Migraine and TMD comorbidity in Adolescents

Abstract

Aim: To assess prevalence, cumulative incidence and risk factors for migraine and comorbid severe headache and facial pain among a population of adolescents. Materials and methods: This is a secondary analysis of a larger study that included a cross-sectional survey of adolescents aged 11-17 with longitudinal follow up of the cohort of participants who were 11 years old. Questions about pain complaints and risk factors were asked through telephone interviews at baseline and a 36-month follow up as well as through mailed questionnaires every three months. Facial pain was assessed through self-report and the RDC/TMD examination was used to assign TMD diagnoses. Severe headache was assessed via self-report. Diagnostic criteria for migraine were based on the International Headache Society classification. Results: A total of 3,100 adolescents from the cross-sectional survey were included in the analysis. A cohort of 1,817 adolescents was included in the analyses of the cohort. Approximately equal numbers of males and females were enrolled. Migraine prevalence decreased from 11% at baseline to 6.3% at age 14 years old. The cumulative incidence of both severe headache and facial pain decreased as age increased from 11 to 14 years old. At baseline the cumulative incidence of severe headache among those participants reporting a history of facial pain was 55.7% versus 30.5% among those reporting no history of facial pain (odds ratio, 2.86; 95% CI, 2.21-3.70). The cumulative incidence of severe headache among those participants reporting a history of facial pain was 41.9% versus 24.5% among those reporting no history of facial pain (odds ratio, 2.00; 95% CI, 1.54-2.59). Other pain complaints (OR=3.2), physical activity (OR=1.86), depression (OR=1.96) and somatization (OR=4.4) were associated with migraine diagnosis at baseline. Other pain complaints (OR=4.42), depression (OR=2.79) and somatization (OR= 2.56), were associated with facial pain-severe headache comorbidity at baseline. Female gender (OR =1.83), physical activity (OR = 2.52), other pain complaints (OR = 1.18), depression (OR = 3.06) and somatization (OR = 2.18) were associated with migraine diagnosis at 36 months. Other pain complaints (odds ratio (OR) = 8.39) and somatization (OR = 3.33) were associated with comorbid severe headache and facial pain at 36 months. Conclusion: Severe headache and facial pain are comorbid in adolescents. Several risk factors are common between migraine and comorbid severe headache and migraine. Better diagnosis and prognostic outcomes can be achieved by addressing such risk factors and by managing both conditions.