A. Headache occurring on ≥15 days/month on average for >3 months (≥180 day/year), fulfilling criteria B–D
B. Lasting hours to days or unremitting
C. ≥2 of the following four characteristics:
1. Bilateral location
2. Pressing/tightening (non-pulsating) quality
3. Mild or moderate intensity
4. Not aggravated by routine physical activity
D. Both of the following:
1. Not >1 of photophobia, phonophobia, or mild nausea
2. Neither moderate or severe nausea nor vomiting
E. Not better accounted for by another ICHD-3 diagnosis
28.3.1 Clues from History and Physical Examination
The provocative tests of temporomandibular function are very compelling here. In particular, the decreased range of motion of her jaw, pain with movements of the jaw, and right temporomandibular tenderness suggest right TMD. Many causes of TMD are not associated with “clicking,” which, even if present, may be intermittent and/or difficult to appreciate even with a stethoscope, so this is not contrary to the diagnosis. Otalgia in the absence of ear or mastoid pathology is also quite suggestive as ear pain is a common referral pain site in TMD.
The International Classification of Headache Disorders (ICHD) has tackled the problem of specifying diagnostic criteria for headache due to TMD in the latest edition (Table 28.2). An alternative set of criteria for diagnosing headache related to TMD has been published by Schiffman et al. and is supported by some compelling validation data (Table 28.3). By either set of criteria, this patient would seem to have a fairly clear case of TMD.
Table 28.2
Diagnostic criteria for headache due to temporomandibular dysfunction (International Classification of Headache Disorders (3rd edition – beta version))
A. Any headache fulfilling criterion C |
B. Clinical and/or imaging evidence of TMD |
C. Evidence of causation demonstrated by ≥2 of the following: |
1. Headache has developed in temporal relation to onset of TMD |
2. Either or both of: |
(a) HA has significantly worsened in parallel with progression of TMD |
(b) HA has significantly improved or resolved in parallel with improvement/resolution of TMD |
3. Headache produced or exacerbated by active jaw movements, passive movements through range of motion of the jaw, and/or provocative maneuvers such as pressure on TMJ and surrounding muscles of mastication |
4. Headache, when unilateral, is ipsilateral to TMD |
D. Not better accounted for by another ICHD-3 diagnosis |
Table 28.3
Diagnostic criteria for headache due to temporomandibular disorders
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