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J Oral Rehabil. 2016 Sep;43(9):702-15. doi: 10.1111/joor.12410. Epub 2016 May 18.

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

Author information

Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.
Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University, Araraquara, Brazil.
Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark.
Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
Scandinavian Center for Orofacial Neurosciences (SCON).


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.


headache disorders; myofascial pain syndromes; pain management; physiopathology; temporomandibular joint disorders; tension-type headache

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