of modalities of headaches and bruxism among patients with craniomandibular disorder. Cranio 1997;15:314-25 https://doi.org/10.1080/08869634.1997.11746026
  25. Hentschel K, Capobianco DJ, Dodick DW. Facial pain. Neurologist 2005; 11:244–249 https://doi.org/10.1097/01.nrl.0000164816.56936.71
  26. 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 2009; Apr 30. (Epub ahead of print)
  27. Kim ST, Kim CY. Use of the ID Migraine questionnaire for migraine in TMJ and Orofacial Pain Clinic. Headache 2006;46(2):253-258 https://doi.org/10.1111/j.1526-4610.2006.00303.x
  28. Graff-Radford SB, Reeves JL, Jaeger B. Management of chronic head and neck pain: effectiveness of altering factors perpetuating myofascial pain. Headache 1987;27:186-190 https://doi.org/10.1111/j.1526-4610.1987.hed2704186.x
  29. Olesen J. Clinical and pathophysiological observations in migraine and tension type headache explained by integration of vascular, supraspinal and myofascialinputs. Pain 1991;46:125-132 https://doi.org/10.1016/0304-3959(91)90066-7
  30. Malick A, Burstein R. Peripheral and central sensitization during migraine. Funct Neurol 2000;15 (suppl 3):28-35
  31. Macfarlane TV, Gray RJM, Kincey J, Worthington HV. Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case-control study. Oral Dis 2001;7:321–330 https://doi.org/10.1034/j.1601-0825.2001.00758.x
  32. Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia 1996;16:175-182 https://doi.org/10.1046/j.1468-2982.1996.1603175.x
  33. Liljestrom MR, Jamsa T, Le Bell Y et al. Signs and symptoms of temporomandibular disorders in children with different types of headache. Acta Odontol Scand 2001;59:413–417 https://doi.org/10.1080/000163501317153284
  34. Svensson P. Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches. Curr Opin Neurol 2007;20:320-325 https://doi.org/10.1097/WCO.0b013e328136c1f9
  35. Bevilaqua-Grossi D, Lipton RB, Napchan U, Grosberg B, Ashina S, Bigal ME. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia 2009; Jul 9. (Epub ahead of print) https://doi.org/10.1111/j.1468-2982.2008.01794.x