SHOULD PATIENTS WITH NECK PAIN AND CERVICOGENIC HEADACHE BE SCREENED FOR TEMPOROMANDIBULAR DISORDERS? EVIDENCE FROM A SYSTEMATIC REVIEW

P. Bizzarri¹, A. Giusti², M. Pernici², P. Bulzacca², G. Asquini³, F. Maselli², F. Mourad⁴, E. Balli², G. Pisacane², C. Bagnoli², A. Manzari², M. Pompi², A. Scafoglieri¹ | ¹Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), Belgium; ²Department of Human Neurosciences, University of Roma “La Sapienza”, Italy; ³Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, UK; ⁴Department of Health, LUNEX University of Applied Sciences, Differdange, Luxembourg

Introduction. Neck pain (NP) and cervicogenic headache (CGH) frequently coexist with temporomandibular disorders (TMD), suggesting a potential need for integrated clinical assessment. However, it remains unclear whether routine screening for TMD is warranted in these populations. This study aimed to synthesize current evidence on TMD prevalence and orofacial dysfunctions in patients with NP and CGH to inform clinical decision-making.
Methods. A systematic search of PubMed, CINAHL, Web of Science, and Scopus was conducted up to July 2025. Analytical cross-sectional studies comparing NP or CGH patients with asymptomatic controls were included. Outcomes included TMD prevalence, jaw mobility, pressure pain thresholds (PPT), and muscle or temporomandibular joint (TMJ) tenderness. Random-effects meta-analyses were performed, and certainty of evidence was assessed using GRADE.
Results. Nine studies were included (n=444). NP was associated with a higher prevalence of TMD compared to controls (OR 3.64, 95% CI 1.35–9.84). Patients with NP/CGH showed reduced jaw mobility and lower PPTs in masticatory muscles, indicating increased pain sensitivity. Myofascial trigger points and pain on palpation of masticatory muscles and TMJ were more frequently reported in symptomatic groups. Heterogeneity ranged from low to high across outcomes, and overall certainty of evidence was very low.
Conclusions. Patients with NP and CGH present a consistent pattern of orofacial dysfunctions and increased pain sensitivity. These findings support the clinical relevance of screening for TMD in these populations. Incorporating a targeted assessment of the cranio-cervical region may improve diagnostic accuracy and guide multimodal pain management. Further longitudinal studies are needed to clarify causal relationships and optimize screening strategies.