The Overlap of TMJ Dysfunction and Chronic Migraine
We’re back with the follow up in our primer on TMD. In today’s post, we’ll examing the overlap between Chronic Migraine and TMJ dysfunction.
Temporomandibular joint (TMJ) dysfunction and chronic migraine are two distinct but related disorders. It is pretty common for people to have both, and unfortunately, this can compound the pain and the impact it has on life. The reasons for this overlap can be complex, so let's get started.
Understanding TMJ Dysfunction
TMJ dysfunction (TMD) is a disorder of abnormal biomechanics of the Temporomandibular joint (the TMJ). Symptoms include jaw, temple, or facial pain, difficulty opening the jaw (often with clicking and popping sounds), and can lead to headache and ear pain. Check here for more information about TMD.
The So What
The interplay between TMJ dysfunction and chronic migraine is undeniable. Part of that is because of shared neuroanatomy, physiology, and triggers. Other reasons for this include shared overlap in other painful conditions. Addressing this overlap through comprehensive care is the best way forward by using all the effective tools in the toolbox.
On to Chronic Migraine
Chronic migraine is complicated, and one of our specialties at Brain Body Health Alliance. Normally, chronic conditions mean a long-term condition occurring over at least 3 months. Because ALL migraines are considered chronic conditions, chronic migraine means more than that. A chronic migraine is both a long-term and a very FREQUENT migraine. It is defined as any type of headaches occurring on 15 or more days per month (essentially at least every other day on average), with migrainous features present on at least 8 days (essentially half of those headaches). It is a condition that is highly tied in with other conditions, including dysautonomia or POTS, Long-term, chronic consequences from a concussion, hypermobility disorders, ADHD, and Fibromyalgia. It is an intentionally vague definition because chronic migraines are very blurry in the lines between migraine and tension-type headaches.
Overlap between TMD and Chronic Migraine
Central Sensitization
Central sensitization refers to the heightened responsiveness of neurons in the central nervous system to stimuli. In TMJ dysfunction, peripheral pain signals from the jaw muscles and joint can amplify central pain processing, which is similarly seen in chronic migraine patients. The pain of chronic migraine can also feed back to heightened muscle tension, creating an unfortunate feedback loop.
Trigeminal Nerve Involvement
Both conditions heavily involve the trigeminal nerve, which innervates the face. This is not the same as trigeminal neuralgia, which is an entirely different condition. Chronic migraine and TMD are both pains transmitted by the trigeminal nerve, and they feed into the same part of the brain.
Muscular and Myofascial Contributions
Tightness and trigger points in the temporalis, masseter, and other jaw muscles exacerbate TMJ pain. These muscles are also implicated in the onset of tension-type headaches, which may evolve into migraines.
Psychological and Stress Factors
Stress, anxiety, and bruxism (teeth grinding) are common in TMJ dysfunction and are known triggers for migraines. The hypothalamic-pituitary-adrenal (HPA) axis dysregulation in stress exacerbates both conditions.
Clinical Evidence of Overlap
Research consistently highlights a significant overlap between TMJ dysfunction and chronic migraine:
Prevalence Studies: Studies indicate that 50-75% of patients with TMJ dysfunction report migraines or severe headaches.
Comorbid Risk: People with migraines have a higher likelihood of developing TMJ pain, with up to 200 to 600% higher rates than people without migraines.
Symptom Exacerbation: Migraine episodes can intensify TMJ symptoms due to heightened pain perception during attacks. Essentially, all things hurt more during a migraine, particularly the TMJ.
Treatment Synergies
Because there is so much cross-over in physiology, the good news is that treatments also can help both at the same time!
Non-Pharmacological Interventions
Physiotherapy: Exercises for jaw mobility and myofascial release benefit TMJ dysfunction and muscle tension. When expanded to include neck stretching and strengthening, it can be even more helpful for headaches.
Stress Management: Cognitive-behavioral therapy (CBT) and mindfulness mitigate triggers.
Oral Appliances: Night guards reduce bruxism and alleviate TMJ strain. They also protect your molars from the grinding. These can be obtained from Dentists.
Pharmacological Management
Analgesics and Muscle Relaxants: These are commonly used in both disorders. Care must be taken not to overuse analgesics, which can lead to Medication Overuse Headaches. We'll discuss more in future posts.
Migraine-Specific Drugs: Triptans may reduce secondary TMJ pain by modulating trigeminal activity.
Botulinum Toxin (Botox): This is an FDA-approved treatment for chronic migraine. It shows promise in reducing TMJ-related muscle tension when performed by a knowledgeable clinician.
Lifestyle Modifications
Dietary Adjustments: Avoiding hard, chewy foods reduces TMJ strain. Also, limiting foods that require the mouth to be opened widely (like apples and double-stack burgers) can be helpful.
Postural Improvements: Correct posture decreases jaw and neck tension, alleviating migraine and TMJ symptoms.
So that’s chronic migraine and TMD in a nutshell. Look out for more posts over the coming week!