A psychological comparison of temporomandibular disorder and chronic daily headache: are there targets for therapeutic interventions?

OBJECTIVE: Temporomandibular disorder (TMD) and chronic daily headache (CDH) are chronic problems affecting the head and face. The aim of this study was to compare TMD and CDH, in terms of cognitive factors, including illness perceptions and coping strategies.

STUDY DESIGN: A total of 102 patients, 18 to 70 years of age, classified into 2 groups, TMD or CDH, were recruited in this study from a variety of centres in London. On initial consultation patients underwent clinical examination and were asked to complete 8 questionnaires and checklists evaluating mental and psychological state. Six months later, identical questionnaires were posted to all patients; response rate was 76% and 65% for the TMD and CDH patients, respectively. The data were then analyzed to assess different targets for therapeutic interventions.

RESULTS: At first observation, TMD patients were found to have more clinical signs: localized increased jaw sounds, limited mouth opening, arthralgia, and myalgia during palpation, however, the duration of pain was higher in the CDH group. Significant differences (P < .01) in terms of psychological distress, were identified between the 2 groups. The CDH group scored higher in 3/3 bands of the Toronto Alexithymia Scale, indicating difficulty expressing emotion; the consequence band of the Illness Perceptions Questionnaire, indicating they were less likely to expect a cure; and were more likely to catastrophize as shown by the Coping Strategies Questionnaire. The 2/4 bands of the McGill Pain Questionnaire showed that CDH group had more severe pain and more depression as measured by the Hospital Anxiety and Depression Scale. TMD patients scored higher in the control band of the Coping Strategies Questionnaire indicating greater control over pain. However, at 6-month follow-up, the only significant difference (P < .01) was in the physiological band of the Illness Perception Questionnaire, the CDH group scored higher. However, this is probably of limited clinical significance. There were no significant differences except in the depression part of the Hospital Anxiety and Depression Scale, the headache group scored higher. Temporomandibular disorder was reported to be less painful, more controllable, and possibly less responsive to reassurance.

CONCLUSION: This study suggests that differences in cognitive findings between the 2 groups of patients are not sustained over time. Initially, the headache patients catastrophized, were more distressed, and more depressed. However, these differences disappeared at follow-up. Significant correlations between perceived performance ("timeline" IPQ); disability and anxious mood; perceived consequence with disability and depressed mood; and catastrophizing (CSG) with pain, disability, and anxious mood present possible targets for therapeutic intervention.