Headaches and pain referred to the teeth: frequency and potential neurophysiologic mechanisms

Objective: To assess frequency of pain referred to the teeth in occipital neuralgia, migraine and tension-type headache. Material and methods: 153 patients presenting with bruxing behavior and craniomandibular disorders (CMDs). Clinical examination, questionnaires, palpation, criteria for CMDs, bruxing behavior (BB), occipital neuralgia (ON), migraine (MIG), tension-type headache (TTH) and pain referred to the teeth. Results: Mean ages in the ON, MIG and TTH patients and controls were about 38.0, 37.0, 33.0 and 36.6 years, respectively (p = 0.17). The frequencies of dental pains in the subgroups ON and MIG were 37.1% and 25% (p = 0.52), ON and TTH, 37.1% and 18.6% (p = 0.03), ON and Controls 37.1% and 6.7% (p = 0.006), MIG and TTH 25% and 18.6% (p = 0.51), MIG and Controls 25% and 6.6% (p = 0.16) and TTH and controls 18.6% and 6.7% (p = 0.15). The frequencies of pain referred to the teeth decreased from the ON to the MIG, and then to the TTH and Control groups (x-square for independence p < 0.002, x-square for trends p < 0.001). Conclusion: The ON subgroup demonstrated the highest frequency of dental pain referred to the teeth. This frequency increased with the severity of pain. Neurophysiological mechanisms may explain higher frequency of referred pain associated with the severity of headache.