Usefulness of an occlusal device in the treatment of medication overuse headache and persistent idiopathic facial pain: preliminary results

Abstract

There is a debate in literature about the therapeutic usefulness of oral devices in patients suffering from Medication Overuse Headache (MOH) or in patients suffering from Persistent Idiopathic Facial Pain (PIFP). From the case histories of 3356 patients, referred to us with a diagnosis of chronic craniofacial pain for assessment of the eventual application of an occlusal device to correct an impaired neuromuscular relationship between the mandible and the maxilla, we selected, following the criteria of the International Classification of Headache Disorders (ICHD-3beta), two groups of patients suffering from MOH and PIFP. All patients of the two groups underwent a Kinesiographic exam and an EMG to evaluate the freeway space (FWS). Patients presenting an impaired FWS were placed in treatment with the application of an occlusal device. At the follow-up after 6 months and after 1 year, we found a significant decrease in pain with regard to the intensity resulting in the reduction of clinical disability. The preliminary data collected using the VAS scale and the MIDAS questionnaire confirm that the neuromuscular cranio-mandibular system can have an important role in the diagnostic process of the MOH and the PIFP, suggesting the usefulness of treatment with an occlusal device, where there is adequate FWS.

Oral splints in the management of nociceptive pain and migraines: A scoping review

“…Myofascial pain (29,30,33,34,36,40,43) and TMJ pain (29,31,34,37,40,42) were investigated in a number of studies. Pain assessment was usually assessed using questionnaires, like the Fonseca questionnaire (42) and a visual analog scale was cited by numerous studies (29)(30)(31)(32)34,35,38,40,42). The migraine disability score was applied in two studies (38,39).…”

“…Pain assessment was usually assessed using questionnaires, like the Fonseca questionnaire (42) and a visual analog scale was cited by numerous studies (29)(30)(31)(32)34,35,38,40,42). The migraine disability score was applied in two studies (38,39). The Headache Impact Test questionnaire was used by Blumenfeld and Boyd (41).…”

“…All included publications were published in the last 15 years and came from a variety of sources, including one from Austria ( 29 ), four from Brazil ( 30-33 ), one from Denmark ( 34 ), one from Germany ( 35 ), one from India ( 36 ), one from Iran ( 37 ), three from Italy ( 38-40 ), one from the USA ( 41 ) and two from Turkey ( 42 , 43 ). The continental distribution of these publications was similar across America (33.33%), Asia (26.66%) and Europe (40%).…”

“…The reported outcomes of splint therapy varied. A number of studies (60%) reported a positive outcome for splint therapy, including Aksakalli et al ( 42 ), Amin et al ( 36 ), Blumenfeld and Boyd ( 41 ), Conti et al ( 30 , 31 ), Costa et al ( 32 ), Didier et al ( 38 ), Haggiag et al ( 33 ) and Mortazavi et al ( 37 ). Aksakalli et al ( 42 ) demonstrated that splint therapy decreased TMD complaints, improved the movements of the mandible in patients with TMD and reduced overall pain in patients with both SSs and NTISs.…”

“…Costa et al ( 32 ) reported an early improvement of symptoms in patients with masticatory myofascial pain, wearing a SS. Didier et al ( 38 ) demonstrated that occlusal devices are effective and well-tolerated in the treatment of headaches and persistent idiopathic facial pain. Haggiag et al ( 33 ) reported that an intraoral device could aid in the reduction of pain in subjects suffering from chronic migraine headaches.…”