ASSOCIATION BETWEEN TEMPOROMANDIBULAR JOINT DYSFUNCTION (TMD) AND MIGRAINE IN PATIENTS PRESENTING WITH HEADACHE: AN OBSERVATIONAL STUDY

Abstract

Background: Temporomandibular Joint Dysfunction (TMD) and migraine are two highly prevalent craniofacial pain
conditions, which are frequently seen together in clinical practice. The two conditions converge in the trigeminal
nucleus caudalis, and central sensitization has been suggested as a common neurobiological mechanism between joint-
and muscle-based nociception from the TMJ and migraine chronification. Although there is increased clinical interest,
the exact nature of the relationship between TMD and migraine ,Although there is increased clinical interest, the exact
nature of the relationship between TMD and migraine – whether TMD triggers migraine , migraine exacerbates TMD,
both share common risk factors-remains poorly understood.
Objective: To evaluate the association between TMD and Migraine in patients presenting with headache and to
compare the pain intensity, the impact of the headache, and disability due to migraine across diagnostic subgroups.
Methods: An observational study was conducted on 164 participants (age 20–60 years) at the Department of
Physiotherapy, Pacific Medical College and Hospital, Bedla, Udaipur, over nine months, using purposive sampling. The
participants were divided into the following diagnostic groups: Group A – TMD Only (n=35); Group B – Migraine
Only (n=40); Group C – TMD + Migraine (n=55); and Group D – Other Headache (n=34). The outcome measures used
were the Visual Analogue Scale (VAS), Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Scale
(MIDAS). The categorical association between TMD and migraine was assessed using Chi-square testing while pain
intensity, headache impact and migraine disability were compared across the four diagnostic subgroups using the
Kruskal–Wallis test with Dunn's post-hoc pairwise comparisons.
Results: Group C (TMD + Migraine) recorded the highest scores on all three outcome measures — VAS 7.18 ± 0.97,
HIT-6 64.72 ± 3.93, and MIDAS 27.45 ± 4.41 — all significantly higher than the other groups (p < 0.001). The chi-
square test for the binary presence of TMD and migraine was not significant (χ² = 0.830, p = 0.362, OR = 1.336, 95%
CI 0.72–2.49). However, severity –based comparison showed that patients with both conditions (Group C) had
significantly higher mean pain, headache impact and disability scores compared to any other group (p < 0.001 for all
three scores), suggesting that the categorical presence/absence test underestimated the actual clinical association
between TMD and migraine.
Conclusion: Although the categorical co-occurrence of TMD and migraine was not statistically significant, severity-
based analyses show that the clinical burden of migraine is significantly higher in patients with TMD. Early screening
and integrated management is supported by the co-existence of TMD and migraine resulting in a significantly higher
clinical burden.