We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Ascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in atients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.