Headache or orofacial pain associated with chronic secondary temporomandibular disorders

Definition

Chronic secondary temporomandibular disorder pain is chronic pain in the temporomandibular joint(s) or masseter or temporalis muscle(s) associated with persistent inflammation (due to e.g. infection, crystal deposition or autoimmune disorders), structural changes (such as osteoarthritis or spondylosis), injury, or diseases of the nervous system. It occurs on at least 50% of the days during at least three months. The duration of pain per day is at least 2 hours. If the etiology is vague, consider using codes in the section of chronic primary pain. Chronic secondary temporomandibular disorder pain is also termed myofascial temporomandibular disorder (TMD) pain or temporomandibular joint (TMJ) arthralgia. It can be difficult to separate between primary and secondary orofacial pain in some cases (e.g., Chronic temporomandibular disorder pains). Each distinct type, subtype, or subform of headache or orofacial pain that the patient has, must be separately diagnosed and coded. When a patient receives more than one diagnosis, these should be listed in the order of importance to the patient. Criteria: Conditions A to H are fulfilled: A. Chronic orofacial pain occurring for >2 hours on >15 days per month on average for >3 months (>180 days per year), is present. B. The pain lasts hours to days, or unremitting C. The pain is characterized be both of the following: 1. The pain is localized in the jaw, temple, in the ear or in front of ear. 2. The pain is modified with jaw movement, function or parafunction. D. The following conditions are fulfilled: 1. Clinical examination confirms pain location(s) in the area of the temporomandibular joint(s) or masseter or temporalis muscle(s) 2. Report of familiar pain in the temporomandibular joint(s) or masseter or temporalis muscle(s) with at least one of the following provocation tests a. Palpation of the lateral pole or around the lateral pole or masseter or temporalis muscle (s) b. Maximum unassisted or assisted opening, right or left lateral, or protrusive movement(s) E. Another disorder scientifically documented to be able to cause orofacial pain has been diagnosed. G. Evidence of causation demonstrated by at least two of the following: G.1 Myofascial temporomandibular disorder pain or temporomandibular joint arthralgia have developed in temporal relation to the onset of the causative disorder G.2 Myofascial temporomandibular disorder pain or temporomandibular joint arthralgia has significantly worsened in parallel with progression of the causative disorder G.3 Myofascial temporomandibular disorder pain or temporomandibular joint arthralgia has significantly improved or resolved in parallel with improvement in or resolution of the causative disorder H. The pain is not better accounted for by another chronic pain condition.

Index Terms