Primary headaches in patients with temporomandibular disorders: Diagnosis and treatment of central sensitization pain

Abstract

Objectives: Central sensitization (CS) has been found in patients with temporomandibular disorders (TMD), craniofacial pain (CP) and primary headaches, but its clinical implications remain uncertain. The first aim was to provide a synthesis of the current state of knowledge about the link between CS and TMD associated with primary headaches; the second goal was to find methodologies to assess and treat CS in this subgroup of patients.

Methods: A narrative review of the literature was conducted.

Results: CS is described in literature as an aggravating factor in patients with TMD-related primary headaches. Further studies are required to support this assertion.

Conclusions: The importance of excluding chronic neuropathic pain and recognizing CS as the main component using a top-down approach to target the best pharmacological and non-pharmacological treatments is evident. Some useful tools to discriminate patients with CS from others have become available, but more research is required to enable an appropriate diagnosis.

Keywords: Central nervous system sensitization; clinical reasoning; cranio-facial pain; decisional making; headache; pain management; temporo-mandibular disorders.