743: Impact of Migraine Treatment on Comorbid Temporomandibular Disorders

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Mixed pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Temporomandibular disorders (TMD) are musculoskeletal conditions characterised by pain and functional limitations involving the masticatory muscles, temporomandibular joint, and associated orofacial structures. Migraine is among the most prevalent comorbidities in patients with TMD, and both conditions disproportionately affect women. Despite their frequent co-occurrence and overlapping symptomatology, which may contribute to misdiagnosis, the relationship between these conditions remains incompletely understood. Emerging evidence suggests shared pathophysiological mechanisms, as well as a potential bidirectional relationship between the two disorders. Previous studies have examined the effects of TMD treatment on migraine and the potential role of propranolol in managing facial pain. However, whether migraine directed treatment may benefit comorbid TMD has received limited attention. This study aimed to assess the impact of migraine treatment on TMD symptoms in patients with both conditions and to determine whether the onset and temporal patterns of co-occurrence between TMD and migraine are associated with treatment response.

Methods: A mixed retrospective-prospective observational study was conducted at the Orofacial Pain Clinic, Dental Institute, King's College Hospital, London (2023–2024). Forty-five patients aged over 18 years with concurrent diagnoses of migraine and TMD were recruited. Migraine was diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), and TMD according to the International Classification of Orofacial Pain, 1st edition (ICOP). The retrospective component collected clinical and demographic data from medical records, including TMD and migraine characteristics, onset relationship, and temporal co-occurrence patterns. The prospective component comprised face-to-face and telephone interviews post-treatment initiation, assessing outcomes using the Patient Global Impression of Change (PGIC), a validated 7-point self-report scale where scores of 5–7 indicate meaningful improvement. Statistical associations between clinical characteristics and treatment outcomes were examined using Fisher's Exact Test, with category collapsing applied where expected cell counts were below 5.

Results: Of the 45 participants (69% female; mean age 36.9 ± 7.18 years), the most common presentations were myalgia subtype TMD (80%) and chronic migraine (62.2%). Following migraine treatment, 71% of participants showed improvement in migraine and 62% showed improvement in TMD based on PGIC criteria. Notably, 40% demonstrated TMD improvement without receiving any TMD specific treatment. Three statistically significant associations were identified. First, successful migraine treatment was associated with TMD improvement (Fisher exact test, p = 0.048). Second, participants whose TMD developed after migraine onset showed greater TMD improvement compared with those with TMD onset before or concurrent with migraine (100% vs 50%; p = 0.006). Third, participants whose TMD and migraine episodes occurred independently or infrequently together showed greater TMD improvement than those with constant co occurrence (92% vs 52%; p = 0.015).

Conclusions: This study provides statistically supported evidence that migraine treatment confers significant benefit on comorbid TMD, even without targeted TMD therapy. Three potential predictors of favourable TMD response were identified: successful migraine treatment outcome, TMD onset after established migraine, and infrequent rather than constant TMD-migraine co-occurrence. When TMD develops after migraine onset, migraine treatment alone is highly effective for both conditions (100% improvement). When TMD and migraine attacks occur independently, migraine treatment remains effective — possibly because shared trigeminal pathways drive TMD regardless of temporal overlap. Conversely, when both conditions constantly co-occur, TMD may have become chronified and self-sustaining, requiring dedicated TMD management alongside migraine treatment. These onset and co-occurrence patterns should be routinely assessed in clinical practice to guide treatment prioritisation. Larger prospective studies are needed to confirm these findings and define optimal intervention timing before TMD chronification reduces treatment efficacy.

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Presenting Author: Pankaew Yakkaphan
Submitting Author: Pankaew Yakkaphan

Senior Author: Tara Renton

IASP 2026 Global Year theme of Neuropathic Pain: No

• Tara Renton: PhD - Emeritus Professor