If you have a TMJ Headache – Myofascial Pain should be on your radar! Problems with the Temporo-Mandibular Joint (TMJ) cause pain in the face and head. In addition, TMJ disorders (TMJD) can cause myofascial problems AND myofascial dysfunction can cause TMJ pain, reinforcing each other.
For most people, pain in the face and side of the head is the primary symptom. Sometimes, TMJ issues cause headaches in the back of the head.
Conventionally, TMJ disorders have been considered as a type of musculoskeletal, neuromuscular, or rheumatological disorder. It has also been called a functional pain syndrome, and a psychogenic disorder.
However, in our experience, a significant number of TMJD patients also have myofascial pain in key muscles that act on that jaw. Sometimes, this happens in response to a problem in the jaw joint. Other times, TMJ headache – myofascial pain IS the problem.
Like other forms of headache, TMJ headache can get worse through ‘central sensitivity syndrome’.
For treatment of TMJ headache – myofascial pain relief is a practical treatment.
In a word, “Yes!”
Cluster headaches have some symptoms that are similar to migraines. They can be trigger like migraines. They may some variation of aura, which suggests a vascular component.
However, cluster headache is a neurological disorder. Distinguishing symptoms are the rapid cycling of the headaches, extreme pain, autonomic symptoms and prevalence in men.
Extensive studies of the brain, in particular specific areas of the hypothalamus, have shown unusual activity.
Current therapy focuses on medications that target these areas.
Myofascial trigger points and dysfunction often develop in muscles of the face, head and neck in response to the rapid cycling, extreme pain.
TMJ Pain Characteristics
You have pain and tenderness the muscles around your jaw. Sometimes it feels like the joint itself the joint itself, just in front of your ear. Pain is the defining feature of TMD.
Usually, it is aggravated by manipulation or substantial use, such as when chewing, clenching, or yawning. Also it is often worse upon waking.This may be due to clenching during the sleep.
Your pain usually has adull or aching quality. Typcially, it is poorly localized and intermittent. However, sometime it can be constant. The pain is more usually unilateral (located on one side) rather than bilateral.
- Limited range of jaw movement, which may cause difficulty eating or even talking. Your jaw might even lock. In addition, you have stiffness in yourjaw muscles and the joints, especially upon waking. Also, you may have incoordination, asymmetry or deviation of mandibular movement.
- Noises from the jaw joint during movement, often intermittent. Joint noises may be described as clicking, popping, or grating.
- Headache in the back of your head or forehead; or other types of facial pain including myofascial pain.
Less Common Symptoms
- Pain your teeth or neck.
- Hearing loss.
- Sensation that your teeth do not meet together properly.
Internal Joint Pain
The temporo-mandibular joint (TMJ) can become mis-aligned and inflamed for various reasons. This is called either TMJ or TM disorder (TMJD or TMD). This diagnosis is most often made by your dentist. Infections, missing teeth and arthritis in the TM joint are typical causes of this.
In this case, the TM joint can cause pain radiating into the face and head. This can be part of a stimulus for central sensitization. Then, the feed-forward mechanism turns periodic TM joint pain into a chronic headache. The best way to approach this is to address the underlying dental problem.
Myofascial Reaction to Jaw Issues
On the other hand, relatively minor problems with your TM joint can cause muscles in your face and head to splint. In response, these muscles can develop taut bands and trigger points. Underlying causes of this type of TM joint issue are clenching, bruxism at night and teeth that don’t meet properly because of missed orthodontic work. Night guards are helpful. Trigger points can be released to provide relief from most of the pain.
Primary Myofascial TMJ Pain
Lastly, it is possible that you have a myofascial problem with muscles of the face and head that has caused inflammation of your TM joint.
Myofascial treatment for TMD includes, work with the temporalis, masseter, pterygoids, digastric, hyoids, SCM, scalenes, trapezius, longus colli and suboccipitals.
You have some muscles that are easily accessible from the outside of the head that are probably part of the story. However, there are also important muscles inside the mouth. We can provide advice and training for you to access those muscles in self-care.
TMJ Headache – Myofascial Pain
We focus on history, lifestyle, pain patterns and other symptoms to sort out your myofascial pain. There is a myofascial component to many types of headaches.
Notably, myofascial pain is not caused by contracted or ‘tense’ muscles. They have no electrical activity.
Chronic Headache – Myofascial TriggerPoint Referral Patterns
We can clearly see how referral patterns of head and neck muscles evoke the pain patterns of migraines, tension headaches, cervicogenic headaches. They even overlay the symptoms of cluster headaches and TMJ headache pain. Some of the factors that activate those muscles may not covered by doctors. Those activation factors are things we care a lot about.
Myofascial activations are a part of most headache patterns!
Sometimes, when people are in chronic pain, medical history reveals problems with body mechanics. Body mechanics includes all the various ways that hold ourselves and move as we do things. Sometime is it how we hold ourselves when we are NOT doing things, like sitting.
When ever we are making repetitive movements, we should be mind of using proper body mechanics. This will help minimize repetitive stress injuries and myofascial activations. For instance, lifting in a stooped posture and then twisting is always ill-advised. Doing it repetitively is worse. Therefore, if this type of lifting is required, we should rethink the task and try to organize it in a way that reduces stooping and twisting.
However, even simple movements matter. For instance, what if your desk is arranged phone on the wrong side. In fact, with every call, you have to twist your head and neck and reach over with your arm to the wrong side of the desk This is poor body mechanics. Fixing it might be as simple as moving the phone.
It pays to think about basic body mechanics in this common sense way each time we engage in a repetitive activity. Fortunately, we’re starting to teach this important skill to young people, as in this student guide at University of Michigan.
We can experience chronic overload when we do things like wear high heels, carry a heavy bag or lean into our work.
However, acute overload happens when we decide to lift, push, pull or otherwise move something that is too heavy for us. Most often, we overload our muacles with an eccentric contraction.
For example, lifting a heavy box, correctly using your legs instead of your back, requires concentric contractions of your quads. However, setting that same heavy box down, slowly and with control, require eccentric, lengthening contractions. These should be done carefully.
Of course, if you have a diagnosis from your doctor, we need to know. If you have recent imaging or other test results, even better!
We’ve all been knocked around a bit. We’d like to know everything you can think of about prior accidents, injuries, surgeries and other treatments.
It is important to know about previous or current medical conditions that could impact our treatment. Anything from high blood pressure to TMJD to disc problems are vital information.
Hopefully, medications align with your diagnosis. Sometimes, certain medications will also modify our reatment options. Some drugs interfere with nutrient absorbtion.
Increasingly, supplement use is common. Typically, we’re on the look out to make sure you whether you taking certain supplements.
TMJ Headache – Myofascial Pain Referrals Overlap Joint Pain
Your dentist should evaluate you for dental issues that may be contributing to TMJ disorder. Generally we assume that some of the muscles around the TMJ have also developed myofascial pain.
If dental causes have been eliminated, or are being treated by your dentist, then myofascial trigger point referrals are probably the primary source of the pain in TMJD.
A wide variety of muscles in your face, head and neck can harbor myofascial trigger points. The lateral pterygoid, pictured here is one of several likely myofascial suspects.
The pain of TMJ headache itself usually focuses near your jaw. But you may also have a headache in back of your head or your forehead. Even jaw pain has individual trigger points for specific muscles such as the masseter pictured here, versus the lateral pterygoid previously and the medial pterygoid below.
Where Does The Pain Refer?
When looking for trigger point referrals, we are considering the whole range of head and neck muscles. The precise pain patterns are quite varied. They can also extend into your cheeks, temples, jaw and more.
TMJ headache – myofascial pain can be relieved easily with trigger point therapy.
It pays to be precise. Notice that this pattern in the medial pterygoids is different in subtle but important ways from the lateral pterygoids, pictured at the start of the section.
Determining which muscles are referring pain is crucial to myofascial trigger point treatment…
From the outset, education is important. It is our job as therapists to educate you about our assessment and our process. Then, throughout our treatment, we continue this education process.
Trigger Point Therapy can get at some aspects of myofascial pain that you might not have thought of!
Unfortunately, sleep posture and sleep disturbances contribute to many myofascial pain syndromes. However, this is especially important for relief from chronic headaches. Because of this, we always have a thorough discussion about how you sleep during an initial assessment.
Diaphragmatic breathing is at the foundation of myofascial trigger point treatment. But, if you don’t know how to do it, we will teach you. On the other hand, if you already know about it, we will help you deepen the technique.
Of course, the medications and supplements you are taking matter too. Usually, reducing drug consumption is a good thing. However, it should be done gradually and in consultation with your physician.
Keeping a headache diary is an important tool for understanding headaches. Also, it is how we clearly see things that improve our headaches – or not.
Structural variations need to be explored and understood. Once treatment begins, they can be accomodated or corrected in various ways.
It is surprising, but most of us our not taught proper body mechanics. Whether we are at home or at work, we need to learn how to use our body correctly.
Most people are self-conscious about their posture. But, identifying the postural aspects that should be improved is a challenge. Even harder, is understanding how they vary with movement. Ultimately, devising a strategy for improving them is essential.
However, it usually takes more than hands on work to really erase the pain and keep it away.
First, the chances are that we were not your first stop. As a general rule of thumb, the longer you have experienced headaches, the longer it will take to make them go away.
Secondly, there are usually at least some factors that might be part of your headache picture that are out of our scope of practice.
In contrast, if we are treating someone for tennis elbow, we can work on the muscles at play. We can talk with you about some modifications for your game and your lifestyle. Then, we can tell you that if you feel the OTC pain reliever you are taking isn’t needed anymore that you can stop taking it. Finally, we can offer you stretches and other self-care advice that are pretty straightforward
However, if you are suffering from serious headaches, you may have some other more complex factors at play. Often, you may be working with other providers on vascular (blood vessel), neurological, psychological and other issues. You may be taking prescription medications that you should discuss with your doctor.
Chronic headache treatment is often inter-disciplinary.
Myofascial tigger point therapy – it’s how you work this!
Education is the first step in the myofascial treatment protocol.
Sometimes, we may not be good enough at explaining how myofascial pain works and how it activates your headaches.
However, we believe that people can make more progress when they know more about their condition. So, we try to understand what your learning style is give you as much information as you want – but hopefully not too much!
Typically, we performing series of miniature cycles of test/assess, treat and test/assess again. It is an informed exploration for both of us.
We have an initial assessment from your history, postural and range of motion exams, etc. Then, we use various treatment techniques before testing and assessing again.
Manual Therapy Techniques
First, we specifically expertly use manual pressure release therapy, neuromuscular techniques, and deep stroking, friction, skin rolling. When indicated, we also use fascial stretching. Sometimes, we use less common techniques like cupping, spray and stretch and acoustic compression.
In addition, we may also use active and passive muscle activation techniques. This includes reciprocal inhibition, postisometric relaxation, contract/relax, strain/counter-strain and muscle energy techniques. Sometimes, we also use hot/cold therapy.
Range of Motion/Testing
Finally, routinely run the muscle we are treating through its entire, pain-free range of motion. This is part of your treatment. However, it also the start of a new test/assess cycle.
We learn together whether your range of motion has increased and whether your pain is reduced. We may have you get up and use your body in the way that causes pain to ‘test’ more dynamically.
As we finish our hand-on work, we transition into learning new movement strategies and self-care.
Myofascial tigger point therapy – it’s how you work this!
For general myofascial wellness, a quiet, regular self-inspection of our own bodies will often tell us where trouble lies. In addition, it will also give us the opportunity to address problem areas.
For example, in Tai Chi, we go through a slow, controlled series of movements. However, we are not trying to stretch or strengthen anything. Rather, we are re-calibrating our nervous system and our myofascial system with each other. Instead, it is basically a form of movement or neuromuscular therapy.
However, during these gentle movements, we may notice variations in our range of motion. In fact, limited range of motion is a symptom of an unhappy muscle. Plus, we may experience pain. That is also a symptom of an unhappy muscle.
In activities like the Yamana rolling ball technique, we also go through series of movements. However, as we move, we are rolling over muscles that may be sore. So, we also have the opportunity to treat them with manual compression.
TMJ Headache – Myofascial Pain Trigger Point Compression
For treating the muscles of chewing, we may use a tennis ball or small rubber ball to gently compress them externally. A small ball rolled between the face and your hand is a useful technique. This includes the masseter (side of the cheek), the temporalis (the temples) and digastric muscle under the jaw.
In this photo, the therapist is treating muscles of chewing from the inside. This could include the lateral and medial pterygoids and inner masseter. In addition, there are some smaller muscles near the roof of the mouth and base of the tongue than can be released.
Your therapist can train you to perform this type of self-care at home. At first, it might seem weird. But soon, you will amazed at how much it helps!
Myofascial self-care helps reduce the frequency and severity of migraines!
TMJ Headache – Myofascial Pain Trigger Point Therapy Self-Care Stretches
We don’t typically ‘stretch’ the muscles of chewing. As with other muscles during self-care, we do run them through their range of motion. But, we do not stretch, per se.
Typically, certain other muscles tend to be tight in most chronic headache patients. Your therapist will give you specific advice about muscles that you should stretch.
However, most of us need to stretch our pecs, SCM, upper traps and levator scapula. After self-compression, these muscles can be stretched gently and effectively. You may also benefit from stretches of certain muscles on the back of your neck. Unfortunately, most of these muscles are over-stretched by head forward posture anyway. Your therapist can help you target specific muscles in the back of the neck.
In addition, this is the time to strengthen your deep cervical flexors, serratus anterior, lower traps and other postural muscles.