Headaches that do not respond
The association between CMD and migraine is one of the best documented in this whole field. What it is not: causality. The difference determines what we can offer you.
You know these patients
Chronic or medication-resistant headaches, atypical facial pain, unclear trigger patterns. Often with bruxism, jaw joint noises or tender masticatory muscles, without anyone having looked for them.
What has been measured
The figure – and it is large
Systematic reviews with meta-analysis show an odds ratio of around 3.79 for TMD and migraine; for chronic migraine, values of up to around 24 are reported. That is a proven association. Causality has expressly not been demonstrated.
The anatomical pathway is not a model but a finding
The trigeminal nucleus caudalis converges functionally with the cervical dorsal horns C1–C3. That is the anatomical basis of referred pain between neck, face and head – and explains why jaw and neck findings project into the same pain region.
Chronification: the same language as yours
Chronic CMD is classified as nociplastic pain with central sensitisation. The most consistent predictors of persistence are pain catastrophising and depressive symptoms – not occlusal findings.
Where the evidence ends
The reliability of the DC/TMD category “headache attributed to TMD” is only fair, whereas the other categories perform good to excellent. So precisely this one attribution is the least certain. We do not set it against your diagnosis, but alongside it.
When a referral is useful
First and without exception: red flags and unclear findings belong in a specialist work-up, before any functional diagnostics. The CMD perspective is complementary, not a substitute.
Useful
- treatment-resistant head or facial pain with jaw or masticatory muscle findings
- bruxism, jaw joint noises or restricted mouth opening in the history
- persistence over three months despite guideline-based first-line treatment
- before escalating prophylaxis – to clarify a functional component
Not useful
- for headache classification – that stays with you
- with unresolved red flags
- with the expectation that a splint will end a migraine
Your patient remains yours. After the assessment, or after the regulation is complete, we always refer back to you. We take on any treatment beyond this exclusively at your express, written request.
Three routes – you choose
I want to know more
The sources in full text, our measurement protocols and the clinical explanatory model with the level of evidence disclosed.
I have a question about a case
A call back from the CMD specialist, not from reception.
I would like to refer
By phone, e-mail or letter – whichever suits you. The findings report comes back to you.