Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review

Hedwig A Van Der Meer,Leticia B Calixtre,Raoul H.H Engelbert,Corine M Visscher,Maria Wg Nijhuis – Van Der Sanden,Caroline M Speksnijder

doi:10.1016/j.msksp.2020.102277

Abstract

BackgroundPhysical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints. ObjectivesThe aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD. Data sourcesPubMed, Cochrane and PEDro were searched. Study eligibility criteriaRandomized or controlled clinical trials studying physical therapy interventions were included. ParticipantsPatients with TMD and headache. AppraisalThe Cochrane risk of bias tool was used to assess risk of bias. Synthesis methodsIndividual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach.Results: and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision. LimitationsThe methodological quality of most included articles was poor, and the interventions included were very different. ConclusionsPhysical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken.

Highlights

One in five adults in Europe are estimated to have a perceived dysfunction of their masticatory system, which is related to temporo mandibular disorders (TMD) (LeResche, 1997; Lovgren et al, 2016)
temporomandibular disorders (TMD) are defined according to the Diagnostic Criteria for TMD (DC/TMD) as complaints involving the masticatory system and can be stratified into myalgia, arthralgia, or functional complaints of the joint, like clicking or locking (Schiffman et al, 2014)
Studies had to meet the following inclusion criteria to be eligible: 1) adult participants with TMD based on the diagnostic criteria for TMD (DC/TMD) (Schiffman et al, 2014; Dworkin and LeResche, 1992); 2) headache pain intensity as outcome measure; 3) randomized controlled trial (RCT) or controlled clinical trial (CCT); 4) TMD-treatment within the physical therapy domain (World Confederation for P, 2017); and 5) article is published in English or Dutch

Summary

Introduction

One in five adults in Europe are estimated to have a perceived dysfunction of their masticatory system, which is related to temporo mandibular disorders (TMD) (LeResche, 1997; Lovgren et al, 2016). The most recent review and meta-analysis concluded that exercise therapy is effective in reducing TMD-pain. Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). There is, no overview of the effect of physical therapy for TMD on concomitant headache complaints. Objectives: The aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision. Conclusions: Physical therapy interventions presented small effect on reducing headache pain intensity on sub jects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken

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