Skip to main content

Advertisement

SpringerLink
Log in

Orofacial Pain and Headache: A Review and Look at the Commonalities

  • Uncommon Headache Syndromes (J Ailani, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Headache and facial pain – in particular, temporomandibular disorders (TMDs) – are very prevalent conditions in the general population. TMDs are defined as a collection of symptoms and signs involving masticatory muscles, the temporomandibular joints (TMJs), or both. The pain reported by TMD patients is typically located in the muscles of mastication, in the preauricular area, or in the TMJs. In many cases, headaches and facial pain will occur in the same patient. Much of the research relative to the relationship of these disorders focuses on statistics of association and prevalence data. This review will provide a brief description of the types and classifications of orofacial pains (OFPs), as well as point to relevant research describing the commonalities and potential comorbid nature of these maladies. Finally, several recent papers describing morphologic changes to the brain in headache and TMD individuals will be discussed in an effort to stimulate further research into the potential common pathophysiologic mechanism that may explain the comorbid nature of these disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cady R et al. Primary headaches: a convergence hypothesis. Headache. 2002;42(3):204–16.

    Article  PubMed  Google Scholar 

  2. Pietrobon D. Migraine: new molecular mechanisms. Neuroscientist. 2005;11(4):373–86.

    Article  CAS  PubMed  Google Scholar 

  3. Appelgren A et al. Neuropeptides in the arthritic TMJ and symptoms and signs from the stomatognathic system with special consideration to rheumatoid arthritis. Journal of orofacial pain. 1995;9(3):215–25.

    CAS  PubMed  Google Scholar 

  4. Macfarlane TV et al. Oro-facial pain in the community: prevalence and associated impact. Community Dent Oral Epidemiol. 2002;30(1):52–60.

    Article  PubMed  Google Scholar 

  5. Lipton RB et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343–9.

    Article  CAS  PubMed  Google Scholar 

  6. Mazzeo N, Colburn S, Ehrlich AD, et al. Comorbid diagnosis, sleep, pain and psychometric inventoriescomparing dental populations. J Dent Res. 2004;83:1200.

    Google Scholar 

  7. de Leeuw R, Klasser GD, Albuquerque RJ. Are female patients with orofacial pain medically compromised? J Am Dent Assoc. 2005;136(4):459–68.

    Article  PubMed  Google Scholar 

  8. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc. 1993;124(10):115–21.

    CAS  PubMed  Google Scholar 

  9. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Critical reviews in oral biology and medicine: an official publication of the American Association of Oral Biologists. 1997;8(3):291–305.

    Article  CAS  Google Scholar 

  10. Yap AU, Chua EK, Hoe JK. Clinical TMD, pain-related disability and psychological status of TMD patients. Journal of oral rehabilitation. 2002;29(4):374–80.

    Article  CAS  PubMed  Google Scholar 

  11. Hargreaves KM. Orofacial pain. Pain. 2011;152(3 Suppl):S25–32.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Merskey HBN, editor. Classification of chronic pain, Task Force on Taxonomy, International Association for the Study of Pain. 2nd ed. Seattle: IASP Press; 1994. p. 210–3.

    Google Scholar 

  13. Headache Classification Committee of the International Headache, S., The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia, 2013. 33(9)629–808.

  14. de Leeuw R, Klasser GD, editors. Orofacial pain: Guidelines for assessment, diagnosis, and management. Fifthth ed. Chicago: Quintessence Publishing Co, Inc; 2013. p. 312.

    Google Scholar 

  15. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301–55.

    CAS  PubMed  Google Scholar 

  16. Aggarwal VR et al. Development and validation of classification criteria for idiopathic orofacial pain for use in population-based studies. Journal of orofacial pain. 2007;21(3):203–15.

    PubMed  Google Scholar 

  17. Magnusson T, Egermark I, Carlsson GE. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. Journal of orofacial pain. 2000;14(4):310–9.

    CAS  PubMed  Google Scholar 

  18. McNeill C et al. Temporomandibular disorders: diagnosis, management, education, and research. J Am Dent Assoc. 1990;120(3):253. 255, 257 passim.

    CAS  PubMed  Google Scholar 

  19. Carlsson GE, L.L., ed. Epidemiology of temporomandibular disorders. Temporomandibular disorders and related pain conditions, progress in pain research and management., ed. B.J. Sessle, Bryant, PS, Dionne, RA. Vol. Vol 4. 1995, IASP Press: Seattle. p. 211–26.

  20. Bender SD. Temporomandibular disorders, facial pain, and headaches. Headache. 2012;52 Suppl 1:22–5.

    Article  PubMed  Google Scholar 

  21. John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain. 2005;118(1–2):61–9.

    Article  PubMed  Google Scholar 

  22. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. Journal of orofacial pain. 1996;10(3):240–53.

    CAS  PubMed  Google Scholar 

  23. Manfredini D et al. Diagnosis of temporomandibular disorders according to RDC/TMD axis I findings, a multicenter Italian study. Minerva stomatologica. 2004;53(7–8):429–38.

    CAS  PubMed  Google Scholar 

  24. Schmitter M et al. Research diagnostic criteria for temporomandibular disorders: a calibration and reliability study. Cranio. 2005;23(3):212–8.

    PubMed  Google Scholar 

  25. Bhat S. Etiology of temporomandibular disorders: the journey so far. Int Dent SA. 2010;12(4):88–96.

    Google Scholar 

  26. McNeill C. Management of temporomandibular disorders: concepts and controversies. J Prosthet Dent. 1997;77(5):510–22.

    Article  CAS  PubMed  Google Scholar 

  27. Salonen L, Hellden L, Carlsson GE. Prevalence of signs and symptoms of dysfunction in the masticatory system: an epidemiologic study in an adult Swedish population. J Craniomandib Disord. 1990;4(4):241–50.

    CAS  PubMed  Google Scholar 

  28. Dando WE, Branch MA, Maye JP. Headache disability in orofacial pain patients. Headache. 2006;46(2):322–6.

    Article  PubMed  Google Scholar 

  29. Ballegaard V et al. Are headache and temporomandibular disorders related? A blinded study. Cephalalgia. 2008;28(8):832–41.

    Article  CAS  PubMed  Google Scholar 

  30. Graff-Radford SB. Temporomandibular disorders and headache. Dental clinics of North America. 2007;51(1):129–44. vi-vii.

    Article  PubMed  Google Scholar 

  31. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap. Cephalalgia. 2007;27(6):542–9.

    Article  CAS  PubMed  Google Scholar 

  32. Ciancaglini R, Radaelli G. The relationship between headache and symptoms of temporomandibular disorder in the general population. J Dent. 2001;29(2):93–8.

    Article  CAS  PubMed  Google Scholar 

  33. Pettengill C. A comparison of headache symptoms between two groups: a TMD group and a general dental practice group. Cranio. 1999;17(1):64–9.

    CAS  PubMed  Google Scholar 

  34. Kemper Jr JT, Okeson JP. Craniomandibular disorders and headaches. J Prosthet Dent. 1983;49(5):702–5.

    Article  PubMed  Google Scholar 

  35. da Silva Junior AA., et al. Temporomandibular disorders and chronic daily headaches in the community and in specialty care. Headache, 2013

  36. Fernandes G et al. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. Journal of orofacial pain. 2013;27(1):14–20.

    PubMed  Google Scholar 

  37. Franco AL et al. Migraine is the most prevalent primary headache in individuals with temporomandibular disorders. Journal of orofacial pain. 2010;24(3):287–92.

    PubMed  Google Scholar 

  38. Tecco S et al. Signs and symptoms of temporomandibular joint disorders in Caucasian children and adolescents. Cranio. 2011;29(1):71–9.

    PubMed  Google Scholar 

  39. Franco AL et al. Headache associated with temporomandibular disorders among young brazilian adolescents. Clin J Pain, 2013. This study emphasised that HAs are a potential risk factor for painful and chronic TMDs. Also, when there is a complaint of HAs in young adolescents, a comprehensive examination of the stomatagnathic structures is recommended.

  40. Goncalves MC et al. Do women with migraine have higher prevalence of temporomandibular disorders? Braz J Phys Ther. 2013;17(1):64–8. This study demonstrates thatTMDs and migraine are clinically associated. It also revealed that women with migraine are more likely to have TMD when compared to women without headache.

    Article  PubMed  Google Scholar 

  41. Stuginski-Barbosa J et al. Signs of temporomandibular disorders in migraine patients: a prospective, controlled study. The Clinical journal of pain. 2010;26(5):418–21.

    Article  PubMed  Google Scholar 

  42. Bevilaqua Grossi D, Lipton RB, Bigal ME. Temporomandibular disorders and migraine chronification. Curr Pain Headache Rep. 2009;13(4):314–8.

    Article  PubMed  Google Scholar 

  43. AASM. International classification of sleep disorders. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  44. Lavigne GJ, Rompre PH, Montplaisir JY. Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study. Journal of dental research. 1996;75(1):546–52.

    Article  CAS  PubMed  Google Scholar 

  45. Johansson A et al. Rehabilitation of the worn dentition. Journal of oral rehabilitation. 2008;35(7):548–66.

    Article  CAS  PubMed  Google Scholar 

  46. Koyano K et al. Assessment of bruxism in the clinic. Journal of oral rehabilitation. 2008;35(7):495–508.

    Article  CAS  PubMed  Google Scholar 

  47. Tsiggos N et al. Association between self-reported bruxism activity and occurrence of dental attrition, abfraction, and occlusal pits on natural teeth. J Prosthet Dent. 2008;100(1):41–6.

    Article  PubMed  Google Scholar 

  48. Pintado MR et al. Variation in tooth wear in young adults over a two-year period. J Prosthet Dent. 1997;77(3):313–20.

    Article  CAS  PubMed  Google Scholar 

  49. Lavigne GJ et al. Neurobiological mechanisms involved in sleep bruxism. Critical reviews in oral biology and medicine: an official publication of the American Association of Oral Biologists. 2003;14(1):30–46.

    Article  CAS  Google Scholar 

  50. Christensen LV. Facial pain from experimental tooth clenching. Tandlaegebladet. 1970;74(2):175–82.

    CAS  PubMed  Google Scholar 

  51. Kydd WL, Daly C. Duration of nocturnal tooth contacts during bruxing. J Prosthet Dent. 1985;53(5):717–21.

    Article  CAS  PubMed  Google Scholar 

  52. Nishigawa K, Bando E, Nakano M. Quantitative study of bite force during sleep associated bruxism. Journal of oral rehabilitation. 2001;28(5):485–91.

    Article  CAS  PubMed  Google Scholar 

  53. Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep. 1994;17(8):739–43.

    CAS  PubMed  Google Scholar 

  54. Camparis CM et al. Sleep bruxism and temporomandibular disorder: Clinical and polysomnographic evaluation. Archives of oral biology. 2006;51(9):721–8.

    Article  PubMed  Google Scholar 

  55. Camparis CM, Siqueira JT. Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2006;101(2):188–93.

    Article  CAS  PubMed  Google Scholar 

  56. Ciancaglini R, Gherlone EF, Radaelli G. The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population. Journal of oral rehabilitation. 2001;28(9):842–8.

    Article  CAS  PubMed  Google Scholar 

  57. Celic R, Jerolimov V, Panduric J. A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD. The International journal of prosthodontics. 2002;15(1):43–8.

    PubMed  Google Scholar 

  58. Macfarlane TV et al. Association between local mechanical factors and orofacial pain: survey in the community. J Dent. 2003;31(8):535–42.

    Article  CAS  PubMed  Google Scholar 

  59. Manfredini D, Chiappe G, Bosco M. Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnoses in an Italian patient population. Journal of oral rehabilitation. 2006;33(8):551–8.

    Article  CAS  PubMed  Google Scholar 

  60. Rompre PH et al. Identification of a sleep bruxism subgroup with a higher risk of pain. Journal of dental research. 2007;86(9):837–42.

    Article  CAS  PubMed  Google Scholar 

  61. Carlsson GE, Egermark I, Magnusson T. Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood. Acta Odontol Scand. 2002;60(3):180–5.

    Article  PubMed  Google Scholar 

  62. Pergamalian A et al. The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders. J Prosthet Dent. 2003;90(2):194–200.

    Article  PubMed  Google Scholar 

  63. Rossetti LM et al. Association between rhythmic masticatory muscle activity during sleep and masticatory myofascial pain: a polysomnographic study. Journal of orofacial pain. 2008;22(3):190–200.

    PubMed  Google Scholar 

  64. Molina OF et al. Prevalence of modalities of headaches and bruxism among patients with craniomandibular disorder. Cranio. 1997;15(4):314–25.

    CAS  PubMed  Google Scholar 

  65. Hirose M et al. Three-dimensional finite-element model of the human temporomandibular joint disc during prolonged clenching. European journal of oral sciences. 2006;114(5):441–8.

    Article  PubMed  Google Scholar 

  66. Alstergren P et al. TMJ pain in relation to circulating neuropeptide Y, serotonin, and interleukin-1 beta in rheumatoid arthritis. Journal of orofacial pain. 1999;13(1):49–55.

    CAS  PubMed  Google Scholar 

  67. Kopp S. The influence of neuropeptides, serotonin, and interleukin 1beta on temporomandibular joint pain and inflammation. J Oral Maxillofac Surg. 1998;56(2):189–91.

    Article  CAS  PubMed  Google Scholar 

  68. Takahashi T et al. Proinflammatory cytokines detectable in synovial fluids from patients with temporomandibular disorders. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 1998;85(2):135–41.

    Article  CAS  PubMed  Google Scholar 

  69. Charles A. The evolution of a migraine attack - a review of recent evidence. Headache. 2013;53(2):413–9.

    Article  PubMed  Google Scholar 

  70. Cady RK. The convergence hypothesis. Headache. 2007;47 Suppl 1:S44–51.

    Article  PubMed  Google Scholar 

  71. Olesen J. Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, supraspinal and myofascial inputs. Pain. 1991;46(2):125–32.

    Article  CAS  PubMed  Google Scholar 

  72. Cairns BE, Sessle BJ, Hu JW. Evidence that excitatory amino acid receptors within the temporomandibular joint region are involved in the reflex activation of the jaw muscles. The Journal of neuroscience: the official journal of the Society for Neuroscience. 1998;18(19):8056–64.

    CAS  Google Scholar 

  73. Garrett FG, Durham PL. Differential expression of connexins in trigeminal ganglion neurons and satellite glial cells in response to chronic or acute joint inflammation. Neuron Glia Biol. 2008;4(4):295–306.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Laird DW. Life cycle of connexins in health and disease. The Biochemical journal. 2006;394(Pt 3):527–43.

    CAS  PubMed  Google Scholar 

  75. Nagy JI, Dudek FE, Rash JE. Update on connexins and gap junctions in neurons and glia in the mammalian nervous system. Brain research Brain research reviews. 2004;47(1–3):191–215.

    Article  CAS  PubMed  Google Scholar 

  76. Watkins LR, Maier SF. Beyond neurons: evidence that immune and glial cells contribute to pathological pain states. Physiological reviews. 2002;82(4):981–1011.

    CAS  PubMed  Google Scholar 

  77. Thalakoti S et al. Neuron-glia signaling in trigeminal ganglion: implications for migraine pathology. Headache. 2007;47(7):1008–23. discussion 24–5.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Hanani M. Satellite glial cells in sensory ganglia: from form to function. Brain research reviews. 2005;48(3):457–76.

    Article  CAS  PubMed  Google Scholar 

  79. Huang TY, Hanani M. Morphological and electrophysiological changes in mouse dorsal root ganglia after partial colonic obstruction. American journal of physiology Gastrointestinal and liver physiology. 2005;289(4):G670–8.

    CAS  PubMed  Google Scholar 

  80. Guo W et al. Glial-cytokine-neuronal interactions underlying the mechanisms of persistent pain. The Journal of neuroscience: the official journal of the Society for Neuroscience. 2007;27(22):6006–18.

    Article  CAS  Google Scholar 

  81. Watson DH, Drummond PD. Head pain referral during examination of the neck in migraine and tension-type headache. Headache. 2012;52(8):1226–35. This study demonstrated a reproduction of individuals headache pattern via manipulation of neck structures. This would seem to reinforce the convergance theory of miraine pathophysiology.

    Article  PubMed  Google Scholar 

  82. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001;5(4):382–6.

    Article  CAS  PubMed  Google Scholar 

  83. Bartsch T, Goadsby PJ. Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain: a journal of neurology. 2003;126(Pt 8):1801–13.

    Article  CAS  Google Scholar 

  84. Lous I, Olesen J. Evaluation of pericranial tenderness and oral function in patients with common migraine, muscle contraction headache and 'combination headache'. Pain. 1982;12(4):385–93.

    Article  CAS  PubMed  Google Scholar 

  85. Kidd RF, Nelson R. Musculoskeletal dysfunction of the neck in migraine and tension headache. Headache. 1993;33(10):566–9.

    Article  CAS  PubMed  Google Scholar 

  86. Fernandez-de-Las-Penas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia. 2006;26(9):1061–70.

    Article  CAS  PubMed  Google Scholar 

  87. Burstein R et al. An association between migraine and cutaneous allodynia. Annals of neurology. 2000;47(5):614–24.

    Article  CAS  PubMed  Google Scholar 

  88. Lipton RB et al. Cutaneous allodynia in the migraine population. Annals of neurology. 2008;63(2):148–58.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Welch KM et al. Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache. 2001;41(7):629–37.

    Article  CAS  PubMed  Google Scholar 

  90. Ichesco E et al. Altered functional connectivity between the insula and the cingulate cortex in patients with temporomandibular disorder: a pilot study. Headache. 2012;52(3):441–54. The author’s hypothesis that in TMD patients an, increase in anterior IC–ACC connectivity is sugestivee of an adaptation of the pain modulatory system early in the chronification process.

    Article  PubMed Central  PubMed  Google Scholar 

  91. Gerstner G et al. Changes in regional gray and white matter volume in patients with myofascial-type temporomandibular disorders: a voxel-based morphometry study. J Orofac Pain. 2011;25(2):99–106. This study demonstrated morphologic changes to brain regions in individuals with myofacial pain similar to those seen in migraine individuals.

    PubMed  Google Scholar 

  92. Bashir A et al. Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology. 2013;81(14):1260–8. This review emphasis the changes that may occur in the brain regions in migraine individuals.

    Article  PubMed  Google Scholar 

  93. Noseda R, Burstein R: Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain, 2013. This is another good paper describing changes occurring in the brain in migraine individuals.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Steven Bender declares no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. North Texas Center for Head, Face & TMJ Pain, 5068 W Plano Pkwy. Ste. 100, Plano, TX, 75093, USA

    Steven D Bender

  2. Department of Periodontics Stomatology Center, Texas A&M University Baylor College of Dentistry, 3302 Gaston Ave, Dallas, TX, 75246, USA

    Steven D Bender

Authors
  1. Steven D Bender
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven D Bender.

Additional information

This article is part of the Topical Collection on Uncommon Headache Syndromes

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bender, S.D. Orofacial Pain and Headache: A Review and Look at the Commonalities. Curr Pain Headache Rep 18, 400 (2014). https://doi.org/10.1007/s11916-013-0400-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-013-0400-5

Keywords

Search

Navigation