The effects of manual therapy and cognitive exercise therapy approach on headache and quality of life in patients with temporomandibular dysfunction-related headache

This study aimed to comparatively investigate the effects of Manual Therapyand Cognitive Exercise Therapy Approachon headache, sleep quality, depression, anxiety, fatigue, and quality of life in individuals with temporomandibular dysfunction-related headache. A total of 62 participants were randomly assigned to three groups: Manual Therapy (MT) (n=22), Cognitive Exercise Therapy Approach (BETY) (n=20), and Control Group (n=20). The MT group received home exercises and patient education alongside trigger point therapy, myofascial release, temporomandibular joint (TMJ) and cervical mobilization, TMJ soft tissue mobilization, stretching of cervical muscles, muscle energy technique for masticatory muscles, and relaxation techniques for the occipital, temporal, and parietal regions. The BETY group was provided with home exercises, patient education, along with function-focused corestabilization exercises, dance therapy-authentic movements, and pain management education. The control group received only home exercises and patient education. The MT and BETY interventions were administeredtwice weekly for 45 minutes over 8 weeks. The control group was instructed to perform home exercises five days a week, once a daily, for 30-35 minutes, over 8 weeks. Participants' demographic data were recorded, and clinical assessments included posture analysis, cervical and TMJ range of motion, pain intensity (Visual Analogue Scale and McGill Pain Questionnaire-Short Form), and trigger point sensitivity. Muscle viscoelastic properties were measured using Myoton Pro, and pressure pain threshold measurements were conducted with an algometer (Wagner Instruments). The biopsychosocial status of participants was evaluated using the Cognitive Exercise Therapy Approach – Biopsychosocial Questionnaire (BETY-BQ). Additionally, functional status and quality of life were assessed using the Jaw Function Limitation Scale (JFLS), Oral Health Impact Profile-14 (OHIP-14), Pittsburgh Sleep Quality Index (PSQI), Neck Disability Index (NDI), Fatigue Severity Scale (FSS), Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS) and patient satisfaction measures including the Patient Satisfaction Questionnaire Short Form (PSQ-18) and Global Rating of Change (GROC). Post-treatment evaluations at 8weeks and the follow-up assessments at 5 months revealed significant improvements in all three groups in pain levels in the jaw, head, and neck regions, trigger point sensitivity, muscle viscoelastic properties, jaw function, cervical and TMJ range of motion, sleep quality, and fatigue levels (p<0.05). The MT group showed more pronounced improvements than the other groups at the end of the 8th week (p<0.05). However, at the 5-month follow-up, The BETY group demonstrated more sustained benefits with statistically significant improvements (p<0.05). In conclusion, for individuals with TMD-related headaches, BETY provided more sustained effectson pain intensity, sleep quality, fatigue, depression, anxiety, and quality of life compared to MT in the long term. Future studies should investigate the long-term effects of combining both approaches.