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For neurology

Headaches that do not respond

The association between CMD and migraine is among the best documented in this entire field. What it is not: causation. The difference determines what we can offer you.

You know these patients

Chronic or drug-resistant headaches, atypical facial pain, unclear trigger patterns. Often with bruxism, TMJ sounds or tender masticatory muscles, without anyone having looked for them.

The connection

What has been measured

  1. 01Measured / described

    The figure – and it is large

    Systematic reviews with meta-analysis show for TMD and migraine an odds ratio of about 3.79; for chronic migraine, values up to around 24 are reported. This is a documented association. Causation has explicitly not been demonstrated.

  2. 02Measured / described

    The anatomical pathway is not a model but a finding

    The trigeminal nucleus caudalis converges functionally with the cervical dorsal horns C1–C3. This 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.

  3. 03Measured / described

    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.

  4. 04Where the evidence ends

    Where the evidence ends

    The reliability of the DC/TMD category “headache attributed to TMD” is only fair, while the other categories perform good to excellent. This one attribution is therefore the least certain. We do not set it against your diagnosis but alongside it.

Indication

When a referral is worthwhile

First, and without exception: red flags and unclear findings belong in specialist work-up, before any functional diagnostics. The CMD perspective complements, it does not replace.

Worthwhile

  • Treatment-resistant head or facial pain with jaw or masticatory muscle findings
  • History of bruxism, TMJ sounds or restricted mouth opening
  • Persistence beyond three months despite guideline-based first-line treatment
  • Before escalating prophylaxis – to clarify a functional component

Not worthwhile

  • For headache classification – that stays with you
  • With unresolved red flags
  • With the expectation that a splint ends migraine

Your patient remains yours.

After the assessment or after regulation is complete, we always refer back to you. We only provide further treatment at your explicit written request.

Next steps

Three routes – your choice

  • 01

    I want to know more

    The full-text sources, our measurement protocols and the clinical explanatory model with its level of evidence disclosed.

    Request documents
  • 02

    I have a question about a case

    Call-back from the CMD specialist, not from reception.

    Ask a question
  • 03

    I would like to refer

    By phone, email or letter – whatever suits you. The findings report comes back to you.

    Referral

Other specialties

To the overview