Are Orthodontic Interventions Associated With Headaches in Children and Adolescents? A Systematic Review and Meta-Analysis.

This study aimed to assess the prevalence of headaches in children and adolescents during and after completing orthodontic treatment. This systematic review followed the PRISMA guidelines. An extensive literature search was conducted in the following databases: MEDLINE, Embase, CINAHL, Web of Science, and Cochrane from inception until December 20, 2024. Studies targeting individuals between 7 and 18 years old, diagnosed with malocclusions, and receiving orthodontic treatment were included. A meta-analysis (odds ratio) was performed considering the number of individuals with and without headache, who did and did not undergo orthodontic treatment. The quality of studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. Finally, the overall certainty of the evidence was assessed by the GRADE approach. Seven studies met the inclusion criteria with a pooled sample size of 1.141 individuals. No statistically significant difference in the prevalence of headache was found between children who received orthodontic intervention compared to no treatment (OR 1.22 [CI 0.78; 1.92]; p = 0.38). Children with malocclusion who were treated orthodontically had significantly fewer headaches after treatment compared to untreated children with class II malocclusion (OR 0.42 [CI 0.19; 0.92]; p = 0.03). All studies had a high risk of bias, and the certainty of evidence was very low. In summary, no increased prevalence of headaches was detected during or after orthodontic interventions in children and adolescents with malocclusions when compared to those who did not receive orthodontic treatment. Instead, children with malocclusion treated orthodontically had significantly fewer headaches after treatment compared to untreated children with malocclusion. Further research is needed, as the conduct and quality of the existing studies need substantial improvement. Trial Registration: CRD42022340817 (PROSPERO).