Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction

There is evidence that temporomandibular disorder (TMD) may be a contributing factor to cervicogenic headache (CGH), partially due to the influence of dysfunction of the temporomandibular joint on the cervical spine. The authors conducted this randomized controlled trial to determine whether orofacial treatment as well as to cervical manual therapy, was more effective than cervical manual therapy alone on measures of cervical movement impairment in patients with features of CGH and signs of TMD. In their study, 43 patients (27 women) with headache for more than 3-months and with some features of CGH and signs of TMD were randomly assigned to undergo either cervical manual therapy (usual care) or orofacial manual therapy to address TMD in addition to usual care. Subjects were assessed at baseline, after 6 treatment sessions (3-months), and at 6-months follow-up. 38 subjects (25 female) completed all analysis at 6-months follow-up. Their outcome criteria were: cervical range of movement (including the C1-2 flexion-rotation test) and manual examination of the upper 3 cervical vertebra. The group that received orofacial treatment in addition to usual care displayed substantial reduction in all aspects of cervical impairment after the treatment period. The improvements persisted to the 6-month follow-up, but they did not observed these gains in the usual care group at any point.

The authors concluded that these observations in addition to previous reports suggest that manual therapists should look for features of TMD when examining patients with headache, especially if treatment fails when directed to the cervical spine.