A Mandibular Advancement Appliance Reduces Pain and Rhythmic Masticatory Muscle Activity in Patients with Morning Headache

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. J OROFAC PAIN 2011;25:240-249