Bruxism, temporomandibular dysfunction, tension-type headache, and migraine.

CLINICAL HISTORY A 32-year-old woman was seen for frequent migraine without aura present since she was a teenager. She reported having seen her general dentist for a cleaning who recommended a nociceptive trigeminal inhibition (NTI) bite guard to prevent migraine which he told her was US Federal Drug Administration (FDA) approved. She then went to see a temporomandibular joint (TMJ) specialist for a second opinion who told her that she had bruxism and TMD, although she was not aware of any symptoms. The specialist also recommended a splint to be worn nightly. Physical therapy was also proposed. Questions.—What is the evidence that the NTI bite guard reduces migraine frequency? Are there adverse events associated with its use? How common is bruxism and is bruxism associated with migraine or other headaches? Can bruxism be diagnosed by a dentist if the patient’s bed partner does not report this behavior? Is TMD associated with migraine? Can headaches be due to TMD? Should the headache specialist include a TMJ examination as part of the routine headache examination? What treatments can the non-dentist provide? When should a dental referral be made?