{"product_id":"headaches-in-the-dental-office-a-patients-guide-to-understanding-facial-pain-jaw-disorders-and-headache-connections","title":"Headaches in the Dental Office: A Patient's Guide to Understanding Facial Pain, Jaw Disorders, and Headache Connections","description":"\u003cp\u003eHeadaches affect more than half of the world's population each year, and for dental clinicians, recognizing the connection between headaches, jaw disorders, and facial pain is critical to providing effective care. This comprehensive review explains how common headache conditions—including migraine, tension-type headache, and cluster headache—can appear in dental practice, and why many patients with temporomandibular disorders (TMD) also suffer from headaches. The article provides practical guidance for identifying \"red flag\" warning signs that require urgent medical referral, and explores how certain facial pain conditions can actually be headaches presenting in disguise. For patients, understanding these connections can mean the difference between receiving unnecessary dental treatments and getting the right care for their underlying condition.\u003c\/p\u003e\n\n\u003ch1\u003eHeadaches in the Dental Office: A Patient's Guide to Understanding Facial Pain, Jaw Disorders, and Headache Connections\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#introduction\"\u003eWhy This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#primary-vs-secondary\"\u003ePrimary vs. Secondary Headaches: Key Distinctions\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#study-methods\"\u003eHow This Review Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#migraine\"\u003eMigraine: More Than Just a Bad Headache\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#tension-type\"\u003eTension-Type Headache: The Most Common Headache Disorder\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#tacs\"\u003eTrigeminal Autonomic Cephalalgias (TACs): The Cluster Family\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#secondary-headaches\"\u003eSecondary Headaches: When Another Condition Causes the Pain\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#warning-signs\"\u003eRed Flags: When to Seek Emergency Care\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#orofacial-pain\"\u003eFacial Pain That Mimics Headaches\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#clinical-implications\"\u003eWhat This Means for Patients and Clinicians\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eHeadaches and temporomandibular disorders (TMD) have a bidirectional relationship; treating both together leads to better outcomes.\u003c\/li\u003e\n\u003cli\u003eMigraine is diagnosed after at least 5 episodes with features like unilateral pulsating pain, moderate\/severe intensity, and aggravation by activity.\u003c\/li\u003e\n\u003cli\u003eTension-type headache is common, with bilateral pressing pain not aggravated by activity; treatment includes NSAIDs and preventive antidepressants.\u003c\/li\u003e\n\u003cli\u003e20% to 35% of TAC patients with facial pain had unnecessary dental treatments before correct diagnosis, so ruling out headache disorders is critical.\u003c\/li\u003e\n\u003cli\u003eRed flags for urgent care include thunderclap headache, fever, neurologic deficit, first headache after age 50, trauma, or pregnancy-related onset.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"introduction\"\u003eWhy This Research Matters\u003c\/h2\u003e\n\u003cp\u003eHeadaches are one of the most common health conditions worldwide. According to global estimates, \u003cstrong\u003e52% of the world's population experienced a headache in the past year\u003c\/strong\u003e. Two types dominate the statistics: tension-type headache (TTH) and migraine, which are the most prevalent forms.\u003c\/p\u003e\n\u003cp\u003eBut here's what makes this topic especially relevant for dental patients: researchers have found a \u003cstrong\u003esignificant and consistent overlap between temporomandibular disorders (TMD)—conditions affecting the jaw joint and chewing muscles—and headaches\u003c\/strong\u003e. If you have headaches, you may be at higher risk of developing TMD. Conversely, if you have TMD, it can influence how often your headaches occur and how intense they become.\u003c\/p\u003e\n\u003cp\u003eThis bidirectional relationship means that managing both conditions together is essential for achieving better treatment outcomes. The authors of this review emphasize that dental care clinicians, other healthcare practitioners, and patients all benefit when orofacial pain, headaches, and TMD are recognized as interconnected conditions rather than separate problems.\u003c\/p\u003e\n\n\u003ch2 id=\"primary-vs-secondary\"\u003ePrimary vs. Secondary Headaches: Key Distinctions\u003c\/h2\u003e\n\u003cp\u003eUnderstanding the difference between primary and secondary headaches is crucial for proper diagnosis and management. \u003cstrong\u003ePrimary headaches are independent disorders\u003c\/strong\u003e—they are not caused by an underlying disease. \u003cstrong\u003eSecondary headaches result from an underlying condition\u003c\/strong\u003e that is known to cause headache, such as a brain tumor, bleeding, infection, neck or jaw problems, or head trauma.\u003c\/p\u003e\n\u003cp\u003ePatients can experience multiple headache types simultaneously, including both primary and secondary headaches. For example, a person with a history of migraine (a primary headache) may later develop medication-overuse headache (a secondary headache) from taking too many pain relievers.\u003c\/p\u003e\n\u003cp\u003eThis review is based primarily on two established classification systems: the \u003cstrong\u003eInternational Classification of Headache Disorders, Third Edition (ICHD-3)\u003c\/strong\u003e for headache diagnoses, and the \u003cstrong\u003eInternational Classification of Orofacial Pain (ICOP)\u003c\/strong\u003e for orofacial pain diagnoses. Management recommendations follow guidelines from the European Academy of Neurology.\u003c\/p\u003e\n\n\u003ch2 id=\"study-methods\"\u003eHow This Review Was Conducted\u003c\/h2\u003e\n\u003cp\u003eThis is what medical researchers call a \u003cstrong\u003enarrative review\u003c\/strong\u003e—a comprehensive overview that synthesizes information from existing scientific literature. The authors drew on established classification systems and high-quality scientific evidence, using the ICHD-3 and ICOP classifications as key resources.\u003c\/p\u003e\n\u003cp\u003eThe ICHD-3 was developed in collaboration with the World Health Organization and based on the International Classification of Diseases, 11th revision. It was built on high-quality evidence and expert consensus. Similarly, the ICOP was created through expert consensus with input from several prestigious organizations, including:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eThe Orofacial and Head Pain Special Interest Group of the International Association for the Study of Pain\u003c\/li\u003e\n  \u003cli\u003eThe International Network for Orofacial Pain and Related Disorders Methodology\u003c\/li\u003e\n  \u003cli\u003eThe American Academy of Orofacial Pain\u003c\/li\u003e\n  \u003cli\u003eThe International Headache Society\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eTo examine the overlap between headache and TMD, the authors used data from a systematic review by Réus and colleagues, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They also performed targeted literature searches in the PubMed and Scopus databases using keywords such as \"headache,\" \"temporomandibular disorder,\" \"TMD,\" \"orofacial pain,\" and \"comorbidity.\"\u003c\/p\u003e\n\u003cp\u003eThe search was limited to English-language, peer-reviewed studies involving humans. All study designs—including observational studies, experimental studies, and reviews—were considered if they were clinically relevant to the relationship between headache and TMD. Headache management guidance was adapted from the European Academy of Neurology, which used a rigorous evidence-based approach to ensure patient-centered recommendations.\u003c\/p\u003e\n\n\u003ch2 id=\"migraine\"\u003eMigraine: More Than Just a Bad Headache\u003c\/h2\u003e\n\u003cp\u003eMigraine is the \u003cstrong\u003ethird most prevalent disorder globally and the seventh leading cause of disability\u003c\/strong\u003e, with consistently high rates of years lived with disability over time. This is not merely an uncomfortable condition—it is a major public health issue that affects quality of life on a massive scale.\u003c\/p\u003e\n\n\u003ch3\u003eWho Gets Migraine?\u003c\/h3\u003e\n\u003cp\u003eApproximately one-third of migraine patients experience \u003cstrong\u003eaura\u003c\/strong\u003e, which refers to reversible focal neurologic symptoms that occur before the headache begins. Among those who experience aura, \u003cstrong\u003e90% report visual disturbances\u003c\/strong\u003e, making this the most common type. Other aura types include sensory, verbal, and motor symptoms, and some patients may experience multiple aura types.\u003c\/p\u003e\n\u003cp\u003eMigraine prevalence is \u003cstrong\u003e2 to 3 times higher in women than in men during reproductive years\u003c\/strong\u003e. A subset of women experiences menstrual migraine, with attacks peaking near menstruation. This is largely attributed to the rapid premenstrual drop in estrogen—often called the \"estrogen withdrawal hypothesis\"—which affects pain modulation and promotes the release of calcitonin gene–related peptides (CGRPs) and prostaglandins.\u003c\/p\u003e\n\n\u003ch3\u003eHow Migraine Is Diagnosed\u003c\/h3\u003e\n\u003cp\u003eFor a diagnosis of migraine, a patient must have had at least \u003cstrong\u003e5 episodes\u003c\/strong\u003e and at least \u003cstrong\u003e2 of the following 4 characteristics\u003c\/strong\u003e:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eUnilateral head pain (pain on one side of the head)\u003c\/li\u003e\n  \u003cli\u003ePulsating pain quality\u003c\/li\u003e\n  \u003cli\u003eModerate or severe intensity pain\u003c\/li\u003e\n  \u003cli\u003ePain aggravated by routine physical activity (such as walking or climbing stairs)\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eIn addition, another ICHD-3 diagnosis must not better explain the headaches. Conditions that can mimic migraine include tension-type headache, cluster headache, acute glaucoma, sinus pathology, carotid artery dissection, temporal arteritis, and other pathologies causing raised intracranial pressure.\u003c\/p\u003e\n\n\u003ch3\u003eMigraine Treatment Options\u003c\/h3\u003e\n\u003cp\u003eTreatment falls into two main categories: abortive (stopping an attack in progress) and prophylactic (preventing future attacks).\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbortive treatments\u003c\/strong\u003e include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or diclofenac; paracetamol\/acetaminophen; acetylsalicylic acid (aspirin); and triptans.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eProphylactic (preventive) treatments\u003c\/strong\u003e include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eBeta-blockers (e.g., propranolol, metoprolol, atenolol, bisoprolol)\u003c\/li\u003e\n  \u003cli\u003eAnticonvulsants (e.g., topiramate, valproic acid)\u003c\/li\u003e\n  \u003cli\u003eAngiotensin II receptor blockers (e.g., candesartan)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eNewer medications are showing promise. \u003cstrong\u003eMonoclonal CGRP antibodies and CGRP receptor blockers\u003c\/strong\u003e seem promising for migraine prevention. Researchers have found that \u003cstrong\u003ebotulinum neurotoxin type A (Botox) has been effective for chronic migraine prevention\u003c\/strong\u003e, although it has not shown substantial benefit over placebo in episodic migraine cases.\u003c\/p\u003e\n\u003cp\u003eSome dietary supplements—including \u003cstrong\u003emagnesium, riboflavin, and coenzyme Q10\u003c\/strong\u003e—have been studied for migraine prevention, with preliminary evidence suggesting potential benefits. However, official migraine guidelines do not endorse them, as supporting evidence remains limited and inconsistent across studies.\u003c\/p\u003e\n\u003cp\u003eNonpharmacologic approaches, including neuromodulation, cognitive behavioral therapy, biofeedback, and relaxation techniques, offer potential benefit as add-on treatments to medication. These strategies may reduce medication use and support multidisciplinary care, although evidence remains limited.\u003c\/p\u003e\n\n\u003ch2 id=\"tension-type\"\u003eTension-Type Headache: The Most Common Headache Disorder\u003c\/h2\u003e\n\u003cp\u003eTension-type headache (TTH) is the \u003cstrong\u003esecond most prevalent disorder worldwide\u003c\/strong\u003e. In a population-based study, \u003cstrong\u003e87% of participants reported experiencing TTH within the past year\u003c\/strong\u003e. The overall lifetime prevalence is \u003cstrong\u003e78%\u003c\/strong\u003e, and it is higher in women (88%) than in men (69%).\u003c\/p\u003e\n\u003cp\u003eTTH prevalence peaks between ages \u003cstrong\u003e30 and 39 years\u003c\/strong\u003e for both men (42.3%) and women (46.9%). This means that a substantial portion of working-age adults—a demographic that includes many dental patients—actively deals with this condition.\u003c\/p\u003e\n\n\u003ch3\u003eHow TTH Is Diagnosed\u003c\/h3\u003e\n\u003cp\u003eFor a diagnosis of tension-type headache, a patient must have had at least \u003cstrong\u003e10 episodes\u003c\/strong\u003e and at least \u003cstrong\u003e2 of the following 4 characteristics\u003c\/strong\u003e:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eBilateral head pain (pain on both sides of the head)\u003c\/li\u003e\n  \u003cli\u003ePressing or tightening pain quality (non-pulsating, often described as a band or vice around the head)\u003c\/li\u003e\n  \u003cli\u003eMild or moderate intensity\u003c\/li\u003e\n  \u003cli\u003ePain not aggravated by routine physical activity\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eCompared with migraine, TTH may be considered a \"featureless\" headache because it lacks the distinctive nausea, vomiting, and sensitivity to light and sound that commonly accompany migraine.\u003c\/p\u003e\n\u003cp\u003eChronic TTH is defined as occurring \u003cstrong\u003e15 or more days per month for at least 3 months\u003c\/strong\u003e, while episodic TTH occurs \u003cstrong\u003efewer than 14 days per month\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003ch3\u003eTreating Tension-Type Headaches\u003c\/h3\u003e\n\u003cp\u003eAbortive treatment includes NSAIDs (ibuprofen, naproxen, diclofenac), paracetamol\/acetaminophen, and acetylsalicylic acid. Prophylactic treatment includes certain antidepressants: \u003cstrong\u003eamitriptyline, venlafaxine, and mirtazapine\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eThere is generally limited evidence to support nonpharmacologic treatments for TTH specifically. However, patient education, trigger avoidance, behavioral therapy, physical therapy, occupational therapy, and lifestyle changes (such as proper hydration, diet, and sleep habits) have shown beneficial effects for patients.\u003c\/p\u003e\n\n\u003ch2 id=\"tacs\"\u003eTrigeminal Autonomic Cephalalgias (TACs): The Cluster Family\u003c\/h2\u003e\n\u003cp\u003eTrigeminal autonomic cephalalgias (TACs) are a family of headache disorders that include \u003cstrong\u003ecluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua\u003c\/strong\u003e. These conditions share similar clinical features and are characterized by severe, one-sided pain accompanied by autonomic symptoms.\u003c\/p\u003e\n\u003cp\u003eTACs are much rarer than migraine or tension-type headache. The estimated 1-year prevalence for these conditions is:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCluster headache: 0.02% to 0.1%\u003c\/strong\u003e of the population\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eParoxysmal hemicrania: approximately 0.05%\u003c\/strong\u003e of the population\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eShort-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing: approximately 0.1%\u003c\/strong\u003e of the population\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eThese are uncommon conditions, but they are highly relevant to dental practice for an important reason: \u003cstrong\u003ethe pain from TACs can radiate to the upper and lower jaw areas (maxillary and mandibular regions)\u003c\/strong\u003e, leading to a misdiagnosis of dental pathology or TMD. This is not merely theoretical—the literature confirms that \u003cstrong\u003e20% to 35% of patients with TAC who experience facial pain have undergone unnecessary dental treatments\u003c\/strong\u003e before receiving the correct diagnosis.\u003c\/p\u003e\n\n\u003ch3\u003eDiagnostic Features of TACs\u003c\/h3\u003e\n\u003cp\u003eCommon features of TACs (as detailed in the review's Table 1) include:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eUnilateral head pain, typically in the orbital, supraorbital, or temporal regions\u003c\/li\u003e\n  \u003cli\u003eSharp and stabbing pain of severe intensity\u003c\/li\u003e\n  \u003cli\u003eAt least one associated autonomic symptom on the same side of the pain, such as:\n    \u003cul\u003e\n      \u003cli\u003eConjunctival injection (redness of the eye)\u003c\/li\u003e\n      \u003cli\u003eLacrimation (tearing)\u003c\/li\u003e\n      \u003cli\u003eNasal congestion or runny nose\u003c\/li\u003e\n      \u003cli\u003ePtosis (drooping eyelid) or miosis (constricted pupil)\u003c\/li\u003e\n      \u003cli\u003eForehead and facial sweating\u003c\/li\u003e\n      \u003cli\u003eEyelid edema (swelling)\u003c\/li\u003e\n    \u003c\/ul\u003e\n  \u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eDuration and frequency differ among the TAC subtypes. Cluster headache attacks last \u003cstrong\u003e15 to 180 minutes\u003c\/strong\u003e and occur from \u003cstrong\u003eonce every 2 days to 8 times per day\u003c\/strong\u003e. Paroxysmal hemicrania attacks last \u003cstrong\u003e2 to 30 minutes\u003c\/strong\u003e and occur more than \u003cstrong\u003e5 times per day\u003c\/strong\u003e, with a complete response to indomethacin (an NSAID). Short-lasting unilateral neuralgiform headache attacks last \u003cstrong\u003e1 to 600 seconds\u003c\/strong\u003e and occur at least once per day. Hemicrania continua is present for at least \u003cstrong\u003e3 months\u003c\/strong\u003e with exacerbations in intensity, and also responds absolutely to indomethacin.\u003c\/p\u003e\n\n\u003ch3\u003eManaging TACs\u003c\/h3\u003e\n\u003cp\u003e\u003cstrong\u003eCluster headache abortive treatment\u003c\/strong\u003e includes oxygen therapy and subcutaneous sumatriptan. \u003cstrong\u003eProphylactic treatment\u003c\/strong\u003e includes verapamil, topiramate, lithium, and greater occipital nerve blocks. Corticosteroids can be used for episodic cluster headache as a transitional therapy (for example, while waiting for verapamil to take effect), but long-term use is not recommended due to the adverse effects of prolonged steroid use.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndomethacin is the primary prophylactic treatment for paroxysmal hemicrania and hemicrania continua\u003c\/strong\u003e, and its effectiveness also serves as a key diagnostic feature—such a response is not seen in migraine or other TACs. If gastrointestinal side effects occur, proton pump inhibitors can be prescribed at the same time; alternatively, greater occipital nerve blocks and COX-2 inhibitors (a type of NSAID) can be used.\u003c\/p\u003e\n\u003cp\u003eFor short-lasting unilateral neuralgiform headache attacks, \u003cstrong\u003elamotrigine is the mainstay treatment\u003c\/strong\u003e, followed by gabapentin and topiramate.\u003c\/p\u003e\n\n\u003ch2 id=\"secondary-headaches\"\u003eSecondary Headaches: When Another Condition Causes the Pain\u003c\/h2\u003e\n\u003cp\u003eSecondary headaches arise from an underlying condition known to cause headache, such as a brain tumor, bleeding, infection, neck or jaw pain, or head trauma. The review focuses on two secondary headaches frequently observed in patients with orofacial pain: \u003cstrong\u003eheadache attributed to TMD (HATMD)\u003c\/strong\u003e and \u003cstrong\u003emedication-overuse headache (MOH)\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003ch3\u003eHeadache Attributed to TMD (HATMD)\u003c\/h3\u003e\n\u003cp\u003eHeadache attributed to TMD (HATMD) is a headache caused by temporomandibular disorder and is usually modified by jaw function or parafunction such as bruxism (teeth grinding). This type of headache is \u003cstrong\u003eusually bilateral (affecting both sides of the head) and pressing in quality\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eIn a retrospective study, researchers found that patients with HATMD exhibited not only a greater number of painful sites in the head and neck regions, but also greater intensity of TMD pain compared with TMD patients without headaches.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic criteria for HATMD:\u003c\/strong\u003e A diagnosis corresponds to any headache with at least \u003cstrong\u003e2 of the following 3 causation criteria\u003c\/strong\u003e:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eHeadache aggravated by jaw motion, jaw function (such as chewing), or jaw parafunction (such as bruxism)\u003c\/li\u003e\n  \u003cli\u003eHeadache developed in temporal relation to the onset of the TMD, or led to its discovery\u003c\/li\u003e\n  \u003cli\u003eHeadache provoked by palpation of the temporalis muscle (a major chewing muscle on the side of the head) or passive movement of the jaw, with the headache affecting chewing structures on one or both sides\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eIt can be debated whether HATMD is a separate entity or simply a painful TMD experienced in the temporalis muscle.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment:\u003c\/strong\u003e To our knowledge, there are no randomized controlled trials specifically assessing the management of HATMD. However, it is generally recommended that the underlying TMD be managed, as this is thought to be the original cause. Since researchers have found that HATMD is most likely pain in the temporalis muscle, treatment can be particularly directed at that muscle—for example, with therapeutic injections or physical therapy.\u003c\/p\u003e\n\n\u003ch3\u003eMedication-Overuse Headache (MOH)\u003c\/h3\u003e\n\u003cp\u003eMedication-overuse headache is defined as a headache occurring on \u003cstrong\u003e15 or more days per month in a patient with a preexisting primary headache\u003c\/strong\u003e, and it develops because of overuse of medication used to treat the symptoms of the underlying headache. The prevalence of MOH in the general population is \u003cstrong\u003e1% to 2%\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eThe specific drugs that contribute to MOH have varied over time and across different regions. Key limits for medication use to avoid this condition are:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\u003cstrong\u003eErgotamine, triptans, opioids, and combination analgesics: no more than 9 days per month\u003c\/strong\u003e\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSimple analgesics\u003c\/strong\u003e such as paracetamol\/acetaminophen, NSAIDs, and acetylsalicylic acid: \u003cstrong\u003eno more than 14 days per month\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cstrong\u003eManagement:\u003c\/strong\u003e The cornerstone of MOH management is \u003cstrong\u003estopping the overused medication\u003c\/strong\u003e, combined with education and counseling. A randomized controlled trial suggested that there is no difference between starting withdrawal of the medication and starting preventive treatment at the same time, versus preventive treatment without withdrawal, versus starting withdrawal and later adding preventive treatment.\u003c\/p\u003e\n\u003cp\u003eIt is recommended that patients diagnosed with MOH be managed with a multidisciplinary approach, including neurologists or pain specialists and behavioral psychologists. Emerging evidence indicates that \u003cstrong\u003ecombining anti-CGRP monoclonal antibodies with traditional pharmacologic treatments may offer improved outcomes compared with using either strategy alone\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003ch2 id=\"warning-signs\"\u003eRed Flags: When to Seek Emergency Care\u003c\/h2\u003e\n\u003cp\u003eBeyond the headaches discussed above, there are certain symptoms that imply higher urgency and require immediate specialist referral or emergency care because of the risk of malignancy or life-threatening conditions. Based on research by Do and colleagues, the following are warning signs of secondary headaches:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eUnexplained systemic symptoms, including fever\u003c\/li\u003e\n  \u003cli\u003eNeoplasm and history of malignancy (cancer)\u003c\/li\u003e\n  \u003cli\u003eNeurologic deficit, including decreased consciousness or dysfunction\u003c\/li\u003e\n  \u003cli\u003eAbrupt or sudden onset of headaches (often described as \"thunderclap\")\u003c\/li\u003e\n  \u003cli\u003eFirst headache onset at age 50 years or older\u003c\/li\u003e\n  \u003cli\u003eHeadache that has changed pattern or is of recent onset\u003c\/li\u003e\n  \u003cli\u003eHeadache modified by changes in head position\u003c\/li\u003e\n  \u003cli\u003eHeadache triggered by exercise, coughing, or sneezing\u003c\/li\u003e\n  \u003cli\u003ePresence of papilledema (swelling of the optic disc, seen on eye examination)\u003c\/li\u003e\n  \u003cli\u003eProgressive headaches and nontypical presentation\u003c\/li\u003e\n  \u003cli\u003eHeadache onset during pregnancy or the postpartum period\u003c\/li\u003e\n  \u003cli\u003eAutonomic symptoms and a painful eye\u003c\/li\u003e\n  \u003cli\u003eHeadache onset after physical trauma to the head\u003c\/li\u003e\n  \u003cli\u003eImmune system disease, such as HIV, potentially related to opportunistic infections\u003c\/li\u003e\n  \u003cli\u003eNew medication at headache onset, or overuse of painkillers—drug incompatibility may be present\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cstrong\u003eIf you experience any of these warning signs along with a headache, you should seek emergency medical care promptly.\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003ch2 id=\"orofacial-pain\"\u003eFacial Pain That Mimics Headaches\u003c\/h2\u003e\n\u003cp\u003eThe ICOP classification identifies a family of diagnoses where facial pain occurs \u003cstrong\u003ewithout any head pain\u003c\/strong\u003e, but has characteristics similar to primary headaches. These conditions are uncommon, and there is limited scientific information about them. However, they are extremely relevant in dental practice because they can lead to confusion with dental conditions.\u003c\/p\u003e\n\n\u003ch3\u003eOrofacial Migraine\u003c\/h3\u003e\n\u003cp\u003eOrofacial migraine is pain exclusively in the orofacial region (the face, mouth, and jaw) without head pain, but with the characteristics and associated features of migraine described in the ICHD-3.\u003c\/p\u003e\n\u003cp\u003eThe numbers tell an important story: \u003cstrong\u003e58 out of 1,176 patients (4.9%) with migraine had migraines manifesting as isolated facial pain\u003c\/strong\u003e. Of these, \u003cstrong\u003e84.5% of the pain was localized in the maxillary branch of the trigeminal nerve (V2) territory\u003c\/strong\u003e (the cheek area), followed by \u003cstrong\u003e10.3% in both the maxillary and mandibular branches (V2-V3)\u003c\/strong\u003e (cheek and jaw area), and \u003cstrong\u003e5% in the mandibular branch (V3) only\u003c\/strong\u003e (jaw area). Additionally, research shows that patients with migraine and facial pain experience more trigeminal autonomic symptoms (such as tearing, eye redness, or nasal congestion) than those without facial pain.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic criteria:\u003c\/strong\u003e For a diagnosis of orofacial migraine, a patient must have had at least \u003cstrong\u003e5 episodes\u003c\/strong\u003e with at least \u003cstrong\u003e2 of the following 4 characteristics\u003c\/strong\u003e:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eUnilateral location\u003c\/li\u003e\n  \u003cli\u003ePulsating pain quality\u003c\/li\u003e\n  \u003cli\u003eModerate or severe intensity\u003c\/li\u003e\n  \u003cli\u003eAggravation by routine physical activity\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment:\u003c\/strong\u003e There are no randomized clinical trials testing treatment specifically for orofacial migraine. However, several case series have found that patients with orofacial migraine respond well to \u003cstrong\u003etriptans\u003c\/strong\u003e, and that prophylactic medications such as \u003cstrong\u003ebeta-blockers, topiramate, and valproic acid\u003c\/strong\u003e can lead to significant reduction in attack frequency. It is recommended that both abortive and prophylactic treatment recommendations for migraine be followed when it comes to orofacial migraine.\u003c\/p\u003e\n\n\u003ch3\u003eTrigeminal Autonomic Orofacial Pain\u003c\/h3\u003e\n\u003cp\u003eTrigeminal autonomic orofacial pain consists of attacks of pain exclusively in the orofacial region without head pain, but with the characteristics and associated features of the TAC disorders described in the ICHD-3. According to several studies, these attacks usually occur in the \u003cstrong\u003emidfacial, mandibular, and intraoral sites\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment:\u003c\/strong\u003e Orofacial cluster attacks respond well to abortive medications such as oxygen and triptans, and to prophylactic medications such as \u003cstrong\u003eprednisolone and verapamil\u003c\/strong\u003e. These conditions appear to respond similarly to their headache counterparts and should therefore be managed according to TAC guidelines.\u003c\/p\u003e\n\n\u003ch3\u003eNeurovascular Orofacial Pain\u003c\/h3\u003e\n\u003cp\u003eNeurovascular orofacial pain is usually distinguishable from orofacial migraine by its pain location and pain quality. \u003cstrong\u003eA total of 23 out of 328 patients (7%) with orofacial pain received a diagnosis of neurovascular orofacial pain\u003c\/strong\u003e, and the pain location was reported mostly in the \u003cstrong\u003eoral and perioral region\u003c\/strong\u003e (inside and around the mouth)—a finding supported by another study.\u003c\/p\u003e\n\u003cp\u003eFor diagnosis, there must have been at least \u003cstrong\u003e5 episodes of facial pain\u003c\/strong\u003e with the characteristic features shown in the review's Table 3.\u003c\/p\u003e\n\n\u003ch2 id=\"clinical-implications\"\u003eWhat This Means for Patients and Clinicians\u003c\/h2\u003e\n\u003cp\u003eThe overlap between headaches and TMD is clinically significant and bidirectional. Headaches may increase the risk of developing TMD, and conversely, TMD can influence headache frequency and intensity. This creates a clinical reality where treating one condition without addressing the other may lead to suboptimal outcomes.\u003c\/p\u003e\n\u003cp\u003eThe authors emphasize the importance of \u003cstrong\u003einterdisciplinary management and a thorough diagnostic approach\u003c\/strong\u003e to enhance treatment outcomes for patients with concurrent headaches and TMD. For dental care clinicians and other healthcare practitioners, recognizing the intersection of orofacial pain, headaches, and TMD is crucial. This understanding promotes better diagnosis, encourages interdisciplinary collaboration, and is the best approach to improved patient care and treatment outcomes.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerhaps the most striking patient-relevant statistic is this:\u003c\/strong\u003e among patients with TACs who experience facial pain, \u003cstrong\u003e20% to 35% have undergone unnecessary dental treatments\u003c\/strong\u003e before receiving a correct diagnosis. This highlights the importance of ruling out headache disorders before proceeding with invasive dental procedures, especially when pain presentation is atypical.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations\u003c\/h2\u003e\n\u003cp\u003eSeveral limitations should be acknowledged when interpreting the findings of this review:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eThis is a \u003cstrong\u003enarrative review\u003c\/strong\u003e rather than a systematic review, meaning that the selection and interpretation of studies involves expert judgment and may not capture the entirety of available evidence.\u003c\/li\u003e\n  \u003cli\u003eThere are \u003cstrong\u003eno randomized controlled trials assessing the management of HATMD\u003c\/strong\u003e specifically, so treatment recommendations rely on clinical experience and extrapolation from related conditions.\u003c\/li\u003e\n  \u003cli\u003eFor orofacial migraine and related facial presentations, there are \u003cstrong\u003eno randomized clinical trials testing treatment efficacy\u003c\/strong\u003e; evidence comes from case series and observational studies, which provide a lower level of evidence.\u003c\/li\u003e\n  \u003cli\u003eThe conditions described as \"orofacial pain resembling manifestations of primary headache\" are \u003cstrong\u003enot common, and there is little scientific information regarding them\u003c\/strong\u003e, limiting the strength of any conclusions about their diagnosis and management.\u003c\/li\u003e\n  \u003cli\u003eEvidence supporting nonpharmacologic approaches for both migraine and TTH remains \u003cstrong\u003elimited and heterogeneous\u003c\/strong\u003e, which is why official guidelines do not yet strongly endorse them.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\u003cp\u003eBased on this review, here are actionable recommendations for patients who experience headaches, facial pain, or both:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have both headaches and jaw pain, tell your dental provider about both.\u003c\/strong\u003e Because headache and TMD are bidirectional conditions, treating only one may not fully resolve your symptoms. Your dentist or doctor should evaluate both.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTrack your medication use carefully.\u003c\/strong\u003e If you are taking pain relievers for headache, be aware of the threshold limits: triptans, opioids, and combination analgesics should not be used more than 9 days per month, and simple analgesics such as ibuprofen, acetaminophen, or aspirin should not be used more than 14 days per month. Exceeding these limits can cause medication-overuse headache—a treatable but often missed condition.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBe aware of \"red flag\" symptoms.\u003c\/strong\u003e Sudden severe headache, headache with fever, headache after head trauma, first headache after age 50, headache with neurologic symptoms (weakness, confusion), or headache associated with pregnancy requires immediate medical attention.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf your facial pain persists despite dental treatment\u003c\/strong\u003e, consider that the pain may not be dental in origin. Ask your dentist about the possibility of a headache disorder presenting as facial pain, and seek evaluation by a specialist in orofacial pain, a neurologist, or a headache specialist.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFor migraine and tension-type headache, follow your provider's treatment plan.\u003c\/strong\u003e This may include abortive medications for acute attacks and prophylactic medications—such as beta-blockers, topiramate, or antidepressants—for prevention. Lifestyle factors including hydration, diet, sleep, stress management, and trigger avoidance can also play a significant role.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have TMD-related headache, treatment directed at the jaw muscles may help.\u003c\/strong\u003e Since headache attributed to TMD appears to be pain originating in the temporalis muscle, treatments targeting this muscle—including physical therapy and therapeutic injections—may be beneficial in addition to standard TMD management.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not hesitate to seek a second opinion.\u003c\/strong\u003e The high rate (20%–35%) of unnecessary dental treatments in patients with certain headache disorders underscores the value of a thorough diagnostic evaluation before proceeding with invasive or irreversible dental procedures.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eUltimately, this review reinforces that headache disorders, orofacial pain, and temporomandibular disorders exist on a shared clinical spectrum. The best outcomes are achieved when dental professionals, physicians, and patients work together to identify the true source of pain and develop a comprehensive, multidisciplinary treatment plan.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eCan jaw problems (TMD) cause headaches?\u003c\/h3\u003e\n\u003cp\u003eYes, the relationship between headaches and temporomandibular disorders (TMD) is bidirectional. Headaches may increase the risk of developing TMD, and TMD can influence how often headaches occur and how intense they become. Treating only one condition may lead to suboptimal outcomes, so both should be evaluated together by your dentist or doctor.\u003c\/p\u003e\n\u003ch3\u003eWhat is medication-overuse headache and how can I avoid it?\u003c\/h3\u003e\n\u003cp\u003eMedication-overuse headache occurs when you have a preexisting primary headache and overuse headache medications, typically on 15 or more days per month. To avoid it, limit triptans, opioids, and combination analgesics to no more than 9 days per month, and simple analgesics like ibuprofen or acetaminophen to no more than 14 days per month.\u003c\/p\u003e\n\u003ch3\u003eWhen should I seek emergency care for a headache?\u003c\/h3\u003e\n\u003cp\u003eSeek emergency care for sudden severe or thunderclap headaches, headaches with fever, neurologic symptoms like weakness or confusion, first headache after age 50, headache after head trauma, headache during pregnancy, or headache triggered by exercise, coughing, or sneezing. Also be alert for headaches with a painful eye or papilledema, and in people with cancer or immune system disease.\u003c\/p\u003e\n\u003ch3\u003eCan facial pain without head pain actually be a migraine?\u003c\/h3\u003e\n\u003cp\u003eYes, a condition called orofacial migraine causes pain exclusively in the face, mouth, or jaw without head pain, but with migraine characteristics. In one study, 4.9% of migraine patients had isolated facial pain, most commonly in the cheek area. These patients respond to triptans and migraine preventive medications, so correct diagnosis matters.\u003c\/p\u003e\n\u003ch3\u003eWhat are trigeminal autonomic cephalalgias (TACs) and why are they important in dental care?\u003c\/h3\u003e\n\u003cp\u003eTACs are a rare family of headache disorders causing severe, one-sided pain with autonomic symptoms like tearing or nasal congestion. Their pain can radiate to the jaw, leading to misdiagnosis as dental problems. In fact, 20% to 35% of TAC patients with facial pain underwent unnecessary dental treatments before correct diagnosis.\u003c\/p\u003e\n\u003ch3\u003eWhat are the treatment options for migraine?\u003c\/h3\u003e\n\u003cp\u003eAbortive treatments stop an attack in progress and include NSAIDs like ibuprofen, acetaminophen, aspirin, and triptans. Prophylactic treatments prevent future attacks and include beta-blockers, topiramate, valproic acid, and candesartan. Botulinum toxin A is effective for chronic migraine prevention. Monoclonal CGRP antibodies and CGRP receptor blockers appear promising for prevention.\u003c\/p\u003e\n\u003ch3\u003eWhen should a patient with facial pain and headaches seek a second opinion before undergoing dental treatment?\u003c\/h3\u003e\n\u003cp\u003eFacial pain can be caused by headache disorders rather than dental problems. If pain persists despite dental treatment, or if attacks are severe, one-sided, and accompanied by eye redness, tearing, or nasal congestion, a headache disorder should be ruled out. Among patients with trigeminal autonomic cephalalgias who had facial pain, 20%–35% received unnecessary dental treatments before a correct diagnosis. Red flags such as sudden thunderclap headache, fever, or neurologic symptoms require emergency care, not a dental opinion. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Headaches in dental practice\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Nicole Renner, DDS; Shuting Yang, DDS; Yuri M. Costa, DDS, MSc, PhD; Peter Svensson, DDS, PhD, Dr odont; Fernando G. Exposto, DDS, MSc, PhD\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e JADA (Journal of the American Dental Association), 2025;156(9):750-761\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1016\/j.adaj.2025.06.010\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey resources referenced:\u003c\/strong\u003e International Classification of Headache Disorders, Third Edition (ICHD-3); International Classification of Orofacial Pain (ICOP); European Academy of Neurology management guidelines\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccess:\u003c\/strong\u003e This is an open-access article under the CC BY license (https:\/\/creativecommons.org\/licenses\/by\/4.0\/).\u003c\/p\u003e\n\u003cp\u003e\u003cem\u003eNote: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not constitute medical advice. Always consult your healthcare provider for diagnosis and treatment of any medical condition.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47549356671132,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/pt\/products\/headaches-in-the-dental-office-a-patients-guide-to-understanding-facial-pain-jaw-disorders-and-headache-connections","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}