Musculoskeletal orofacial pains - overlap between tension type headache and temporomandibular disorder

Abstract

A number of pain conditions in the head share clinical presentations such as being dull, diffuse, pressing, bilateral and longer-lasting with moderate intensity, often with pain referrals to the neck-shoulder regions, higher prevalence in women before menopause, aggravated by oral functions and stress and associated with considerable psycho-social distress and reduced quality of life. The International Classification of Headache Disorders (ICHD) have well-established criteria for tension-type headache and Headaches attributed to Temporomandbular Disorders (HA-TMD). The Diagnostic Criteria for TMD has set the standards for operationalized, reliable and valid diagnosis of myalgia and myofascial pain related to the jaw muscles and a variant of the HA-TMD diagnosis. Recently also International Classification for Orofacial Pain (ICOP) has proposed subtyping of the muscle pain conditions based on temporal characteristics: acute, infrequent, frequent and chronic occurrence. Nevertheless, the overarching question should be to what extent may underlying pathophysiology vary between these entities and what would the therapeutic implications be? The talk will attempt to review the musculoskeletal orofacial pain conditions, present new findings about the potential overlap and further phenotyping, and critically discuss the clinical ramifications.