Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

Abstract

There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.

Effects of Low‐Intensity Contractions of Different Craniofacial Muscles in Healthy Participants – An Experimental Cross‐Over Study

“…Temporomandibular disorders (TMD) and tension-type headaches (TTH) are frequently encountered craniofacial pain conditions 1 with overlapping clinical presentations and significant impact on quality of life. 2 The craniofacial muscles are suspected to be involved in the pathophysiology, and both peripheral and central sensitization as well as impaired endogenous inhibitory controls are implicated in the development and the maintenance of the pain. 3,4 Nevertheless, the triggering causes or events leading to such neuroplastic changes in the trigeminal and cervical parts of the nociceptive system have not yet been convincingly demonstrated.…”

Frequent Episodic Tension-Type Headache in Studentes of Physiotherapy Course

“…And the annual rates for headaches in general may vary between 46% -70.6%. Among the primary headaches, TTH has the highest prevalence with 29.5% to 42%, followed by migraine with 11% to 15.8% and chronic daily headaches with annual indices of 3 to 6.1% (7,8) . It was supposed that the pain of TTH would be due to an exaggerated contracture of the musculature of the head, neck, shoulders, to the face, which would lead to a muscular ischemia and that would release algogenic substances which provoke the sensation of pain.…”

Preclinical Signs of a Temporomandibular Disorder in Female Patients With Episodic Cervicogenic Headache Versus Asymptomatic Controls: A Cross‐Sectional Study

“…Migraine, tension‐type, and secondary cervicogenic headache (CeH) are frequently associated with TMD . CeH and TMD are even hypothesized to share an identical pathophysiology, in which the upper cervical spine is an important processing station for noxious signals . TMD can be associated with an upper‐cervical dysfunction and cervical pain, both of which are diagnostic criteria of CeH .…”