# Temporomandibular Disorders and Orofacial Outcomes in Subjects with Neck Pain and/or Cervicogenic Headache: A Systematic Review with Meta-Analysis

## TL;DR

This study finds that adults with neck pain or cervicogenic headache are more likely to have temporomandibular disorders and show signs of orofacial dysfunction.

## Contribution

The study provides new evidence linking neck pain and cervicogenic headache with temporomandibular disorders through a systematic review and meta-analysis.

## Key findings

- Neck pain is associated with a 3.64 times higher odds of temporomandibular disorders compared to controls.
- Jaw mobility is significantly reduced in individuals with neck pain.
- Masticatory muscle pressure pain thresholds are lower in those with neck pain or cervicogenic headache.

## Abstract

Introduction: Temporomandibular disorders (TMDs), neck pain (NP), and cervicogenic headache (CGH) frequently co-occur. We aimed to assess TMD prevalence and orofacial clinical features in adults with NP or CGH versus asymptomatic controls. Methods: We searched PubMed, CINAHL, Web of Science, and Scopus from inception to 31 July 2025. Eligible designs were analytical cross-sectional studies comparing TMD prevalence, signs, or symptoms between NP/CGH patients and controls. Outcomes included TMD prevalence, jaw mobility, masticatory muscle pressure pain thresholds (PPT), and palpation findings. Risk of bias was appraised with the JBI analytical cross-sectional checklist. Random-effects meta-analyses synthesized odds ratios (ORs) for dichotomous and mean/standardized mean differences (MDs/SMDs) for continuous outcomes; heterogeneity was quantified with I2 (and τ2 where available). Small-study effects were inspected visually (k < 10). Certainty of evidence was assessed with GRADE. Results: From 4130 records, nine studies met the criteria (eight NP, 400 subjects; one CGH, 44 subjects). NP was associated with higher TMD prevalence versus controls (OR 3.64, 95% CI 1.35–9.84; I2 = 13%). Jaw mobility was reduced in either pain-free opening (one study), unassisted opening (one study), or maximum assisted opening (three studies; MD −6.16 mm, 95% CI −10.05; −2.28; I2 = 83%). PPTs were lower in symptomatic groups for masseter (SMD −1.11, 95% CI −1.89 to −0.32; three studies; I2 = 92.6%) and temporalis (SMD −0.77, 95% CI −1.04 to −0.50; five studies; I2 = 69%). Myofascial trigger points and pain on palpation of masticatory muscles or TMJ were more frequent in experimental groups. Discussion: The findings suggest consistent associations between NP/CGH and TMD prevalence with signs of orofacial dysfunctions. Certainty of evidence was very low due to the cross-sectional design, incomplete confounding control, and moderate heterogeneity for several outcomes. Conclusions: Adults with NP/CGH show higher TMD prevalence and reduced jaw mobility with lower masticatory PPTs. The results support integrated assessment, and prospective longitudinal studies are needed.