A mandibular advancement appliance reduces pain and rhythmic masticatory muscle activity in patients with morning headache

Abstract

Aims: To evaluate the influence of an oral appliance on morning headache and orofacial pain in subjects without reported sleep-disordered breathing (SDB).

Methods: Twelve subjects aged 27.6 ± 2.1 (mean ± SE) years and suffering from frequent morning headache participated in this study. Each subject was individually fitted with a mandibular advancement appliance (MAA). The first two sleep laboratory polygraphic recording (SLPR) nights were for habituation (N1) and baseline (N2). Subjects then slept five nights without the MAA (period 1: P1), followed by eight nights with the MAA in neutral position (P2), ending with SLPR night 3 (N3). Subjects then slept five nights without the MAA (P3), followed by eight nights with the MAA in 50% advanced position (P4), ending with SLPR night 4 (N4). Finally, subjects slept 5 nights without the MAA (P5). Morning headache and orofacial pain intensity were assessed each morning with a 100-mm visual analog scale. Repeated measures ANOVAs and Friedman tests were used to evaluate treatment effects.

Results: Compared to the baseline period (P1), the use of an MAA in both neutral and advanced position was associated with a ⋝ 70% reduction in morning headache and ⋝ 42% reduction in orofacial pain intensity (P ⋜ .001). During the washout periods (P3 and P5), morning headache and orofacial pain intensity returned to close to baseline levels. Compared to N2, both MAA positions significantly reduced (P < .05) rhythmic masticatory muscle activity (RMMA).

Conclusion: Short-term use of an MAA is associated with a significant reduction in morning headache and orofacial pain intensity. Part of this reduction may be linked to the concomitant reduction in RMMA.