TMJ Symptoms and Headache
While there has been a recognized association between bruxism (grinding) and temporomandibular disorders, this has not been well-studied with respect to headache disorders. One study found that 40% of patients presenting with TMD also had migraine. The authors of the study note that further research is necessary.
Clenching has been associated with anxiety disorders, and may be highly comorbid with migraine as well. Although formal studies of temporomandibular dysfunction in migraine are lacking, many headache experts note a correlation between TMD symptoms in their migraine patients.
Types of Temporomandibular Dysfunction
The American Academy of Orofacial Pain recognizes two types of temporomandibular dysfunction. These are called myogenous (related to muscles) and arthrogenous (related to joints). Myogenous TMD is due to bruxism, clenching, or both, and has no evidence of joint issues. Arthrogenous TMD is due to problems with the jaw joint itself, and may include degeneration of the disc in the jaw joint. Many people with TMD will have both types.
TMD occurs more frequently in women, with a 4:1 ratio reported. Not everyone with TMD is depressed. Some people with TMD have abnormalities in a gene called serotonin transporter gene, which has also been found in association with depression. Serotonin transporter gene changes have also been associated with the emotional processing of pain, and may cause an increase in migraine attacks as well as TMD pain.
Symptoms of arthrogenous TMD are popping or clicking of the jaw, inability to fully open the jaw, ear pain or a sense of fullness in the ear, ringing of the ear, dizziness, and hyperacusis (hypersensitivity to normal sound levels). Myogenous TMD causes pain in the jaw and muscles of the face.
Treatment of Tempormandibular Dysfunction
The American Academy of Head, Neck, and Facial pain recommends the following self-management measures for TMD: ice packs, avoidance of hard or chewy foods, like hard bread or steak, and postural measures. In addition to maintaining a good posture in general, you should avoid sitting with your chin in your hand, and you should not sleep on your stomach. Also keep in mind the saying, "lips together, teeth apart."
These measures are not a substitute for medical or dental evaluation. If they are minimally helpful, you may require physical therapy or dental treatment, which can include an oral device.Your physician or dentist will be able to determine whether you need referral to an oral surgeon or craniofacial specialist.
There is little evidence that either orthodontia or occlusal adjustment can prevent or treat temporomandibular dysfunction, according to the Cochrane Summaries.
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