Pain, headache, and oromandibular structures

Michael J Marmura MD (Dr. Marmura of Thomas Jefferson University Hospital received research support from Teva and honorariums for consulting services from Alder, Amgen, Promius, Supernus, and Teva.)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
Originally released April 11, 1994; last updated February 4, 2016; expiresFebruary 4, 2019

This article includes discussion of pain, headache, and oromandibular structures; craniomandibular disorders; oromandibular disorders; and temporomandibular joint dysfunction syndrome. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


The relationship of headache and oromandibular disorders, such as temporomandibular joint dysfunction, is confusing to many physicians. In this article, the author explores this complex relationship and specifically describes overlapping disorders, such as atypical odontalgia, contact point headache, and “lower-half migraine,” that create diagnostic difficulties. This article also includes guidance for the diagnosis and management of oromandibular disorders and associated headache.

Key points


• Temporomandibular joint disorders are common and are comorbid with headache disorders, such as migraine.


• Evidence for central sensitization appears to be a very common problem in temporomandibular joint disorders, atypical odontalgia, and chronic headaches.


• It is unclear whether successful treatment of temporomandibular joint disorders will improve headache severity or frequency.


• In many common headache disorders, such as migraine, cluster headache, and trigeminal neuralgia, pain is referred to dental structures.

Historical note and terminology

The International Association of Pain (IASP) has stated that pain involves emotional experiences that could be similar to those evoked by nociceptive stimuli. The IASP defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Mersky 1986). The IASP has also stated that nociception, which is defined as "potentially tissue-damaging thermal or mechanical energy impinging on specialized nerve endings, namely A delta and C fibers," is not a necessary component of pain.

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