What to Know About TMJ and Head Pain
A little more than a year ago, my jaw popped out of place while I was eating. Unfortunately, this was not my first time with this experience, but I knew immediately that it would probably be the most painful.
Sure enough, several days later, my long-term head pain problems flared quite dramatically. I found myself losing several years of progress in terms of how I felt each day. More than a year later, I am still fighting to get back to where I was.
As someone who cannot distract myself from pain, I decided instead that I would focus on researching more about the involvement of my jaw in my own head pain problems.
I learned a great deal from this research, and felt that it would be helpful to share it, as the jaw is frequently overlooked in the role that it can play in acute or chronic head pain.
Along with being overlooked, it is problematic for couple of other reasons too. First of all, it is borderline untreatable in some situations. Secondly, asking your doctor for help can be a tricky proposition for reasons pertaining largely to your insurance.
What is TMJ (and TMD)?
People who experience misalignment and/or pain in the jaw or from the jaw often refer to the condition as “TMJ.”
This is actually a misnomer. TMJ stands for “temporomandibular joint.” That is the name of the joint which links your jaw to the rest of your skull. It is not actually technically the name of a health condition.
The proper name of the condition is “temporomandibular joint dysfunction.” This is properly abbreviated as “TMD.”
Nonetheless, I will use the two terms interchangeably in this article. I will do this simply because this mistake is so common, and I want people who are searching for information on “how to treat TMJ” and similar topics to be able to find this reference too.
TMJ or TMD Symptoms
One of the first things that is important to understand about TMD is that it does not refer to a single disorder with a single well understood cause.
It seems that there are a number of different things which can go wrong with the jaw. So it is more properly termed “temporomandibular joint dysfunctions.”
As you might expect, symptoms can vary quite a bit as well. It is even possible to have a disorder of the TMJ without being aware of it. It can be entirely asymptomatic (this is more likely to occur in male patients than female patients).
For other people, TMJ symptoms can be mild or moderate. For others still, they can be debilitating.
Here are some of the most common signs and symptoms that a person might have a disorder of the TMJ:
- Sometimes, pain is felt directly within the temporomandibular joints. It may also be felt anywhere along the jaw.
- Pain may be referred to the ear, cheeks, or other parts of the head or face.
- It is possible to experience neck, shoulder and back pain in conjunction with TMJ if it pulls your spine out of alignment or causes tension for other reasons.
- You may have a clicking noise which seems like it is coming from inside your ear.
- Chewing your food may be harder than usual. Your teeth may not align the way you feel they should. You may experience pain during or after you eat, especially with extremely chewy foods.
- The jaw may no longer open and close smoothly, and may be prone to dislocation if you open your mouth too widely.
- Sometimes, it is not possible to open the jaw fully anymore. Indeed, in particularly severe cases, the jaw may lock completely in either an open or closed position.
- You may have the sensation of “grating.” This can happen when you chew, or even just open and close your mouth.
Do not assume if you have no pain but do have other symptoms that your jaw does not need treatment.
Many medical resources and doctors will tell you that such treatment is unnecessary, but my personal experience has taught me otherwise.
I’m not alone in this experience either. One of the most informative articles I have found pertaining to my specific case (and which I recommend that anyone with jaw issues checkout) is this one from a Dr. Halligan in San Diego.
This article concerns one specific source of TMJ-related pain, which is “occlusal cant.” This simply refers to the angle of the jaw being misaligned (top and/or bottom) along the horizontal plane. It is easy to see in the photographs in the article.
Here’s a relevant excerpt:
“The disruption is usually caused by partial or total disc displacement sometime before the growth spurt that occurs in mid-to-late teen years. In other words, the disc displacement happens first, then the unequal ramus length follows. Even if the patient is unaware of the problem for years or even decades. “Oh, I always had a clicking jaw;” the patient might say, “ever since I was a kid. But it didn’t hurt like this until now.” How many times have we heard that one?”
This is pretty much a spot on description of my own experiences. I too developed such a clicking sound in my teens right after a blow to the head, but had no pain. It was only in my early 20s that I found myself in moderate to severe facial and head pain which was, in the beginning, intractable. My jaw looks just like what you see in these photographs.
So this is why I advise that you do not ignore symptoms associated with TMJ, even if you’re not in pain. This is especially important if you are still experiencing that mid-to-late teen growth spurt.
If you ignore the issue, your upper palate will be pulled out of place by your lower jaw while it is still developing. Once your upper palate sets, it will be difficult or impossible (there is some contention on this issue) to correct. You will have a permanent facial deformity that can cause severe functional issues.
If, on the other hand, you have someone push your lower jaw back in place before it has a chance to disrupt the development of your upper palate, it seems feasible that this permanent damage would not need to take place.
Some doctors can perform this for you. If you do not find a regular medical doctor who is capable (or feels it is necessary), go to see a chiropractor who has experience dealing with jaws.
What Causes TMJ and TMD?
Causes of disorders of the TMJ can vary quite a bit, as you might expect. Here are some possible origins of these problems.
- Sometimes, TMJ disorders are the result of defects which were present at birth.
- Any injury to the jaw which causes a displacement can lead to acute or chronic problems with the TMJ or other structures in the head or neck.
- Some people cite dental alignment problems as a possible source of TMD (i.e. overbite, underbite, crossbite).
- It is believed that clenching or grinding your teeth in the night may cause the TMJ issues.
- Soft tissue problems that tug the jaw out of alignment can lead to TMJ.
- Arthritis which causes damage to the cartilage in your joint is another possible cause of TMD.
- Sometimes, the disk in the jaw joint seems to slip out of place for no obvious reason. It could be caused by something as simple as chewing or yawning incorrectly.
Given the somewhat confusing and mysterious nature of TMJ disorders, it is likely that this is far from an extensive list of possibilities.
What is the Connection Between TMJ and Head Pain?
I have already alluded to the connection between TMJ and head pain. But I want to go into this subject in significantly greater detail.
TMJ Seems to Cause Direct Pain for Some
For some patients, the pain of TMD seems to issue from the jaw joint itself, especially in cases of a slipped disc or arthritis.
For other patients, the joint itself does not seem to be implicated in TMD pain (I’m a good example).
When jaw alignment problems make it difficult to chew, this can also create tension in the muscles of the jaw and face which can result in myofascial pain.
A Misaligned Jaw Can Mean a Misaligned Neck
A surprising amount of pain associated with TMD may actually source from other structures than the jaw joints themselves.
Certain forms of TMJ misalignment can pull the vertebrae of the neck out of their proper orientations. This can put excessive stress on the soft tissues in the neck, shoulders and back.
Some possible results can be:
- Migraines. Tension in certain trigger points can result in migraines for many people.
- Myofascial pain and cervicogenic headaches. There are trigger points found throughout the neck, shoulders and back which refer directly to the head. These can cause head and face and pain in the form of cervicogenic headaches that are virtually indistinguishable from migraine pain.
- Pain in the neck, shoulders and back is common as well, especially if myofascial pain syndrome develops.
- Tight muscles in the neck, shoulders and back can also cause more traditional tension-type headaches.
My case is a good demonstration of head and face pain caused more by misalignment of the neck than pain which comes directly from the jaw joints.
In fact, my lower and upper jaws actually need to be out of alignment with each other (my teeth meet unevenly as a result) in order to reduce the strain on my neck as much as possible.
When my jaw popped “out” last year, my teeth met evenly, as did my jaws, but my lower jaw lined up so poorly with my neck that much worse pain resulted.
With other patients, this is not always the case. Many patients seem to report that if their teeth meet unevenly, that is exactly when their pain occurs.
Regardless, the bottom line is that all of the structures in question (your skull, jaw, neck, shoulders and back) are interconnected, and any or all could be involved with your migraines, cervicogenic headaches, and/or tension headaches.
That means that you need to be prepared hypothetically to address all of these structures holistically if possible.
How is TMJ Diagnosed?
In some cases, you or your doctor can diagnose a problem with the jaw simply by noting common signs and symptoms and/or examining the jaw itself visually.
Sometimes, additional tests may be ordered. These might include:
- MRI scans
- CT scans
These can provide insight into structural issues involving your bones and soft tissue. Quite a few of them, however, are quite expensive. Whether they are worth it or not depends on your specific case and whether they might inform treatment in a useful fashion.
A Word of Caution: Try Not to Get Your TMJ Diagnosed
I remember a wise doctor who once told me, “What you are looking for isn’t a diagnosis. It’s a cure. Not all diagnoses are helpful.”
In the case of TMJ, that could not be better advice. A diagnosis of TMJ made on paper is arguably just about the least helpful diagnosis you can ever receive.
It is perfectly okay (and potentially helpful) for a doctor to inform you verbally but you may have a disorder of the TMJ, but you should take steps to ensure that this information not be written down as such under any circumstances.
Why? Because if this becomes your official diagnosis, you are pretty much guaranteed of getting no medical coverage for it for the rest of your life.
I’m not entirely sure why this is the case, but I can tell you based on my own research that there are almost no health insurance carriers anywhere in the USA which will cover TMJ. It is almost universally listed as an exception.
Medical doctors tend to see the TMJ as the province of dentists and orthodontists. Dentists and orthodontists in turn tend to punt patients off to medical doctors. In short, nobody wants to deal with this problem or be responsible for it.
The whole issue is probably exacerbated by the fact that there are no medical reliable treatments for TMD as of this point in time. This is likely the case because manifestations of TMD can be so widely varied from one patient to the next.
It also likely doesn’t help that it is largely a women’s health issue, and the medical profession remains dominated by male researchers and doctors who tend to de-prioritize women’s issues.
There is also the issue of the jaw joint being the single most used joint in the human body, and one which is notoriously difficult to repair in any permanent fashion.
I do not tell you any of this to discourage you, simply to warn you before you walk into a doctor’s office and allow a diagnosis of TMJ to be written down.
There are options for treating TMJ, and you do not want to be denied coverage because of these ridiculous rules.
Dealing With Insurance Companies and TMJ
How do you get around problems with your insurance company? My recommendation is that if you are going to bring up any issue involving jaw pain or dysfunction with a doctor, you preface the conversation by stating outright that you will only have it if no formal diagnosis of TMJ or TMD will be made.
Do not be surprised if your doctor asks you why. Many medical professionals have no idea that insurance carriers have exceptions for covering issues related to TMJ or TMD. Simply explain the problem. A decent doctor will sympathize and work with you.
The way they will work with you is usually to write down something else which insurance companies will be willing to cover.
So, for example, if your TMD is causing head pain, they’re more likely to write down a diagnosis like “migraines.”
Why Do More Women Than Men Have TMJ Pain?
I mentioned previously that more female patients than male patients have TMJ pain. You may be wondering just how much more prevalent TMJ issues are among women, and why they are so much more pervasive.
The ratio is actually quite astonishing. According to the TMJ Therapy & Sleep Center of Colorado, “Surprisingly, 90% of TMJ sufferers seeking treatment for severe symptoms are women in their childbearing years.”
Researchers do not have a definite understanding yet of why women are so disproportionately affected by TMJ compared to men, but there are some theories.
First of all, fluctuations in female hormones mean that on the whole, pain conditions tend to be more prevalent in the female population. There are other possible reasons why pain disorders appear to affect women more as well. Some of these are physiological while others involved social factors.
Some examples include:
- Increased inflammation via prostaglandins
- Low testosterone compared to men
- High prolactin levels
- The influence of the hormone relaxin (likely why my own jaw popped out last year at the specific time of the month that it did)
- Differences in pain sensitivity and tolerance
- Neurotransmitter issues
- Sympathetic nervous system imbalances, possibly due in some situations in part to trauma
One specific point of interest regarding TMJ is the presence of estrogen receptors in the tissue of the jaw. Curiously enough, estrogen seems to exacerbate the condition in some women and reduce it in others. So the specific role of estrogen in TMD is unclear.
This sheds some more possible light:
“It should be noted that articular cartilage is estrogen sensitive. In fibrous joints, such as the temporomandibular joints, estrogen stimulating chemicals have been demonstrated to accelerate DJD and estrogen repressors to slow the process (92). This may partially explain the prevalence of females in most populations of TMD patients. In fact, lower estrogen levels in post menopausal females may partially explain why TMD is less common in the elderly population.”
If you want to learn more about the challenges affecting women with regards to pain management, please check out “Why Are Migraines More Common With Women Than Men?”
Can Surgery Fix TMJ?
An entire article could easily be written to talk about different surgical options for attempting to treat or “cure” TMD.
I have investigated this option in detail, but do not want to make it the focus of this article. So I will simply say that jaw surgeries are notorious for a high failure rate. Sometimes, this is apparent immediately, and in other cases, the surgery initially seems successful, but then the jaw quickly reverts to its previous state.
It is common to have to go back for multiple subsequent surgeries to correct issues with the first one.
This type of surgery is very expensive, and trying to get your insurance company to cover it is incredibly unlikely to be successful.
I have even read accounts from people who clearly ended up with TMD as a result of an obvious catastrophic injury who were unable to get their insurance companies to pay for their surgeries, or only succeeded after arguing back and forth for years.
This is why most experts recommend you stay away from surgery or other drastic measures for treating TMD, even in relatively severe cases.
It’s even possible to come out worse rather than better from jaw surgery. Does this mean it never works? No, but the risk level is very high. It is worth trying out pretty much everything else under the sun before you decide to give it a go.
Alternatives to Surgery for TMJ Pain
Since surgery is likely out of the question for most people, this will leave you wondering what you can possibly do to treat head pain from the TMJ.
Following are some of your options along with a bit of commentary on each.
Start by Eliminating or Avoiding Bad Behaviors
The first thing you can do is start by developing an understanding of what you should not be doing with your jaw.
- Resist the urge to open your mouth to widely for any reason, including yawning. It’s hard to control the action of a yawn with your jaws alone, so it is wise to hold your mouth partly closed with your hand when you yawn or sneeze. In my experience, you do not need to worry about your jaw freezing if you stop opening it wide. Actually, you are far more likely to have it lock if you overextend it.
- Take small bites of your food to avoid opening your mouth too wide or engaging too enthusiastically with your chewing. I recommend switching to a smaller spoon if possible. This prevents you from needing to open your mouth widely, and forces you chop up your food into safer sizes.
- Certain foods cannot be eaten the way other people eat them. A sandwich should probably be torn into little pieces to consume one by one. Corn on the cob needs to come off the cob. An apple needs to be chopped up, and so forth.
- Chew your food slowly and carefully, taking as much time as you need to in order to eat.
- When possible, favor foods which are softer and require less effort to chew. Chewy foods like beef jerky will cause you the most distress. Overly crunchy foods also can sometimes be problematic.
- Do not clench or grind your teeth while you’re awake. If you become aware that you do it in your sleep, see the section below.
- I have found that drinking through a straw seems to exacerbate tension in the muscles of the jaw and face, and recommend either avoiding it or approaching it with caution.
- Limit your time on the telephone, because holding a phone tends to be a strenuous position no matter how you do it. The worst of all is when you hold your phone against your shoulder by tilting your face against it. Talking on your computer using a speakerphone (or sometimes, a headset) is better.
- Stop sleeping in incorrect positions like lying on your stomach with your face turned to the side. This is terrible for your jaw and neck alignment. If you sleep on your side, ensure that there is sufficient support for your neck. If you sleep on your back, do likewise.
- Do not chew gum. There is no point in continuing to overuse your jaw muscles.
Just by putting a stop to everything listed above, you should start to see some improvements. At the very least, you will not be unnecessarily contributing to your own problems.
Dentists and orthodontists sometimes will deal with issues involving TMD. Usually, this involves either:
- Correction of your bite
- Fitting you with a mouth guard.
In both cases, there are anecdotes about improvements. Based on my own experiences, I believe that the emphasis put on how the teeth meet may be a bit overstated. I do not mean to assert that I don’t believe that this could be a factor—but I suspect that a lot of people with TMD have other problems that need to be addressed to get pain relief.
As far as mouth guards go, it only makes sense to use one if you suspect that you are clenching or grinding at night. There is an annoying tendency for medical professionals to assume that this is the overwhelming cause TMD, but again, I suspect that its involvement is exaggerated.
Obviously, if your jaw is stressed out or out of alignment, clenching and grinding can only make things worse. But there’s a good chance that you have an underlying problem which goes beyond the clenching and grinding which needs to be addressed.
Some underlying structural issues are unlikely to be treatable at this time through orthodontics. Mine is such a case. There are some experimental treatments for correcting misaligned upper palates through orthodontistry in adults, but we’re talking about a handful of case studies (maybe a couple of handfuls—not a lot, regardless).
Orthodontic adjustments and/or mouth guards generally are going to carry a much lower price tag than something like double jaw surgery. But it should be noted that they are still quite expensive.
Your orthodontist may recommend creating a custom mouth guard for you. Usually, the service costs hundreds of dollars. From what I can tell, it is quite unnecessary.
If you want a custom mouth guard, you can order one yourself online for a much lower price.
One product I can recommend is the Mouth Guard from ProDental.
A friend with headaches induced by cross-bite as well as nighttime grinding discovered this product and says that it has worked well for her. Since then, I have recommended it to my chiropractor, who also said it has worked out for her.
You get three mouth guards in this pack, and all of them can be trimmed down as necessary in order to fit.
That is certainly more cost effective option than paying hundreds of dollars for a dentist or orthodontist to make you a single custom mouth guard.
Many cases of TMD can benefit from exercising the jaw. The same friend who I mentioned above was taught to do some basic jaw exercises. According to her, doing these religiously each day has vastly reduced her head pain.
The main one which she described to me can be found in this publication from Oxford University Hospitals.
Two quick words of caution:
- First, remember that with stretching, it is always best to proceed with caution. Start small and work your way up. Soft tissue damage can take a few days to become obvious, so you may want to skip a few days between your first few exercises just make sure that you’re not doing anything wrong. Once you feel confident that you are stretching appropriately, you can begin to do it daily.
- The second thing to know is that while this particular stretch in the linked publication seems to be almost universally recommended, there are still cases where it may not be suitable. I’m not sure, for example, if it can even be done with a severe occlusal cant like mine, because you cannot move your jaw “straight down.” My PT agreed that the prospect would be dubious.
In any case, if you can add helpful stretching to your repertoire, it may end up being one of the most beneficial things you can do for your TMD. For my friend, it has been a night and day difference in quality of life.
Heat or Ice
Heat and ice are often recommended for treating the pain produced by jaw problems. Either can be applied to the face or to structures in the neck which may be strained and referring pain to your head.
My experience is that cold is best for numbing your nerves, and heat is best for restoring circulation and softness to tight muscles.
It can take some trial and error to figure out when these treatments are most useful, and how to most helpfully apply them. Using them for extended time periods (i.e. half an hour at a time) seems most effective.
NSAIDs and other OTC Pain Medications
Also very useful for controlling pain relating to the jaw are over-the-counter pain medications, particularly NSAIDs. Inflammation can be related to TMD in a variety of ways:
- Injured jaw joints can themselves be inflamed.
- If arthritis is involved in your TMJ disorder, that is an inflammatory condition.
- Myofascial pain connected to TMD has a strong inflammatory component.
- Frequent re-injury is possible when you have a structural issue which cannot be corrected. Any time you strain soft tissue, you can expect inflammation in response.
Inflammation can become a chronic issue which worsens the pain of TMD, so you can expect to be medicating it on a regular basis if your pain is moderate, severe or persistent.
You can also pursue prescription medications to try and help you manage TMD. Most of them have more side effects and higher risks associated with their use than medication you can get over-the-counter.
Try Various Positions
Since much of the pain involved with TMJ may well be radiating from neck, shoulder and back muscles, it is worth it to try changing positions if you are feeling bad in the one you are in.
For example, if lying on your left side is unpleasant, try lying on your right side or on your back. If that doesn’t work, try sitting up, and so on. Continuing to strain your already-strained muscles is not going to help. If you can possibly find a position which relaxes them, it may help you recover from an attack.
TENS and EMS
A couple of similar-sounding (and similar-looking) devices you may find helpful are TENS and EMS. Both are very reasonably priced, and can be ordered online. I recommend this store.
TENS stands for “transcutaneous electrical nerve stimulation.” By sending electronic impulses to your nerves, this device targets your opioid receptors, releasing endorphins and competing against the pain sensation.
You cannot actually place electrodes for a TENS unit on your head, but you can get away with putting them over the masseter in my experience. Please note that there are some experts who do not recommend this, and there is controversy over whether this could possibly cause nerve damage. Try it only at your own risk.
You can also put TENS electrodes on safe locations on your neck (some locations are unsafe on your neck, so learn them) as well as on your back and shoulders.
With clever placement targeting trigger points that refer pain to your head, you can refer relief to your head as well.
EMS, the similar-looking device, is for “”electronic muscle stimulation.”
Instead of targeting your nerves, it stimulates muscle to boost circulation. You can see research supporting EMS and TENS for myofascial pain here.
For ideas for placing your electrodes, and to learn more about trigger points in general, please read my article, “Trigger Points and Migraines.”
PT, Chiropractor, Massage Therapist, Acupuncturist, Dry Needling
What your regular primary care provider can do for you regarding TMD probably will be pretty limited. Thankfully, there are other healthcare professionals who may be able to do more for you.
- Physical therapist: A PT can teach you stretches for your jaw and neck, and give you ideas for improving your posture.
- A massage therapist can help to loosen up tense muscles and get trigger points to release. Inducing this sort of relaxation seems easiest when it is entirely passive on your part, so this can work better than, say, a tennis ball (though that can be useful too).
- A chiropractor can make corrections to the alignment of your lower jaw as well as your neck, shoulders and ribs. Doing this can greatly reduce symptoms in some cases by relieving stress on overburdened muscles and ligaments.
- Acupuncture and dry needling are two similar alternative therapies which may help to combat the pain of TMJ and/or related myofascial pain.
Any or all of these may be worth a try. In many cases, initial appointments are expensive, but subsequent visits are much less so.
Another approach you can take to treating TMJ is to try taking herbal supplements. Obviously, you cannot correct a structural problem with an herb, but you may be able to reduce symptoms through other means. Here are some ideas:
- If you believe that myofascial pain may be involved with your symptoms, some supplements you can try include lavender, lemon balm, rosemary, kava kava, skullcap, passionflower, rose and valerian. Learn more in this insightful article.
- If you think that migraines are being triggered by your jaw problems, some herbs to consider include ginger extract, boswellia, butterbur and feverfew. Increasing your magnesium, vitamin B12, vitamin B6 and vitamin D also may be beneficial.
- If hormonal imbalance issues are exacerbating your symptoms, think about trying chaste tree berry (Vitex) extract. Keep in mind that hormonal imbalances can be complex and extremely varied. There are a number of other herbs which may be worth trying as well. The same herbs will not work for everyone since imbalances can differ so much. So be ready to experiment.
Summary of Tips for Fighting TMJ
- Surgery is the very last option you should consider for treating TMJ and associated headaches. Many healthcare professionals recommend never trying it at all.
- Avoid the temptation to spend hundreds or thousands of dollars on expensive custom orthodontic solutions if cheaper alternatives are available.
- Do not let a doctor diagnose you with “TMD” or “TMJ.” If this happens, it will alert your insurance company not to cover anything associated with your jaw and/or related symptoms or problems.
- Alternative care practitioners such as chiropractors, massage therapists, acupuncturists and physical therapists may be able to help you greatly with TMD.
- Avoid actions with make your symptoms worse. These include eating chewy foods, yawning too widely, sleeping in incorrect postures, and so forth.
- Diligently try at-home treatments. I have shared many different ideas for treating TMJ-related pain at home. These include heat, cold, herbal supplements, over-the-counter medications, TENS, EMS, and more.
- Be patient; healing takes time. In my experience, it can take many months of daily effort to start seeing significant improvements in pain connected to the TMJ. It is very important not to give up if you want results.
- Keep notes. Keep a comprehensive log each day on your pain levels, the locations where you feel pain, and the treatment methods you are trying. Search for patterns in the data over time, and you will figure out more about your specific jaw problems, possible complications you may have (i.e. myofascial pain), and what is working and what is not.
You now are aware of the complex relationship between the TMJ and head pain. If you suspect your jaw might be playing a role in your own headaches, it is well worth investigating.
Just remember to proceed with caution where doctors and insurance are concerned—and think very hard before you do anything drastic and irreversible.
Even with tough cases of TMD, improvements are often possible on at least some level. So try not to get discouraged. The more you learn, the more you empower yourself. Good luck, and keep checking back here for more tips on managing your head pain.