We have been doing a bit of a deeper dive in to TMJ dysfunction (TMJD) lately on our social media channels, and this blog is a distillation of all the helpful information about TMJ dysfunction and how this can impact the severity and frequency of another sort of headache, Migraine. While these two conditions might seem worlds apart, there’s a fascinating connection between them. Let’s explore this relationship and how the right treatment, in conjunction with migraine prevention medication, can bring relief.
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Understanding TMJD and Its Impact
First things first, let’s get to grips with what TMJD is. Your temporomandibular joint (TMJ) is the hinge that connects your jaw to your skull, allowing you to chew, speak, and open your mouth. TMJD refers to a range of conditions affecting this joint, encompassing pain, clicking, popping, and limited mobility of the jaw. While the exact cause of TMJD can vary from person to person, factors like stress, bruxism (teeth grinding), bite asymmetry, or even genetics can contribute to its development.
One of the other horrible symptoms of TMJD, aside from the jaw pain and clicking, is headache. Usually one sided, and either behind the eye / forehead region, or through to the back of the head on the same side (extra-trigeminal) these headaches are often described as “ice-pick” like. These can be confused with migraine, as they can also cause nausea, vomiting, and sensitivity to light, all of which can be symptoms of migraine as well.
Diabolically, the pain from TMJD can also trigger migraine events, in people who suffer from this condition. It can be difficult without proper assessment to understand the difference between them. There are some key features that can help you tell the difference;
But before we explore that connection, let’s understand what sets these headaches apart.
Migraine Headaches: The Mysterious Throb
Migraines are notorious for their debilitating and often mysterious nature. Here are some defining features:
- Pulsating Pain: Migraines typically present as a throbbing or pulsating pain, usually on one side of the head.
- Aura: Some migraine sufferers experience an “aura” before the headache, which can include visual disturbances, smells, numbness, or difficulty speaking.
- Nausea and Sensitivity: Migraines often come with nausea, vomiting, and heightened sensitivity to light, sound, smell or taste.
- Duration: Migraine attacks can last anywhere from a few hours (but are defined by being longer than 4 hrs, as opposed to TMJ headaches which are shorter than 4 hrs) to several days, severely affecting daily life.
- Medication: Migraine often responds very well to both preventers and relievers, but can take some trial and error to work out the best combination of medication for each sufferer. See below for further information on migraine medication.
Now, let’s shift our focus to TMJD-related headaches and Cervicogenic headaches.
TMJD-Related Headaches: Jaw Pain and Beyond
Temporomandibular Joint Disorder (TMJD) can lead to headaches that share some characteristics with migraines but have distinct differences (for more detail check out this link to Mayo Clinic article
- Jaw Pain: A very common symptom of TMJD-related headaches is jaw pain, although it is possible to be unaware of jaw issues. You may experience discomfort or pain in the jaw joint and surrounding muscles.
- Facial Pain: TMJD can radiate pain into the face, ears, and neck, often mimicking sinus headaches.
- Limited Jaw Movement: Difficulty in opening or closing the mouth due to TMJD can exacerbate the pain.
- No Aura: Unlike migraines, TMJD-related headaches typically do not come with auras or neurological symptoms.
- Medication: TMJD and cervicogenic headache tends not to respond very well at all to medications, like opiates, NSAIDs or antihistamines.
Understanding these defining features and differences is crucial because accurate diagnosis is the first step towards effective treatment. Now, let’s explore how TMJD can influence the frequency and severity of migraine events and how the right treatment, in conjunction with migraine prevention medication, can bring relief.
The TMJD-Migraine Connection
Migraines are notoriously complex, with various triggers and contributing factors. One such factor is muscle tension and dysfunction, which plays a pivotal role in both TMJD and migraine episodes.
- Muscle Tension: TMJD often leads to heightened muscle tension in the jaw, neck, and shoulders. These tight muscles can radiate pain throughout your head and face, which may trigger or exacerbate migraines.
- Nerve Irritation: The jaw and head are rich in nerves, and when TMJD is present, it can irritate these nerves, causing referred pain that can mimic migraine symptoms.
- Inflammation: Chronic inflammation in the TMJ region can release substances that contribute to migraine attacks, making them more frequent and severe.
- Stress: While this is certainly a common mediator for both TMJD and migraine headaches, it is also true severe headache can be a stressor of its own. This can increase the circulating cortisol and have effects on the vasoconstriction in the brain, leading to migraine.
How TMJD Treatment Can Help
So, what can you do to break this vicious cycle of TMJD and migraines? Here are some steps you can take:
- Consult a TMJD-aware therapist: Start by seeking professional help from a physiotherapist / osteo / myotherapist with expertise in TMJD. They can diagnose the condition and suggest appropriate treatments, which may include oral appliances, manual therapy, mindfulness meditation and stress relief, and lifestyle modifications.
- Physiotherapy: Physiotherapy techniques (such as we offer at Hills Physiotherapy) can be incredibly beneficial. Our approach involves hands-on techniques to reduce muscle tension, improve jaw mobility, motor control retraining, and alleviating pain.
- Stress Management: Since stress is a common trigger for both TMJD and migraines, learning stress management techniques such as relaxation exercises, yoga, or meditation can be immensely helpful.
- Dental Splints: Customized dental splints or mouthguards can help alleviate TMJD symptoms by reducing teeth grinding (in some people).
- Sleep assessment: Sleep apnoea is a common cause of TMJD as the jaw falls backward during sleep, blocking the airway and causing strain on the TMJ. A proper sleep assessment, followed by prescription of a CPAP machine (constant positive air pressure) can minimise the apnoea and therefore the irritation of the joint.
- Lifestyle Changes: Making adjustments in your daily habits, such as avoiding chewy or tough foods, practicing variation of posture, avoiding stressors, and staying hydrated, can go a long way in managing TMJD and migraines.
Combining TMJD Treatment with Migraine Prevention Medication
While TMJD treatment is can have profound benefit in reducing the intensity and frequency of migraine, many sufferers also benefit from preventive medications. Here are a few options:
- Beta-blockers: These drugs can reduce the frequency and severity of migraines by regulating blood pressure and heart rate.
- Calcium Channel Blockers: By relaxing blood vessels, calcium channel blockers can help prevent migraines (which are due to vasoconstriction in the brain).
- Antidepressants: Certain antidepressants, like amitriptyline, have proven effective in migraine prevention due to their impact on mood, mental health and pain experience.
- Botox Injections: Botox injections have been approved for the prevention of chronic migraines. They work by relaxing muscles involved in TMJD and reducing nerve sensitivity.
- Anti-seizure Medications: Drugs like topiramate can help stabilize brain activity and reduce sensitivity of neurons.
The connection between TMJD and migraines is more profound than you might have imagined. By addressing TMJD with the right treatments, you can significantly reduce the frequency and severity of migraine events. However, remember that individual responses to treatment can vary, so consult with healthcare professionals who can tailor a plan specifically for you.
If you’re in the Hills area and looking for a physiotherapy approach to TMJD treatment or have questions about managing your migraines, don’t hesitate to reach out to us at Hills Physiotherapy. We’re here to help you live a pain-free and migraine-reduced life.
Take care, and here’s to healthier jaws and fewer migraines!
Written by Ben Kewish