CLINICAL BURDEN AND PHYSIOTHERAPY MANAGEMENT OF TEMPOROMANDIBULAR JOINT DYSFUNCTION WITH COMORBID MIGRAINE: EVIDENCE FROM AN OBSERVATIONAL STUDY

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Background: Temporomandibular Joint Dysfunction (TMD) and migraine often occur simultaneously and their
combination is now recognised as producing a compounded clinical burden, greater than either TMD or migraine alone.
Physiotherapy is well placed to address the musculoskeletal contributors of this comorbidity: TMJ mobility restriction,
masticatory muscle dysfunction, and cervical postural involvement; however, evidence quantifying the burden that
physiotherapy-led management must address is limited.
Objective: To quantify the clinical burden (pain, impact of headache, migraine disability) of comorbid TMD–migraine
with each condition separately, and to outline the physiotherapy management implications of these findings
Methods: An observational study of 164 participants (20–60 years) was conducted at the Department of Physiotherapy,
Pacific Medical College and Hospital, Udaipur, over nine months. The participants were divided into four 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 clinical burden was evaluated by TMJ symptom duration, headache frequency, VAS, HIT-
6 and MIDAS. This is a secondary analysis of the same population that was reported in the paper by Prajapati et al, “
Association Between Temporomandibular Joint Dysfunction (TMD) and Migraine in Patients Presenting with
Headache: An Observational Study,” applying the existing dataset to a distinct clinical-burden and physiotherapy-
management analysis not reported in that paper.
Results: Group C (TMD + Migraine) had the highest clinical burden on all measures including headache frequency
15.90 ± 4.40 days/month (approaching the threshold for chronic migraine), VAS 7.18 ± 0.97 (89.1% severe pain), HIT-
6 64.72 ± 3.93 (94.5% severe impact), and MIDAS 27.45 ± 4.41 (94.5% Grade IV severe disability) which were
significantly higher than all other groups (Groups A, B, and D) (p < 0.001). Symptom duration of TMJ also was
significantly greater for the TMD-associated groups (17–18 months compared with 6 months, p < 0.001).
Conclusion: Comorbid TMD–migraine is a significantly higher and additive clinical burden in terms of the pain,
functional and disability dimensions. The findings in this article support the use of physiotherapy-based screening and
multimodal care – TMJ and cervical mobilization, masticatory muscle re-education, patient education and postural
correction – as an essential element in the management of patients presenting with this comorbidity.