Association Between Primary Headache and Bruxism: An Updated Systematic Review

Jéssica Conti Réus, Helena Polmann, Beatriz Dulcinéia Mendes Souza, Carlos Flores-Mir, Paulo Cesar Trevisol Bittencourt, Efraim Winocur, Jeffrey Okeson, Graziela De Luca Canto

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Aims: To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults? Materials and Methods: A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Ana lysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria. Results: Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis. Conclusion: Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial. J Oral Facial Pain Headache 2021;35:129–138, doi: 10.11607/ofph.2745

Original languageEnglish
Pages (from-to)129-140
Number of pages12
JournalJournal of Oral and Facial Pain and Headache
Issue number2
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021. by Quintessence Publishing Co Inc.


  • bruxism
  • migraine disorders
  • primary headache disorders
  • systematic review
  • tension-type headache

ASJC Scopus subject areas

  • Dentistry (miscellaneous)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Association Between Primary Headache and Bruxism: An Updated Systematic Review'. Together they form a unique fingerprint.

Cite this