Temporomandibular dysfunction (TMD) and headache disorder

It is well known that chronic migraine, tension headaches and temporomandibular dysfunction (TMD) can be associated. This is not unexpected as these diseases involve the same painful stimuli system, via the Trigeminal Nerve. The name ‘trigeminal’ is derived from the fact that each nerve has 3 major branches

The TMD headache co-morbidity is bidirectional. The presence of headache increases the prevalence of TMD. Clenching the jaw or grinding the teeth, especially whilst asleep, can trigger migraine attacks.

Diagnosis of TMD can be difficult, however the pain is usually most prominent in the areas of face in front of the ear, angle of the jaw (masseter muscles), and or temple. The pain can be on one or both sides, and referral to the face is common. At times it can have migraine like or tension type headache characteristics. Patients often have a limited range of the motion of the jaw, joint noise, and tenderness to joint palpation.

Treatment of TMD typically involves moist heat or cold packs, a soft diet, over the counter pain medications, a splint or night guard as well as physical therapy or massage. Should these fail, other medications, and or injection therapy, as can be used for chronic migraines, though in this case to the temporalis and masseter muscles, may be trialled.

Studies have shown that the treatment of TMD reduces the frequency of coexisting headaches, use of painkillers and improves the quality of life.

Given this, a simultaneous approach to the treatment of the 2 diseases should be considered, and appears to be more effective than the separate treatment of each.

Note: Information on this site is not a substitute for professional medical advice.

References: Temporomandibular dysfunction and headache disorder, Speciali JG et al, Headache 2015 Feb;55 Suppl 1:72-83Migraine and the Trigeminal nerve, Migraine Action, www.migraine.org.uk