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Moghaddassi M, Togha M, Shahram F, Hanif H, Dadkhah S, Jahromi SR, Mozafari M. Headache in Behcet's disease: types and characteristics. SPRINGERPLUS 2016; 5:1077. [PMID: 27462525 PMCID: PMC4943913 DOI: 10.1186/s40064-016-2721-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/30/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Behcet's disease involves several systems in the body. Neurological involvement is identified by different symptoms. Headache is one of the common complaints of patients with Behcet's disease. It might be a part of neurological involvement or may arise independently in the course of disease. Studies with small sample size have resulted in various findings in this field. Since the prevalence of Behcet's disease is relatively high in Iran, this study was carried out to compare the features of headache between an acceptable number of patients with this rare disease and a control group. METHODS The current case-control study was performed to compare the features of headache between 312 patients with definite Behcet's disease who referred to a Behcet's clinic and healthy individuals. Patients with Behcet's disease were randomly selected. Controls were matched for age and sex. They were personally examined and interviewed meticulously using a questionnaire that met the standards of the International Headache Society classification for different types of headache. RESULTS The incidence of headache in the case and control groups was 28.3 % (n = 120) and 18.6 % (n = 59), respectively (p < 0.05; OR 2.73). Tension-type headache was observed in 12.2 % (n = 38) of cases which was significantly higher than control group (n = 6.3 %) (p = 0.011; OR 2.05). The most frequent type of headache in the case group was tension-type headache (12.2 %). In the control group, however, migraine without aura was the most common type (9.1 %). A correlation between ophthalmological involvement and headache was observed in 11 patients in the case group. In addition, a significantly higher systolic blood pressure was found in the case group compared to the controls (125.1 vs. 121.7 mmHg; p = 0.007). There was no major correlation between prednisolone consumption in patients with Behcet's disease and the type and frequency of headache. CONCLUSIONS Headache, especially tension-type headache, is more common in patients with Behcet's disease. This might be the result of specific types of uveitis-related and non-structural headaches seen in Behcet's disease.
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Affiliation(s)
- Maryam Moghaddassi
- />Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- />Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- />Department of Neurology, Neurology Ward, Sina Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Tehran, 1136746911 Iran
| | - Farhad Shahram
- />Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Hanif
- />Department of Neurosurgery, Birjand University of Medical Sciences, Birjand, Iran
| | - Sahar Dadkhah
- />Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- />Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mozafari
- />Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Jo KB, Lee YJ, Lee IG, Lee SC, Park JY, Ahn RS. Association of pain intensity, pain-related disability, and depression with hypothalamus-pituitary-adrenal axis function in female patients with chronic temporomandibular disorders. Psychoneuroendocrinology 2016; 69:106-15. [PMID: 27082645 DOI: 10.1016/j.psyneuen.2016.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
Patients with temporomandibular disorders (TMD) commonly experience myofascial and joint pain, pain-related disability, and other pain conditions including depression. The present study was carried out to explore the function of the hypothalamus-pituitary-adrenal (HPA) axis in relation to variables of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II and comorbid depression in female patients with TMD. Cortisol and dehydroepiandrosterone (DHEA) levels were determined in saliva samples that had been collected at various periods after waking (0, 30, and 60min) and at nighttime (2100-2200h) from 52 female patients with chronic TMD pain and age- and gender-matched controls (n=54, 20-40 years old). There were no significant differences in the levels and diurnal patterns of cortisol and DHEA secretion between groups of patients with TMD and controls. In patients, the cortisol awakening response (CAR) or diurnal cortisol rhythm were not associated with any variables of the RDC/TMD Axis II or the Beck Depression Inventory (BDI)-II total scores. However, the ratio of overall cortisol secretion within the first hour after waking (CARauc) to overall DHEA secretion during the post-waking period (Daucawk), defined as CARauc/Daucawk, was significantly associated with pain-related RDC/TMD variables (pain intensity and pain-related disability) and BDI-II total scores. Pain intensity and pain-related disability scores were also significantly associated with BDI-II total scores. These results indicated that an increase in molar cortisol/DHEA ratio due to the dissociation between cortisol and DHEA secretion was associated with pain intensity, pain-related disability, and depression in female patients with TMD.
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Affiliation(s)
- Kyung B Jo
- Graduate School of Integrative Medicine, CHA University, Seoul, Republic of Korea
| | - Young J Lee
- Graduate School of Integrative Medicine, CHA University, Seoul, Republic of Korea
| | - Il G Lee
- Department of Dental Surgery, The Armed Forces Dental Hospital, Seoul, Republic of Korea
| | - Sang C Lee
- Research Center for Chronic Pain and Integrative Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jai Y Park
- Department of Anesthesiology and Pain Medicine, The Armed Forces Capital Hospital, Seoul, Republic of Korea
| | - Ryun S Ahn
- Research Center for Chronic Pain and Integrative Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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Harper DE, Schrepf A, Clauw DJ. Pain Mechanisms and Centralized Pain in Temporomandibular Disorders. J Dent Res 2016; 95:1102-8. [PMID: 27422858 DOI: 10.1177/0022034516657070] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Until recently, most clinicians and scientists believed that the experience of pain is perceptually proportional to the amount of incoming peripheral nociceptive drive due to injury or inflammation in the area perceived to be painful. However, many cases of chronic pain have defied this logic, leaving clinicians perplexed as to how patients are experiencing pain with no obvious signs of injury in the periphery. Conversely, there are patients who have a peripheral injury and/or inflammation but little or no pain. What makes some individuals experience intense pain with minimal peripheral nociceptive stimulation and others experience minimal pain with serious injury? It is increasingly well accepted in the scientific community that pain can be generated and maintained or, through other mechanisms, suppressed by changes in the central nervous system, creating a complete mismatch between peripheral nociceptive drive and perceived pain. In fact, there is no known chronic pain condition where the observed extent of peripheral damage reproducibly engenders the same level of pain across individuals. Temporomandibular disorders (TMDs) are no exception. This review focuses on the idea that TMD patients range on a continuum-from those whose pain is generated peripherally to those whose pain is centralized (i.e., generated, exacerbated, and/or maintained by central nervous system mechanisms). This article uses other centralized chronic pain conditions as a guide, and it suggests that the mechanistic variability in TMD pain etiology has prevented us from adequately treating many individuals who are diagnosed with the condition. As the field moves forward, it will be imperative to understand each person's pain from its own mechanistic standpoint, which will enable clinicians to deliver personalized medicine to TMD patients and eventually provide relief in even the most recalcitrant cases.
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Affiliation(s)
- D E Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - D J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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Kothari SF, Baad-Hansen L, Hansen LB, Bang N, Sørensen LH, Eskildsen HW, Svensson P. Pain profiling of patients with temporomandibular joint arthralgia and osteoarthritis diagnosed with different imaging techniques. J Headache Pain 2016; 17:61. [PMID: 27349657 PMCID: PMC4923011 DOI: 10.1186/s10194-016-0653-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background Clinical differentiation between pain mechanisms of temporomandibular joint (TMJ) arthralgia and osteoarthritis (OA) is challenging. The aims were to compare somatosensory function at the TMJs and conditioned pain modulation (CPM) effects between TMJ arthralgia and OA patients diagnosed clinically and based on different imaging techniques and age- and gender-matched healthy controls (n = 41). Methods Patients (n = 58) underwent standard clinical examination and three different TMJ imaging modalities. After each examination, they were classified into arthralgia or OA based on the findings. TMJ region somatosensory testing was performed in all participants. Z-scores were calculated for patients based on healthy reference data. CPM was tested by comparing pressure pain thresholds (PPTs) at TMJ and thenar (control) before, during and after the application of painful and nonpainful cold stimuli. Data were analyzed using analyses of variance. Results Somatosensory abnormalities were commonly detected in both patient groups. Assessment of somatosensory function at the TMJ revealed that arthralgia patients were less sensitive to warmth, cold and tactile stimuli than OA patients (P < 0.048). OA patients showed pressure hyperalgesia compared with arthralgia patients (P = 0.025). There was a significant CPM effect at both test sites during painful cold application in all groups (P < 0.001). There was no significant difference in the relative CPM effect between groups except for clinically diagnosed arthralgia patients showing reduced CPM effect compared with controls (P = 0.047). Conclusions Pain profiles including somatosensory function differed between TMJ arthralgia and OA patients although CPM effects were similar in patients and controls. Thus, different TMJ pain conditions may share common pain mechanisms but the present study for the first time also indicated that differential pain mechanisms could be involved. Electronic supplementary material The online version of this article (doi:10.1186/s10194-016-0653-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simple Futarmal Kothari
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. .,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark.
| | - Lene Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Bang
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University Hospital, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M. The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain 2016; 17:29. [PMID: 27011213 PMCID: PMC4807183 DOI: 10.1186/s10194-016-0621-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporomandibular joint dysfunction are often accompanied by symptoms of headache such as tension-type headache which is the most frequent spontaneous primary headache. Masseter muscle pain is commonly reported in this group. The purpose of the study was to assess the efficiency of intramuscular botulinum toxin type A injections for treating masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. METHODS This prospective outcome study consisted of 42 subjects of both genders aged 19-48 years diagnosed with masseter muscle pain related to temporomandibular joint dysfunction and tension-type headache. The subjects were treated by the intramuscular injection of 21 U (mice units) of botulinum toxin type A (Botox, Allergan) in the area of the greatest cross-section surface of both masseter bellies. Pain intensity was evaluated using visual analogue scale (VAS) and verbal numerical rating scale (VNRS) 1 week before the treatment and 24 weeks after the treatment. The obtained data were analyzed using the Wilcoxon matched pairs test (p ≤ 0,005). RESULTS The results of this study showed a decrease in the number of referred pain episodes including a decrease in pain in the temporal region bilaterally, a reduction of analgesic drugs intake as well as a decrease in reported values of VAS and VNRS after injections (p = 0,000). CONCLUSIONS The intramuscular botulinum toxin type A injections have been an efficient method of treatment for masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.
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Affiliation(s)
- Malgorzata Pihut
- Department of Dental Prosthetics, Jagiellonian University in Krakow, College of Medicine, Institute of Dentistry, 4 Montelupich St., 31-155, Krakow, Poland
| | - Ewa Ferendiuk
- Department of Dental Prosthetics, Jagiellonian University in Krakow, College of Medicine, Institute of Dentistry, 4 Montelupich St., 31-155, Krakow, Poland
| | - Michal Szewczyk
- Department of Dental Prosthetics, Jagiellonian University in Krakow, College of Medicine, Institute of Dentistry, 4 Montelupich St., 31-155, Krakow, Poland
| | - Katarzyna Kasprzyk
- Department of Neurology, Jagiellonian University in Krakow, College of Medicine, 3 Botaniczna St., 31-503, Krakow, Poland
| | - Mieszko Wieckiewicz
- Department of Prosthetic Dentistry, Faculty of Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425, Wroclaw, Poland.
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