The Connection Between TMJ Dysfunction and Migraine

Woman with Jaw Pain

Source: Andrea Piacquadio/Pexels

After surgery for endometriosis, which ultimately resulted in a complete hysterectomy in 2005, my migraine cycle worsened for an extended period of time, and I gradually developed unusual jaw pain with constant aching on both sides. The increase in discomfort and the resulting limitations were gradual, but eventually opening my mouth wide enough to eat was difficult, and yawning was agony. I saw my chiropractor, Dr. Leslie Lange, who worked on the inside of my jaw, (intraoral myofascial release) and outside of my jaw, which did (and does) help, but he eventually ordered an MRI, resulting in a diagnosis of severe TMJ dysfunction and dislocation.

In 2008, my headache specialist, Dr. Joseph Mann, made the connection between my surgery, my worsening migraines, and the ensuing battle with my jaw problems, concluding that the extended intubation during my surgery may have offset what was previously a tenuous balance of my temporomandibular joints.

I went through extensive problems with my teeth, developing a chronic problem with clenching and grinding, wearing away the enamel on some teeth, chipping and cracking others. After trying a night guard, I eventually wore a removable device, all-metal.

Because I was receiving Botox for chronic migraine, Dr. Mann started injections in the right and left in the masseter and temporalis muscles, a treatment which also helped to some degree.

In 2014, Dr. Mann attended a presentation, while at the American Headache Society meeting, by Dr. Howard Israel on a new TMJ surgical procedure and encouraged me to consult him to see if I might be a candidate for this new procedure; I had the surgery with Dr. Israel in 2015.

While the surgery was clearly a success, I still struggle with TMJ (though not nearly to the degree I had), still clench and grind (a behavioral problem, rather than a mechanical one), and still receive Botox and the help from Dr. Lange. There is a definite connection between TMJ and migraine.

What is TMJ Dysfunction and How Does it Affect Migraine?

The Migraine Relief Center explains that:

"The temporomandibular joint (TMJ) is the hinge connecting the lower jawbone to the skull, which enables us to move the jawbone as needed for talking, yawning and eating. The joint gets its support from muscles located underneath the jaw in the throat area, the cheeks, on top and at the sides of the head. These are connected by tendons to muscles in the chest and shoulders… In patients with malocclusion or a 'bad bite,' the TMJ might be out of alignment, which causes strain on the adjoining muscles. When the muscles in the face and head are affected by the strain, the patient can develop a migraine headache attack…”

The article “TMJ and Migraines: What is the Connection,” goes on to point out that:

“migraineurs suffer from a disorder of the trigeminal nerve, which produces chemicals in response to stimulation. The nerve typically only responds when it senses a need to protect itself, but when it does, the chemicals released can cause swelling around the brain and sinuses, resulting in migraine headache pain. If you get frequent migraines, the trigeminal nerve is likely responding to lower stimulation than normal. Unusual clenching of the teeth and jaw during sleep or any other time can impact your trigeminal nerve system and make you more susceptible to migraines” (2017).

We must be cautious, though, in thinking about a cause-and-effect connection. According to Steven B Graff-Radford, DDS, Director, The Program for Headache and Orofacial Pain, The Pain Center:

“The TMJ and associated face and mouth structures should be considered as triggering or persisting factors for migraine. Scientific study has described the pathways and mechanisms for pain referral from the head to the temporomandibular joint and visa-versa. Headache may result from temporomandibular structures, or pain may be referred to the temporomandibular joint, secondary to a primary headache diagnosis. It is essential not to confuse the issue and suggest a cause-and-effect relationship because both are present or based on treatment responses” (Graff-Radford).

Symptoms of TMJ Dysfunction

The Migraine Relief Center suggests that if you have any of the following symptoms, as well as headaches, even if you don’t experience them simultaneously, you could have a TMJ disorder triggering your migraines:

• Jaw clenching or grinding. Even if this is barely noticeable, the touching or occlusion of your teeth for no good reason is called parafunction, and the amount and intensity of parafunction you experience has bearing on whether migraine pain develops.
• Pain and tenderness, either in the jawbone or in one or both of the TMJ joints.
• Pain that resembles earache, in and around one or both of your ears.
• A facial ache, or pain while you’re speaking or eating.
• Stiffness or a sensation of locking in the joint, which makes opening and closing your mouth difficult.
• Clicking or grating sounds accompanied by pain when you move the jaw during chewing or speaking

Treatment Options for TMJ and Migraine

Since both TMJ disorders and migraine are often triggered by stress, anxiety or depression, treatment options include:

• Tricyclic antidepressants, which have a dual effect of relieving both pain and depression.
• Physical therapy
• Chiropractic care
• Massage therapy
• Counseling for stress management.
• Botox
• Biofeedback
• Acupuncture
• Relaxation therapies/exercise
• Corticosteroid injections
• Surgery for complex, damaged joints

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Dr. Paul G. Mathew, MD and Assistant Professor of Neurology at Harvard medical school, argues:

“By treating TMD, neighboring muscle groups may benefit. If TMD/neck pain and tightness improve, there is a tendency for migraine frequency and intensity to also improve, so a physical therapist can be very helpful in addressing coexisting posture and ergonomic issues” (Peckel).

He further reports the frequency of using Botox for his patients: “I would say that if I am performing Botox injections on 15 patients for the treatment of chronic migraine in a day, at least 5 of them are receiving masseter injections for treatment of TMD. TMD is extremely common in my headache medicine practice” (Peckel). The connection between TMJ dysfunction and migraine is real, and this comorbidity is more common today, due to COVID, as well.

Should We Be More Concerned About TMJ and Migraines During COVID?

Dentists are busier than ever during the COVID crisis. Tammy Chen, D.D.S., in her recent article, “A Dentist Sees More Cracked Teeth: What’s Going On,” shares that, “I’ve seen more tooth fractures in the last six weeks than in the previous six years” (Chen). She tells us that after closing her practice in March, except for emergencies, she immediately noticed significantly more calls regarding “jaw pain, tooth sensitivity, achiness in the cheeks, migraines. Then, after reopening in June, she saw a surge in cracked teeth, “at least one a day, every single day that I’ve been in the office” (Chen).

Contributing factors for this increase in jaw/teeth-related problems include increased stress leading to Bruxism (clenching) and grinding, significantly more time working at home and on the computer, leading to poor posture. According to Dr. Chen, “the simple truth is that poor posture during the day can translate into a grinding problem at night… because of the stress of coronavirus, the body stays in a battle-ready state of arousal…all that tension goes straight to the teeth” (Chen). Let’s remember clenching and grinding often lead to TMJ and migraine.

What Can We Do to Help These Problems?

From my experience, once clenching becomes a serious issue, it’s difficult to prevent or stop. What does help is working to develop awareness—becoming aware of how much of the day or during what activities you are clenching. Your top and bottom teeth should never be touching, except when eating. You’ll be surprised, if you have any of the above symptoms, how often they are. Work to keep your tongue on the roof of your mouth, and your teeth slightly apart.

Night guards help a lot of people, particularly if your dentist designs one specifically for your jaw. At the very least, they prevent the fractures, chipped teeth, and further erosion of enamel. Consider wearing one during the day, as well, particularly if you find sitting at the computer, as an example, causes more clenching.

As you finish this article, do a self-check on your posture and the status of your jaw. Doing both consistently might help reduce the symptoms or prevent TMJ dysfunction and may, too, help with your migraines.