11.7 Headache attributed to temporomandibular disorder (TMD)

Headache caused by a disorder involving structures in the temporomandibular region.

Diagnostic criteria:
A. Any headache fulfilling criterion C
B. Clinical and/or imaging evidence of a pathological process affecting the temporomandibular joint (TMJ), muscles of mastication and/or or associated structures
C. Evidence of causation demonstrated by at least two of the following:

    1. headache has developed in temporal relation to the onset of the temporomandibular disorder
    2. either or both of the following:

      a) headache has significantly worsened in parallel with progression of the temporomandibular disorder
      b) headache has significantly improved or resolved in parallel with improvement in or resolution of the temporomandibular disorder

    3. the headache is produced or exacerbated by active jaw movements, passive movements through the range of motion of the jaw and/or provocative manœuvres applied to temporomandibular structures such as pressure on the TMJ and surrounding muscles of mastication
    4. headache, when unilateral, is ipsilateral to the side of the temporomandibular disorder

D. Not better accounted for by another ICHD-3 diagnosis.

11.7 Headache attributed to temporomandibular disorder (TMD) is usually most prominent in the preauricular areas of the face, masseter muscles and/or temporal regions. Pain generators include disk displacements, joint osteoarthritis, joint hypermobility and regional myofascial pain. 11.7 Headache attributed to temporomandibular disorder (TMD) tends to be unilateral when the temporomandibular complex is the generator of pain, but may be bilateral when muscular involvement is present. Pain referral to the face is common.

Diagnosis of TMD can be difficult, with some controversy regarding the relative importance of clinical and radiographic evidence. The use of diagnostic criteria evolved by the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group is recommended.

There is some overlap between 11.7 Headache attributed to temporomandibular disorder (TMD) due to muscular tension and 2. Tension-type headache. When the diagnosis of TMD is uncertain, the headache should be coded as 2. Tension type headache or one of its subtypes (presumably with pericranial muscle tenderness).