As dentists, we are no strangers to patients walking in with “tooth pain” that doesn’t quite fit the clinical picture. Sometimes, what seems like a dental problem turns out to be something bigger. A recent narrative review caught my attention, and I believe it’s something we, as dental professionals, should pay closer heed to: the strong and often confusing overlap between headache disorders and temporomandibular disorders (TMDs).
Headaches remain one of the most common health complaints worldwide, with migraines and tension-type headaches affecting millions every year. What’s concerning is how often these disorders intersect with orofacial pain. Research suggests that up to 35% of patients suffering from headaches have undergone unnecessary dental work—extractions, restorations, even root canals—because their pain was misdiagnosed as odontogenic. That’s a sobering statistic for any of us in clinical practice.
The tricky part is the overlap. Migraines and tension-type headaches (primary headaches) are independent neurological disorders, while headaches caused by TMD (secondary headaches) arise due to jaw dysfunction, parafunction, or muscle tenderness. The problem? They present very similarly in the clinic. Jaw pain, temporalis tenderness, headaches worsened by function or bruxism—it’s easy to mistake one for the other.
But beyond clinical confusion, the relationship is biologically intertwined. Studies show migraine patients are five times more likely to develop painful TMD, while those with tension-type headaches have up to seven times the risk. Chronic headache sufferers are up to 40 times more likely to have painful TMD. Shared mechanisms like central sensitization likely explain this strong bidirectional link.
For us as dentists, the takeaway is crucial: careful evaluation, a conservative approach, and knowing when to refer. Over-treating teeth for pain that’s really neurological helps no one. Conservative TMD management, headache-directed pharmacological therapy, and interdisciplinary collaboration—especially with orofacial pain specialists and neurologists—are where true patient benefit lies.
And we must be alert to red flags. Sudden onset headaches, neurologic signs, or exertion-triggered pain are not “just another headache.” They may indicate systemic or life-threatening causes that need urgent referral. As the first point of contact for many patients in pain, we shoulder a responsibility to identify when to step in—and when to step back.
This review reminds us that our role extends beyond drilling and filling. Recognizing the overlap between headaches and TMD can save patients from years of misdiagnosis, unnecessary procedures, and untreated pain. Sometimes, the ache in the jaw is really a headache in disguise—and it’s our job to know the difference.
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