PROPOSED REVISION OF THE ICHD-II CRITERIA FOR HEADACHE OR FACIAL PAIN ATTRIBUTED TO TEMPOROMANDIBULAR JOINT (TMJ) DISORDERS

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PROPOSED REVISION OF THE ICHD-II CRITERIA FOR HEADACHE OR FACIAL PAIN ATTRIBUTED TO TEMPOROMANDIBULAR JOINT (TMJ) DISORDERS

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Title PROPOSED REVISION OF THE ICHD-II CRITERIA FOR HEADACHE OR FACIAL PAIN ATTRIBUTED TO TEMPOROMANDIBULAR JOINT (TMJ) DISORDERS
Author(s) Nixdorf, Don ; Schiffman, Eric ; Ohrbach, Richard ; Anderson, Gary ; Look, John
Date 2010
English abstract
Aims were to assess the validity of the current International Classification of Headache Disorders (ICHD)-II diagnostic algorithm for Headache or facial pain attributed to temporomandibular joint (TMJ) disorder (11-7), and if indicated to derive a more valid revised diagnostic algorithm. Methods: The multisite RCD/TMD Validation Project subject population’s combined dataset included 614 TMJD cases and 91 controls (82% female; mean age+SD: 37+13 years). This dataset consists of self-report and clinical examination tests as well as imaging findings from bilateral TMJ MRI and CT. Using all available clinical information, 2 TMD experts at each of the 3 sites, established by consensus each subject as either a TMD case or control; for TMD cases, TMD subgroup diagnoses were then established. Using this clinical information, formal tension-type headache (TTHA) diagnoses were computed based on the ICHD-II algorithm. An operational reference standard diagnosis for TTHA attributed to the masticatory system was constructed that reflected current diagnostic standards for masticatory system disorders. The resultant reference standard was based on (1) consensus diagnosis of TMD pain, (2) self-report of mild to moderate intensity headache with location including the temples, and (3) replication of that headache by both TMD experts using any one of 10 jaw provocation tests. A revised algorithm was developed by randomly dividing the Validation Project’s dataset into a testing dataset, used to develop the “best-fit” algorithm relative to the reference standard diagnosis, and then validating the revised algorithm using the other half of the dataset. Target sensitivity and specificity were set a priori at ≥ 0.80 and ≥ 0.80, respectively. Results: Compared to the reference standard, the current ICHD-II diagnostic algorithm for Headache or facial pain attributed to temporomandibular joint (TMJ) disorder exceeded the target for sensitivity but did not reach the target for specificity (0.83, 0.39, respectively). The revised algorithm eliminated the need for TMJ imaging and required: (1) self-report of headache in the temple area that is changed with jaw movement, function or parafunction, and (2) report of familiar headache in the temple with palpation of the temporalis muscle(s). The revised algorithm exceeded the target levels for both sensitivity and specificity (0.83, 0.86, respectively). Conclusions: The revised diagnostic algorithm is recommended for identifying patients with TTH associated with pericranial tenderness that can be attributed to the masticatory system. Since this criterion is not specific to the temporomandibular joint (TMJ) per se, it is proposed that the revised diagnostic criteria be termed Headache or facial pain attributed to temporomandibular disorders (TMD). Acknowledgments: This work was funded by National Institute of Health grants U01 DE013331 and K12 RR023247.
Publisher IASP (International Association for the Study of Pain and Omnipress)
Host/Issue Abstracts of the 13th World Congress of Pain
ISBN 978-0-931092-87-9
Pages Abstract number: PH 019
Language eng (iso)
Subject(s) temporomandibular disorders
headache
Medicine
Research Subject Categories::ODONTOLOGY
Note 13th World Congress on Pain (IASP 2010), 29 Aug - 2 Sept, Montreal, Canada
Handle http://hdl.handle.net/2043/11336 (link to this page)
Link http://www.iasp-pain.org/AM/Template.cfm?Section=World_Congress_on_Pain&Template=/CM/HTMLDisplay.cfm&ContentID=9948 (external link to related web page)

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