3. Discussion
TMD, Headache, migraine headaches, headaches, pain, orofacial pain, head and neck pain, headache, migraine
TENSION-TYPE HEADACHES, MIGRAINE HEADACHES, MIGRAINE
Instead of conservative treatments, such as physical therapy, the use of non-steroidal analgesic agents, and the local injection of anesthetics and steroids, BoNT/A is being increasingly used as an adjuvant treatment for head and neck pain, such as tension-type headaches and migraine headaches [In this study, OVAS and TPs were compared to evaluate the change in the intensity of orofacial pain. Our findings showed a significant reduction in pain intensity over time in the experimental group compared to the control group, as demonstrated by a decrease in the OVAS over time and significant intergroup variation as well as time effects for TPs. Similarly, a double-blind RCT conducted by Lindern et al. [Furthermore, in our study, no time effects for changes in MMO were observed in either group (exp; In addition, we investigated the effect of BoNT treatment on headache by assessing HVAS and HF. Both HVAS (As mentioned above, several studies have only mentioned the pain relief effect of BoNT/A on the masticatory muscles of patients with TMD; however, there has been a lack of prospective, randomized, double-blind approaches to assessing the effect of BoNT/A on both MMP and headache among patients with TMD. Therefore, our study aimed to simultaneously evaluate the effect of BoNT/A in treating both MMP and headache, and the following factors were analyzed: OVAS, TPs, MMO, HVAS, and HF.This study has several limitations. The major limitation of this study was its small sample size. Second, this study was carried out on patients with general headaches without classifying the headaches into detailed diagnoses, such as migraine or tension-type headaches. Despite these limitations, this is the first prospective study to evaluate the therapeutic effects of BoNT/A on both MMP and headache among patients with TMD. Moreover, we adopted a double-blind RCT design to collect evidence-based data on the use of BoNT/A among TMD patients with MMP and headache, enhancing data reliability. Considering the outcomes derived from this pilot study, further studies with larger sample sizes are warranted. Furthermore, it is necessary to conduct additional RCTs and prospective studies to distinctly classify headache diagnoses according to the criteria of the Headache Classification Committee of the International Headache Society. This approach will ultimately allow for a more optimized evaluation of BoNT’s clinical effects on headaches.