Assessing the Effectiveness of Two Treatment Strategies for Tension-type Headache

The primary aim of the pilot data proposal is to compare usual care (medications) versus multi-disciplinary treatment in temporomandibular disorder (TMD) patients.

The primary aim of the pilot data proposal is to compare usual care (medications) versus multi-disciplinary treatment in TMD patients with episodic or chronic tension-type headache (TTH) with pericranial tenderness involving the temporalis muscle at reducing the intensity of TTH pain at 1 and 6 months. The hypothesis is that a team approach will reduce the intensity of headache more than usual care in this group of patients.

• Behavioral: Behavioral therapy, splint therapy and physical therapy
  Treatment will include patient education, use of a mouth guard, jaw muscle exercises and brief cognitive-behavioral intervention.
  Other Name: Medications: Amitryptoline or has unacceptable side-effects, then other tricyclics and/or muscle relaxants are allowed.1
• Drug: Standard care using current drugs
  Standard Drug therapy

• Active Comparator: Standard Care
  Standard care with drug intervention
  Intervention: Drug: Standard care using current drugs
• Experimental: Rehabilitation
  Using rehabilitation for comparing use of drug
  Intervention: Behavioral: Behavioral therapy, splint therapy and physical therapy

Inclusion Criteria:

Fifty consecutive subjects (Age 18 to 65) will be included when they fulfill the diagnostic criteria for episodic or chronic TTH with pericranial muscle tenderness3 and TMD including myofascial pain involving the temporalis muscle -

Exclusion Criteria:

Exclusion criteria, assessed by review of medical history, include:

• systemic rheumatic disease
• widespread pain
• pregnancy
• concurrent use of tricyclic antidepressants, steroids, anti-inflammatories, muscle relaxants, or narcotics
• major psychiatric disease
• any medical contraindications