Migraine Quiz

TMJ/Temporomandibular Dysfunction

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.

References:

1. Palit S, Sheaff RJ, France CR, et al. Serotonin transporter gene (5-HTTLPR) polymorphisms are associated with emotional modulation of pain but not emotional modulation of spinal nociception. Biol Psychol. 2011;86(3):360-369.
2. Kotani K, Shimomura T, Shimomura F, Ikawa S, Nanba E. A Polymorphism in the Serotonin Transporter Gene Regulatory Region and Frequency of Migraine Attacks. Headache: The Journal of Head and Face Pain. 2002;42(9):893-895.
3. Esposito, CJ, Fanucci, PJ, Farman, AG. Associations in 425 patients having temporomandibular disorders. J Ky Med Assoc. 2000;98(5):213-215.
4. Gatchel, RJ, Stowell, AW, Buschang, P. The relationship among depression, pain, masticatory functioning in temporomandibular disorder patients. J Orofacial Pain. 2006;20(4):288-296.
5. Ojima, K, Watanabe, N, Narita, N, Narita, M. Temporomandibular disorder is associated with a serotonin transporter gene polymorphism in the Japanese population. Biopsychosoc Med. 2007;1:3. pub online 2007, Jan 10, doi: 10.1186/1751-0759-1-3.
6. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. In: The Cochrane Collaboration, McDonald F, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010. Available at: http://summaries.cochrane.org/CD006541/orthodontics-for-treating-temporomandibular-joint-tmj-disorders. Accessed January 10, 2012.
7. Koh H, Robinson P. Occlusal adjustment for treating and preventing temporomandibular joint disorders. In: The Cochrane Collaboration, Koh H, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2003. Available at: http://summaries.cochrane.org/CD003812/occlusal-adjustment-for-treating-and-preventing-temporomandibular-joint-disorders. Accessed January 10, 2012.
by Christina Peterson, M.D.
updated January 10, 2012