Analysis of Research Article
Sara Smith
BIO 360- Epidemiology
Instructor: Professor Norm Hubbard
December 9, 2013

Abstract This article analysis a research article that describes an epidemiological study conducted in Brazil. The study sought to find if there is a relation between headaches and temporomandibular disorders in persons of various ages. The research article entails the data collected and the reasoning of the study as a thorough review of the process. This analysis assesses if the research was thorough and if the data justifies the conclusions made by the researchers. The researchers are from the American Academy of Orofacial Pain. The article of discussion is called, Headache and Symptoms of Temporomandibular Disorder: An Epidemiological.

Analysis of Research Article Headaches are a problem that people contend with on a regular basis. They are something that everyone has experienced throughout their life and can be a hindrance whether they are chronic daily headaches, migraines, or tension headaches. The reasoning of their presence is sought out by medical professions for various reasons. The relationships of headaches to other symptoms of the body are often examined, as headaches are a sign of a different complication within the body, such as tumors or infections. To understand the connections of a headache or even a migraine headache to other ailments in the body, are useful information as many things can be misdiagnosed or underdiagnosed. The persons experiencing the headaches seek answers. Sometimes they are led down the wrong path as being diagnosed with temporomandibular disorders. “Temporomandibular disorders (TMDs) is a collective term that embraces a number of clinical problems that involve the masticatory muscles, the temporomandibular joint (TMJ), and the associated structures. The procedures to address the TMDs can be very expensive and painful dental procedures that may not be necessary. The differentiation in diagnosing headaches and TMDs and their possible linkage can be helpful and cost saving (Gonçalves, D., Bigal, M., Jales, L., Camparis, C., & Speciali, J.,2010).
The epidemiological research study of discussion contributes to finding a link between headaches and temporomandibular disorders; it however, is not seeking a causation of either. The study wants to prove the hypothesis that TMDs are more prevalent in persons who experience headaches, no matter which type, than in persons who do not experience headaches. There is no evidence in the study at all to give any possible cause of headaches or TMDs, nor their relationship to one another. The study seeks to find if there is a comorbid relationship between the presents of headaches, migraines, and tension headaches to temporomandibular disorders, which often present themselves with pain. A headache, such as a migraine, can be misdiagnosed as TMDs and can cost a lot of money to treat, which might not be necessary. This knowledge is of importance and can help medical professionals to understand that the symptoms may be something to look into more before treating the patient with expensive procedures. To find out their presence at the same times or separately can help to properly diagnose the two different symptoms and save money (Gonçalves, et al., 2010). The study was conducted in an urban area of Brazil. This study was a population based cross-sectional study that included 1230 participants. A cross sectional study is a study that determines the outcomes of both exposure and disease at the same time (Gordis, 2009). In this study, that means determining the occurrence of headaches at the same time as determining the occurrence of TMDs in order to see if there is a correlation between the two. The gender ratio emulated the true population gender ratio of the area with a slight majority of females. The ratio was 51.5% female and 48.5% male. The selections of participants were random as to reduce bias as much as possible. The way that the surveys were collected and participants identified was by telephone calls. The randomizations included all areas of the population and the area in Brazil would be relatable to the population style in the United States, so that the study could be useful on a global basis as well. The study was accepted by many respectable associations except in Portuguese, as they did not validate the questionnaire utilized in the study (Gonçalves, et al., 2010).
The randomizations intended to include four houses on a street being called to contribute to the survey. If the researchers were not able to get an adequate amount of participants for that street, then they would completely exclude the street and marked as nonparticipants so the numbers would be evenly random for the area. The researchers would call a house with three attempts. The age groups of the study included a large range of people from fifteen to sixty-five years old who would answer and were willing and able to answer questions with complete understanding of the content. The questionnaire covered two topics of discussion. These topics were headaches and TMDs (including signs and symptoms). For the topic of TMDs if the participant answers at least one of the questions as having either sign or symptom within the last month they would count that participant as possibly having TMDs (Gonçalves, et al., 2010). The researchers hypothesized that there was an increased incidence of TMD with headaches than there was if the person was not experiencing headaches. They hypothesized that TMD would be more prevalent in participants that experienced chronic daily headaches. On the contrary though, their hypothesis was wrong as there was a greater prevalence of TMD with participants whom experienced migraine headaches. The prevalence of the questionnaire that was utilized during the phone conversations with the participants is comparable to a questionnaire utilized in the United States with the topic of headaches. The questionnaire had 97% sensitivity and 93% specificity. There was discussion of whether the questionnaire was solid enough to give data about a link between headaches of various types and TMD. There was debate since the questionnaire about TMD included both questions about signs of TMD such as jaw clicks and symptoms of TMD. The researchers continued to utilize questions on both areas as they felt it did not deter data on the possibility of TMD. The different questions helped them break down their analyses further as they could classify patients as having sounds of TMJ and symptoms of TMJ, such as pain. Their questionnaire did not diagnose any participants with TMD just counted them as possibly having TMD (Gonçalves, et al., 2010). Their data was very thorough as they broke down all the different variations of the study. They calculated the prevalence of the combinations of factors. An example would be they found out the prevalence of on TMDs symptom in persons who had; no headache, migraines, tension headaches, or chronic daily headache then would do the same calculations of participants who had two TMDs symptoms and etc. By breaking up all the data of the different types of headaches and the presence of one or more symptoms of TMDs, they were able to conclude that TMDs were more common in all types of headache sufferers than in participants that did not suffer from headaches. The prevalence ratio that was utilized consists of the persons with disease over the exposure prevalence of TMDs (Gonçalves, et al., 2010). The researchers also broke everything down by age group. Their conclusion found that headaches were most common in the age group including participants twenty to forty five years old. They also were able to conclude that TMJ sounds were more prevalent in males whereas TMJ pains were twice as prevalent in females. If the researchers would have excluded the differentiation in the questionnaire of signs versus symptoms they would not have been able to analyze the difference in prevalence between the genders in relation to sounds versus pain. “The sample was stratified by gender and age for study of the associations with TMD and headache. For comparison of proportions, the chi-squared test was performed (Gonçalves, et al., 2010).”
The researchers concluded that “Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine. Future studies should clarify the nature of the relationship (Gonçalves, et al., 2010).”
An epidemiological study that was conducted with similar topics is titled, Temporomandibular dysfunction: an often overlooked cause of chronic headaches. It concludes that TMDs would be a likely cause of headaches and is often misdiagnosed. It states that patients are unnecessarily treated for allergic rhinitis when the headache is attributed to painful TMDs. This has the similar approach to the study of discussion; however, it seems to go in the opposite direction stating that TMDs are underdiagnosed. With the study being analyzed in this paper, the researchers felt that TMDs were being over diagnosed when the patients could be having just headache symptoms (Lupoli, T., & Lockey, R.,2007).
Both the studies included that there need to be a thorough examination and physical so that patients are properly diagnosed. The researchers felt that patients were given the wrong treatments, whether it being unnecessary dental treatments or broad-spectrum antibiotics. Also, both studies included that they were not including any causations within their studies, just the prevalence of headaches and TMDs.
The study was very thorough and was able to answer the hypothesis that was sought at the beginning of the study. The researchers were very formal in the participant selection randomization as to reduce any bias in the study. The use of the telephone surveys was professional as the majority of the population had a telephone present in the home. The gender contribution was mirrored to the population that seems appropriate and the age groups that contributed were a proper age variation. The included all necessary data into the tables given in the research article and gave descriptive detail as to how they calculated all the prevalence factors and ratios. The only problem that seems to arise was rating pain. Pain is subjective and varies throughout persons. One person might state that there is pain present but with the same symptom another person might not describe it as pain. When researchers continue to seek more answers about the relationship between headaches and TMDs they could do neuromuscular testing to see if nociceptors are affected as well as determine if the pain is located in the temporomandibular areas or somewhere else that could be describes as a headache. In order to do this however, the study would be more costly and the participants might not be as willing to contribute to the study as they might feel that the procedure could cause pain or contribute to their symptoms to worsen. The research contributed to the study of headaches as well as temporomandibular disorders and further study can add onto this information and even possibly determine causation for these symptoms. Further knowledge might be able to prevent these symptoms all together. The epidemiologic studies are a way to start further research as to exclude unnecessary testing and costs of different diagnostic testing (Gordis, 2009).

References

Gonçalves, D., Bigal, M., Jales, L., Camparis, C., & Speciali, J. (2010). Headache and symptoms of temporomandibular disorder: an epidemiological study. Headache: The Journal Of Head & Face Pain, 50(2), 231-241. doi:10.1111/j.1526-4610.2009.01511.x
Gordis, L. (2009) Epidemiology, 4th edition. Philadelphia, PA: Saunders/Elsevier.
Lupoli, T., & Lockey, R. (2007). Temporomandibular dysfunction: an often overlooked cause of chronic headaches. Annals Of Allergy, Asthma & Immunology, 99(4), 314-318.