Interação entre cefaléias e disfunção temporomandibular: uma revisão da literatura
Interaction between headaches and temporomandibular disorders: a literature review
Franco, A.L.; Godoi, D.A.; Castanharo, S.M.; Camparis, C.M.
Resumo
Disfunção temporomandibular (DTM) é um termo coletivo para os problemas clínicos que envolvem a musculatura da mastigação, a articulação temporomandibular (ATM) e as estruturas associadas. A cefaléia é um sintoma que aparece frequentemente associado à DTM. Estudos epidemiológicos indicam forte associação entre dor de cabeça e DTM, porém essa interação ainda é passível de discussões. Para esta revisão, foram levantados artigos relevantes do tema, publicados na base de dados PubMed entre os anos de 1982 e 2008. Um dos principais achados apresentados é que parece haver uma importante interação no processamento das dores provenientes das cefaléias primárias e da DTM. Estudos têm mostrado que a fisiopatologia de ambas está intimamente relacionada com os núcleos do nervo trigêmeo. Neurônios no núcleo caudado trigeminal integram informações aferentes vindas de tecidos intra e extracranianos. Com base nessas investigações, observa-se que, apesar de vários mecanismos distintos estarem presentes na fisiopatologia das cefaléias e da DTM, as alterações ocorridas no sistema nervoso central têm fundamental papel na patogênese dessas queixas. Ainda há necessidade de estudos populacionais e longitudinais para esclarecer a relação entre a fisiopatologia das cefaléias e a da DTM.
Palavras-chave
Abstract
Temporomandibular Disorder (TMD) is a collective term for defining clinical problems involving the chewing muscles, the temporomandibular joint (TMJ), as well as its associated structures. Headache is a frequent symptom in TMD, although the meaning of the association is still controversial. This article reviews the literature published from 1982 to 2008, selected by use of a Medline search. Review points to a possible important interaction in the processing of pain information from headaches and TMD. Studies have shown that both share pathophysiological mechanisms, which involve the trigeminal nerve nucleus, where convergent neurons integrate afferent information from intra and extracranial tissues. It may be suggested that although some distinct mechanisms are involved in the physiopathology of primary headaches and TMD, alterations in central nervous system are of importance in the pathogenesis of these complaints. Population and longitudinal studies are still necessary to better clarify the relationship between the physiopathology of such conditions.
Keywords
References
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