New Insights Into Migraine and the Migraine-Preventative Medication, Propranolol, for Management of Painful TMD – Tchivileva

Cross-sectional studies demonstrate positive associations between occurrence of migraine and painful temporomandibular disorder (TMD). However, few prospective studies have investigated the relevance of the association for the purpose of predicting TMD risk or providing treatment for TMD. One exception was our “OPPERA” prospective cohort study of 2,410 initially TMD-free adults who were followed for 3 years, during which time 199 of them developed first-onset TMD.

At baseline, presence of migraine, but not tension-type headache, predicted significantly increased risk of developing TMD. Migraine’s contribution to risk of TMD raises the possibility that facial pain in TMD patients might be mitigated using propranolol, an established preventive medication for migraine. In our “SOPPRANO” randomized controlled trial of 200 patients with chronic TMD myalgia, subjects were randomized 1:1 to either extended release propranolol hydrochloride (60 mg, b.i.d.) or placebo and treated for 10 weeks.

The primary endpoint was change in a facial pain index of pain intensity (0-100 scale) multiplied by pain duration (0-100% of waking day). Nine weeks after randomization, there was a statistically non-significant greater reduction in facial pain in the propranolol group compared with placebo. However, propranolol achieved a ≥30% reduction in the greater proportion of patients than placebo (number needed to treat = 7, 95%CI = 4, 56). Furthermore, efficacy was greater in 104 (52%) TMD cases who, at baseline, had definite or probable migraine. These results give emphasis to the importance of migraine and the migraine-preventive medication, propranolol, for management of painful TMD.

At the end of the presentation, attendees will:
• Review evidence for migraine and TMD comorbidity
• Learn results from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study for the first time demonstrating in a prospective cohort design that migraine is a risk factor for the TMD onset
• Evaluate data for efficacy and safety of propranolol treatment for TMD myalgia from the Study of Orofacial Pain and PropRANOlol (SOPPRANO) clinical trial

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Dr. Inna Tchivileva earned MD and MS in Biochemistry from the Russian State Medical University, Moscow, Russia. She completed her post-doctoral training in pain neurobiology, molecular biology, and genetics at the Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, where she is currently appointed as Assistant Professor. Her research interests comprise such topics as associations between TMD, headache and other functional pain syndromes; the role of genetic variations in nociception; and translation of laboratory findings to clinical applications for personalized pain management. She was a recipient of several NIH awards, including K12 “Biomedical Researcher Development Program in TMJD and Orofacial Pain,” R34, and U01 grants. The results of her research have been published in top scientific journals such as Science, Pain, and Human Molecular Genetics.