Head pain is a frequent complaint and affects almost every mankind during his/her lifetime. According to the International Classification of Headache Disorders (ICHD-3), headache (HA) may be a symptom of a diverse variety of conditions (secondary headaches), or it can be the disease itself (primary headaches). Headache is defined as the pain located above the orbitomeatal line, while facial pain (including Temporomandibular Disorders-TMD) are those located below the orbitomeatal line, above the neck and anterior to the pinnae. Many epidemiological and neurological similarities make the distinction between these two entities difficult and challenging. Both conditions are more frequent in women, are related to stressful life events, are related to impaired intrinsic opioid system and respond relatively well to centrally acting medications, among others. Another relevant overlappings between TMD and HA that hamper the diagnostic process and treatment are the diagnostic criteria and the peripheral and central structures involved with both. Based on research and clinical settings, it is well known that headache and TMD are highly comorbid situations and seems to be bidirectional. The trigeminal nerve is the final target of the face and head pain. The stimulation of the trigeminal system components is believed to play a major role in the underlying mechanisms of headache and TMD disorders. Peripheral and central sensitization take a place and contribute with the comorbidity and with the difficulties to differentiate both conditions separated or in an association.
Muscle contraction used to be considered one of the major causes for initiation and maintenance of both TMD and the so-called “muscle tension type headache”. It has influenced therapies in the past, when strategies to decrease muscle hyperactivity were very popular. However, the real connection between muscle contraction and pain is now reviewed in a scenario where neuronal hyperactivity, impaired modulation, genetic predisposition and psychosocial behavior are considered to have major role in the persistence of facial and head pain. The goal of this presentation is to discuss the bidirectional association between HA and TMD, based on accepted classification systems and to review the efficacy of traditional management strategies, as centrally acting medications and occlusal splints. After the conference, attendees should be able to accurately understand basic mechanisms involved in HA and TMD, to differentiate and to comprehend the comorbidity between both conditions and to elaborate evidence-based management.
Prof. Paulo Conti graduated in 1986 by the Bauru School of Dentistry, University of São Paulo, Brazil, where he also obtained his PhD degree in 1994. He completed a “Fellowship in TMD and Orofacial Pain” at the University of Medicine and Dentistry of New Jersey (currently RUTGERS UNIVERSITY) in 1995. He is also DIPLOMATE, American Board of Orofacial Pain since 1997. Prof. Conti is currently Full Professor at the Prosthodontics Department of University of São Paulo and Coordinator of the BAURU OROFACIAL PAIN GROUP in the same Institution. He was the founder and first President of the “Brazilian Society of TMD and Orofacial Pain (SBDOF)”. Dr. Conti is “Honorary member” of SBDOF and of the Iberolatinoamerican Academy of Craniomandibular Disorders. He has published more than 80 research manuscripts in peer-reviewed journals, supervised more than 30 master and PhD candidates and is currently Editor Assistant of the Journal of Oral Rehabilitation.