Comorbid Temporomandibular Disorder and Headache Associated With Worse Symptoms

Study finds that headache secondary to temporomandibular disorder is associated with increased pain compared with headache as a coexisting disorder.

A community-based, cross-sectional study found evidence that co-occurring painful temporomandibular disorder (TMD) and headache are associated with worse pain symptoms. These findings were published in Pain.

Data for this study were collected between 2014 and 2016 at 4 academic health centers in the United States for the Orofacial Pain: Evaluation and Risk Assessment (OPERA-II) study. Patients with headache without TMD (group A; n=349), patients with co-occurring headache and TMD (group B; n=147), and patients with headache attributed to TMD (group C; n=123) were compared for demographic and clinical features.

Groups A, B, and C were composed of 68.2%, 69.4%, and 84.6% women, respectively. The mean age of study participants was 38.3, 38.5, and 37.4 years; and 62.2%, 68.7%, and 74.8% were White, respectively. The pooled cohort of groups B and C had significantly higher rates of irritable bowel syndrome (P =0.000), low back pain (P =.001), and fibromyalgia (P =.000) compared with group A.

A cervicogenic classification of headache was highest among group C (64.4%) and lowest for group A (22.5%); similarly, group C had the highest rates of rhinosinusitis (17.8%) or posttraumatic (15.3%) headache and group A had the lowest rates (5.0% and 4.4%, respectively). Compared between groups C and B, group C had more patients with a cervicogenic headache classification (P =.007) but not rhinosinusitis (P =.810) or posttraumatic (P =.320) headache classifications.

A headache secondary to the TMD and which is a separate condition from any co-existing primary headache will be associated with yet greater suffering and impact.

Investigators evaluated 10 pain, 14 TMD, 15 quantitative sensory testing, 14 psychosocial, and 11 health domains, respectively. Compared with patients who had headache alone, individuals with TMD differed in 51 total domains. Effect sizes were large (≥0.8) in 16, medium (0.5 to <0.8) in 16, and small (0.2 to <0.5) in 19. Large effect sizes were observed for the following: Manikin scores of the head, neck, and shoulder; palpation neck familiar pain; palpation body familiar pain; palpation body pain; evoked familiar pain; nonspecific jaw symptoms; evoked pain; TMD pain days; temporomandibular joint function; somatic Tampa Scale for Kinesiophobia (TSK); global Jaw Functional Limitation Scale; TSK activity; total Oral Behaviors Checklist (OBC); and pain-free opening.

No large effect sizes were reported when comparing groups B and C; 6 domains had medium effect sizes, and 31 had small effect sizes.

This study was limited by not recruiting patients with TMD without headache.

According to the study authors, “The collective evidence from published literature and this study shows that the presence of overlapping pain conditions reflects substantial worsening of a large majority of characteristics associated with those conditions, and this includes secondary headache as yet another potential overlapping pain condition in an individual.” They conclude, “A headache secondary to the TMD and which is a separate condition from any co-existing primary headache will be associated with yet greater suffering and impact.”


Sharma S, Slade G, Fillingim R, Ohrbach R. A rose by another name? Characteristics that distinguish headache secondary to temporomandibular disorder from headache that is comorbid with TMD. Pain. Published online August 30, 2022. doi:10.1097/j.pain.0000000000002770