Pathophysiological Correlation Between temporomandibular disorders (TMD) and cervicogenic headache (CGH): a critical systemic review

Abstract

Background: Temporomandibular disorders (TMD) and cervicogenic headache (CGH) frequently co-occur, presenting a complex clinical challenge characterized by overlapping craniofacial and cervical pain. While the clinical association between the stomatognathic system and the cervical spine is widely recognized, the precise pathological mechanisms remain debated.Aim: To critically review and evaluate the evidence surrounding the pathological correlation between TMD and CGH, focusing on anatomical, biomechanical, and neurophysiological interactions.Methods: A comprehensive literature search strategy was employed across PubMed, Cochrane CENTRAL, Google Scholar, ResearchGate, to identify cross-sectional, longitudinal, and interventional studies.Main Findings: Current evidence strongly supports a connection mediated by the trigeminocervical complex, where convergence of trigeminal and cervical afferents facilitates referred pain and central sensitization. Biomechanically, cervical dysfunction and forward head posture can negatively alter masticatory muscle activation. Nevertheless, the literature is heavily constrained by observational study designs (predominantly Sackett levels 3b–5), small sample sizes, and significant confounding factors such as bruxism, primary migraines, and psychosocial stressors.Conclusion:While a neurophysiological and biomechanical correlation exists between TMD and CGH, causality remains uncertain due to methodological limitations in current research. Multidisciplinary assessment is crucial, but more high-quality prospective studies are required to confirm causative links and optimize integrated treatment strategies.