Table 3:
‘Red flags’ that require special attention in the assessment of TMD/headache patients†
| Red Flag | Differential diagnoses to consider |
|---|---|
| History of malignancy | Malignancy recurrence |
| Presence of lymphadenopathy or neck masses | Neoplastic, infective, or autoimmune cause |
| Sensory or motor function changes (specifically focusing on cranial nerves V, VII, and VIII) | Intracranial causes, or malignancy affecting the nerve’s peripheral branches |
| Recurrent epistaxis, purulent nasal drainage, or anosmia | Nasopharyngeal carcinoma or chronic sinusitis |
| Trismus | Oral malignancy |
| Unexplained fever, fatigue, weight loss | Malignant tumours, immunosuppression, and infective causes |
| Facial asymmetry or masses | Neoplastic, infective, or inflammatory causes |
| Occlusal changes | Growth disturbance of condyle, neoplasia, rheumatoid arthritis, and traumatic causes |
| Ipsilateral objective change in hearing | Acoustic neuroma, or other ear disease |
| Neurological symptoms (confusion, aphasia, dysarthria) | Artery dissection, intracranial haemorrhage |
| History of recent head and neck trauma | Arterial dissection, intracranial haemorrhage |
| Sudden onset headache | Subarachnoid haemorrhage |
| Postural or positional aggravation | Increased/decreased intracranial pressure (idiopathic intracranial hypertension, meningitis) |
| Onset >50 years of age + jaw claudication | Temporal arteritis |
| Persisting or worsening symptoms despite treatment | Misdiagnosis or more complex case |