Study of parafunctions in patients with chronic daily headache.

The purpose of this paper is to present the results of a questionnaire investigating parafunctions (particularly clenching and grinding). The questionnaire was elaborated by the Dental Clinic of the University of Milano and completed by 125 patients experiencing chronic daily headache and attending the Neurological Institute Carlo Besta for an inpatient withdrawal protocol to treat medication overuse related to chronic headaches. Our results showed high percentages of parafunctions, which were present in 80% of patients with chronic daily headache. We noted that patient information on possible behaviours and coexisting conditions which may be involved in the mechanisms of chronic headaches, as well as education about these factors, are crucial aspects in the management of chronic headache patients. It is important for clinicians to perform a thorough evaluation (based upon history taking and clinical examination) aimed at identifying parafunctions. Several studies showed that cranio-mandibular dysfunction (CMD) is prevalent in different headache forms, such as tension-type headache and migraine, and may have a role in their chronification. Overall, our data encourage the early diagnosis and treatment of muscular and mechanical aspects of CMD. All the diagnostic and therapeutic proposals over the years suggested that converting a dysfunctional stomatognathic system into a physiological and functional one is an appropriate and effective approach to the treatment of headaches. The achievement of a good muscular activity during clenching and a low activity at rest represent the main goals of our therapy. We suggest that patients suffering from chronic headaches are be evaluated as far as the need for interocclusal devices (as pointed out in previous studies of our group) is concerned, and in relation to the possible presence of parafunctions: their analysis, correction and prevention will ultimately limit their role as trigger factors or as coexisting conditions influencing the development/maintaining of headache chronification.