Migraine-Associated Dental Pain in a Patient with Temporomandibular Disorders: A Case Report

Temporomandibular disorders (TMD) and migraine are common comorbidities. Orofacial migraine (OFM), a rare subtype of migraine, is confined to the facial areas innervated by the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve, and presents significant diagnostic challenges because symptoms overlap with other facial disorders. This case report is of a 29-year-old woman patient with TMD who presented with migraine-related orofacial symptoms. Diagnostic evaluation included the Diagnostic Criteria for TMD and validated questionnaires, including Generalized Anxiety Disorder-7, Patient Health Questionnaire (PHQ)-9, PHQ-15, the Graded Chronic Pain Scale (GCPS), the Symptom Checklist-90-Revision (SCL-90-R) and headache questionnaire. Psychological evaluation results showed grade IV disability (GCPS), mild depression (PHQ-9) and low somatic symptom severity (PHQ-15). The SCL-90-R indicated high scores in somatization and positive symptom distress index. Treatment included behavioral therapy, physical therapy, stabilization splint therapy and pharmacological management including aceclofenac and sumatriptan. At 6-month follow-up, pain intensity significantly decreased from 9 to 3 on a 0-10 Numeric Rating Scale. Comfortable mouth opening range increased from 20 to 48 mm, and maximum mouth opening range increased from 40 to 48 mm. Tenderness on palpation of the left temporomandibular joint (TMJ) capsule, masseter, and temporalis muscles resolved, and TMJ noise on the left side also disappeared. This case highlights the importance of recognizing migraine symptoms that can manifest in the orofacial region. Such symptoms may coexist with TMD, necessitating a multidisciplinary diagnostic and therapeutic approach.