Mixed Bruxism Episodes More Common in Migraine and Temporomandibular Disorders, Study Finds

Helena Martynowicz, MD, PhD, DSc

(Credit: Wroclaw Medical University)

New findings from a case-control study indicated that patients with temporomandibular disorders (TMD) who experience migraine are more likely to have mixed bruxism episodes, involving both rhythmic and nonrhythmic muscle activity, compared with those without migraine. Published in Headache, these results may suggest a shared pathophysiology underlying migraine and mixed bruxism.¹

The study examined 119 patients with TMD using polysomnography to assess sleep parameters. Among the 30 patients diagnosed with migraines, mixed bruxism episodes were notably higher (median 0.7 n/h vs 0.5 n/h; P = .044) compared with the 89 controls without migraine. Additionally, the duration of sleep bruxism (SB) episodes was longer in patients with migraine (7.0 s vs 5.9 s; P = .005). However, overall SB prevalence and severity showed no significant difference between groups.

Conducted by senior author Helena Martynowicz, MD, PhD, DSc, associate professor in the Department and Clinic of Internal and Occupational Diseases and Hypertension at Wroclaw Medical University, the sample population included 30 patients with migraine, with a median age of 35 years, and 89 controls, with a median age of 37 years. Of those with migraine, 17 had migraine without aura (MwoA) and 13 had migraine with aura (MwA). Notably, SB was prevalent in both groups (migraine, 86% vs controls, 71.9%), but the bruxism episode index (BEI) was not significantly associated with migraines (OR, 2.68; 95% CI, 0.84–8.55; P = .095).

The study also evaluated the relationship between obstructive sleep apnea (OSA) and migraines. Although the apnea–hypopnea index (AHI) did not differ significantly between migraine and control groups (OR, 1.01, 95% CI: 0.96–1.06, P = .605), patients with MwoA had higher AHI values compared with MwA (mean AHI, 0.9 vs. -0.1, P = 0.049), indicating a potential link between nonaura migraine and sleep apnea.

The findings highlighted a nuanced relationship between sleep disorders and migraine in patients with TMD. Despite SB itself did not increase migraine risk, the higher frequency of mixed bruxism episodes and longer duration of SB events in patients with migraine suggests a potential overlapping mechanism. Further research may be needed to explore these associations and better understand the role of sleep disturbances in migraine pathophysiology.

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Following recent findings on the relationship between SB and migraine in patients with TMD, another recent study further illuminated the complex interplay between migraine and TMD by examining the psychological and clinical profiles of these patients.² The findings build on prior research indicating that sleep disturbances, such as mixed bruxism episodes, may overlap with migraines in patients with TMD. Together, these studies underscored how multiple factors—psychological distress, pain intensity, and sleep disorders—intersect in patients with migraine and TMD.

In the other study, researchers reported that among 64 patients with TMD, those with migraine symptoms requiring medication reported significantly higher levels of psychological distress, including anxiety, depression, and somatization, compared with patients with TMD without migraine. Despite worse pain outcomes at 3 months post treatment (P = .023), this difference disappeared at the 6-month follow-up.

Patients were evaluated using the Diagnostic Criteria for TMD protocol alongside validated psychological questionnaires such as the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. All told, the migraine group showed higher scores across multiple psychological metrics, including somatization (P = .035), obsessive-compulsive behavior (P = .015), interpersonal sensitivity (P = .002), and depression (P = .035).

Younger age (OR, 0.844, P = .001) and women (OR, 0.001, P = .011) were significant predictors of migraine presence, as was having more positive sites on masticatory muscle palpation (OR, 2.580, P = .011). History of mental illness (β = -0.465, P = .002) and higher Oral Behavior Checklist scores (β = 0.483, P = .002) were linked to greater TMD pain intensity among patients with migraine.

Above all, this research adds to the growing body of evidence suggesting that migraine exacerbate the disease burden in patients with TMD by increasing psychological distress and short-term pain levels. Although these effects appear to diminish over time, the findings highlighted the importance of comprehensive, multidisciplinary approaches to treatment that address both physical and psychological factors.

REFERENCES
1. Błaszczyk B, Waliszewska-Prosół M, Smardz J, Więckiewicz M, Wojakowska A, Martynowicz H. Exploring the associations of sleep bruxism and obstructive sleep apnea with migraine among patients with temporomandibular disorder: A polysomnographic study. Headache. 2025;65(2):242-257. doi:10.1111/head.14892
2. Lee SH, Jo JH, Park JW. Temporomandibular disorders patients with migraine symptoms have increased disease burden due to psychological conditions. J Oral Facial Pain Headache. 2025;39(1):70-80. doi:10.22514/jofph.2025.006