Mouth devices ease headaches in OSA

The use of oral appliances (OA), such as mandibular advancement devices, helps combat headache in patients with obstructive sleep apnoea (OSA), according to a recent study.

“There is good literature on OSA, headaches, and the effects of treatment, but all previous studies were based on continuous positive airway pressure treatment (CPAP),” the researchers said. The present study thus aimed to investigate the efficacy of OAs in combatting headaches in OSA patients and to determine potential predictors of patient response to these devices.

Thirteen OSA patients with headache were referred for OA therapy and completed the pre- and postintervention headache assessment. Eight participants showed symptoms that qualified as migraine, and the average visual analogue scale (VAS) intensity for each headache episode was 4.58±1.64; each episode lasted 128.04±80.88 minutes before treatment. [Sci Rep 2021;11:2568]

Among the aggravating factors named were bright lights, stress, loud noises, neck pain, and sleep deprivation.

Six participants reported improvements in headache intensity, with VAS scores dropping by 2.67±1.86 points after OA. Three patients reported a ≥50-percent drop in average headache intensity. These patients who responded to OA treatment were more likely to have bilateral headaches before treatment (p=0.035) and experienced less disability due to headaches after intervention.

Moreover, responders experienced significantly lower peak headache intensity (p=0.018) and less frequent episodes (p=0.011), while nonresponders saw worsening headache severities. OA also led to improvements in morning headaches and concomitant nausea/vomiting.

Polysomnography also revealed important differences between responders and nonresponders. Participants in the former group, for instance, were more likely to have mild OSA (p=0.017). The apnoea-hypopnoea index (AHI; p=0.03), hypopnoea index (p=0.002), and supine AHI (p=0.03) were all significantly lower in responders.

“The results of the current study show that the majority of evaluated patients experienced a significant decrease in headache frequency following OA treatment. This underlies the fact that headache should be routinely considered in the diagnostic process of OSA and treatment based on OA should be actively applied to those for the betterment of not only OSA but also headache severity,” the researchers said.

All participants in the current study were given mandibular advancement devices, custom made with a titratable design and able to cover all upper and lower teeth. Alongside the VAS, the Migraine Disability Assessment Questionnaire was also used to assess headache severity and resulting disability. Patients underwent polysomnography for the characterization of OSA.

“The results tentatively suggest that treatment with an OA is beneficial for many OSA patients with headaches,” said the researchers, however noting that causality has yet to be established and potential mechanistic pathways to be elucidated.

“Based on the data from this relatively small-scale study, OA treatment could be applied in headache patients with mild-to-moderate OSA when the patient is an appropriate candidate or has failed with other OSA treatments including CPAP to further contribute to the improvement of headache symptoms,” they added.