11.7 Headache attributed to temporomandibular disorder (TMD)

Coded elsewhere:

Jaw disease other than temporomandibular disorder, such as jaw malignancy, osteomyelitis or fracture, produces localized pain which can radiate to the face and head but rarely headache alone. When headache occurs in such cases, code as 11.9 Headache or facial pain attributed to other disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure.

Description:

Headache caused by a disorder involving structures in the temporomandibular region.

Diagnostic criteria:
  1. Any headache1 fulfilling criterion C
  2. 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
  3. 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
  4. Not better accounted for by another ICHD-3 diagnosis2.
Note:
  1. Usually temporally located, on one or both sides.
  2. There is some overlap between 11.7 Headache attributed to temporomandibular disorder (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 temporomandibular disorder (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.