Table 5 Appendix 3 Diagnostic criteria for headache attributed to TMD
From: Is painful temporomandibular disorder a real headache for many patients?
ICHD-3* | DC/TMD** |
A. Any headache* fulfilling criterion C B. Clinical evidence of a painful pathological process affecting elements of the temporomandibular joint(s), muscles of mastication and/or associated structures on one or both sides C. Evidence of causation demonstrated by at least two of the following: 1. The headache has developed in temporal relation to the onset of the temporomandibular disorder, or led to its discovery 2. The headache is aggravated by jaw motion, jaw function (eg chewing) and/or jaw parafunction (eg bruxism) 3. The headache is provoked on physical examination by temporalis muscle palpation and/or passive movement of the jaw D. Not better accounted for by another ICHD-3 diagnosis** | Headache in the temple area secondary to pain-related TMD (see note) that is affected by jaw movement, function, or parafunction, and replication of this headache occurs with provocation testing of the masticatory system. |
History Positive for both of the following: A. Headache† of any type in the temple AND B. Headache modified with jaw movement, function, or parafunction. Examination Positive for both of the following: A. Confirmation†† of headache location in the area of the temporalis muscle(s) AND B. Report of familiar headache‡ in the temple area with at least one of the following provocation tests: 1. Palpation of the temporalis muscle(s) OR 2. Maximum unassisted or assisted opening, right or left lateral, or protrusive movement(s). Validity sensitivity 0.89; specificity 0.87. | |
Note: 1. Usually temporally located on one or both sides. 2. There is some overlap between 11.7) Headache attributed to TMD arising from 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 types or subtypes (presumably with pericranial muscle tenderness)‡ Comments: 11.7: Headache attributed to TMD is usually most prominent in the temporal region(s), preauricular area(s) of the face and/or masseter muscle(s). It may be unilateral but is likely to be bilateral when the underlying pathology involves both temporomandibular regions. Pain referral to the face is common; after tooth pain, TMD is the most common cause of facial pain. Pain generators include disc displacements, joint osteoarthritis, degenerative disease and/or hypermobility, and regional myofascial pain. Diagnosis of TMD can be difficult, with some controversy regarding the relative importance of clinical and radiographic evidence. Use of the diagnostic criteria evolved by the International RDC/TMD consortium network and orofacial pain special interest group is recommended. | Comments: The headache is not better accounted for by another headache diagnosis. Note: A diagnosis of pain-related TMD (eg, myalgia or TMJ arthralgia) must be present and is established using valid diagnostic criteria. |
Key: * = The ICHD-3 ** = DC/TMD † = The time frame for assessing pain including headache is in ‘the last 30 days' since the stated sensitivity and specificity of these criteria were established using this time frame. Although the specific time frame can be dependent on the context in which the pain complaint is being assessed, the validity of this diagnosis based on different time frames has not been established. †† = The examiner must identify with the patient all anatomical locations that they have experienced pain in the last 30 days. For a given diagnosis, the location of pain induced by the specified provocation test(s) must be in an anatomical structure consistent with that diagnosis. ‡ = ‘Familiar pain' or ‘familiar headache' is based on patient report that the pain induced by the specified provocation test(s) has replicated the pain that the patient has experienced in the time frame of interest, which is usually the last 30 days. ‘Familiar pain' is pain that is similar or like the patient's pain complaint. ‘Familiar headache' is pain that is similar or like the patient's headache complaint. | |
