What Is TMJ Headache?

TMJ headache arises as pain spreads from the muscles surrounding the temporomandibular joint (TMJ) of the jaw to the face, cheeks, and head. It occurs due to disorders of the joint, such as misalignment of the upper and lower jaw, and other conditions and habits such as gum chewing and bruxism, grinding or clenching of your jaw. In some cases, TMJ headache can be a migraine trigger, and the two conditions are closely associated.

How TMJ headache is managed will depend on its cause. Treatment may include at-home strategies, medications, realignment of the teeth (occlusal therapy), and even surgery. Generally, TMJ headaches, though disabling, resolve either on their own or with conservative measures.

This article will focus on TMJ headache symptoms and causes, as well as the treatments and management strategies used to take care of it.     

TMJ Headache Symptoms

TMJ headache first arises as pain in the joint connecting the jaw to the skull that may travel to other parts of the face and head. Symptoms range from tension headache to migraine attacks. This condition is clinically defined as:

• Recurring pain on one or both sides of the face and head
• Pain and difficulty chewing
• Inability to open the mouth fully or having irregular jaw movements
• Clicking, popping, or locking in the joint of the jaw
• Tenderness and soreness of one or both TMJs (the hinges of the jaw)
• Ringing in the ears (known as tinnitus)
• Headache responds to treatment and resolves without coming back within three months

Migraines triggered by TMJ may cause a range of symptoms, including:

• Throbbing or stabbing headache, usually on one side of the head and/or temples
• Nausea and vomiting
• Sensitivity to lights, sounds, and/or smells
• Aura (shimmering, lines, and other visual disturbances prior to headache onset)
• Pale skin

Causes

TMJ headaches are part of a broader category of temporomandibular disorders (TMDs), which are issues of the jaw and surrounding muscles and tendons. TMDs are often at the root of TMJ headaches and include:

• Hypermobility (too much range of motion) of the TMJ
• Dislocation of the jaw joint (the lower jaw comes out of its normal position)
• Bruxism (teeth grinding or excessive clenching of jaw)
• Arthritis of the jaw
• Accident or trauma
• Malocclusion (misaligned upper and lower jaws)

Specifically, these issues cause inflammation—a swelling of connective fibers and tissues—in the joint, which leads to pain. This can then trigger activity of surrounding nerves, leading to a widespread headache. In addition, the disk-like bone within the joint that separates the upper and lower jaws can slide from its position, causing jaw locking or popping.

Diagnosing TMJ Headaches

The diagnosis of TMJ headache, typically made during dental checkups, involves several steps. Initial evaluation includes assessment of:

• Medical history, as well as medications you’re taking
• Your jaw’s range of motion when opening and closing
• Physical pressing to locate areas of tenderness/pain in the face
• Physical assessment of the TMJ and surrounding areas as you open and close your mouth

In addition, a range of imaging techniques may be used to confirm your diagnosis and give your healthcare professionals a better sense of the underlying problem. Most commonly, you’ll see the following types used:

• Panoramic X-ray: This type of dental X-ray creates a panoramic, encompassing view of your teeth, jaws, and TMJ to allow specialists to identify the scope of your problem and its causes.
• Cone beam computerized tomography (CBCT): This type of CT scan combines data from thousands of X-rays, creating a highly detailed, three-dimensional rendering of your TMJ, jaws, sinuses, or facial bones.
• Magnetic resonance imaging (MRI): Useful for viewing soft tissues surrounding the TMJ or other joints, MRI scans can help assess the scope of inflammation and locate an out-of-place disk. This type relies on strong magnetic and radio waves to create two or three-dimensional representations of affected areas.

Treatment

When it comes to treating TMJ headaches, a range of approaches can help. These vary from lifestyle changes to over-the-counter (OTC) and prescription medications to surgery and other treatments. Working with a dentist—or, in some cases, a specialist called an oral maxillofacial surgeon—you will get an appropriate course of treatment tailored to your needs.

Lifestyle Modifications

Certain changes and adjustments to everyday habits can help ease or prevent TMJ headache. These include:

• Heating or cooling: When the headache or facial pain has begun, apply an ice pack to the affected area for 10 minutes multiple times a day. In addition, five minutes of application with a moist, warm towel can help after stretching the jaw muscles.
• Safe eating: To prevent tension and strain within the TMJ, choose soft foods that are easy to eat, such as applesauce, yogurt, oatmeal, blended soups, smoothies, and cooked vegetables. This also means avoiding hard, crunchy, or difficult to chew foods, like pretzels, taffy, and hard or soft candies. Avoid biting your nails, if you can. 
• Wearing oral appliances: Mouth guards or splints (a guard worn at night and during the day), worn over the top and/or bottom set of teeth, stabilize the bite, ease pressure, and can even work to correct minor misalignment. This can help with teeth grinding and reduce tension building up in the joint.
• Exercises: Certain exercises and stretches of the jaw muscles can help improve mobility and flexibility, reducing the severity of headaches. Furthermore, exercises you do at home can also help promote relaxation. Physical therapists can help you find effective regimens for your case.  
• Careful jaw movements: Minimize the amount that your jaw moves and works. Avoid yelling, yawning, chewing gum, or eating foods that require much chewing, and keep your teeth separated slightly as much as possible.
• Posture: Since head and neck alignment can influence the incidence of headaches, keeping good posture and working to improve it can help prevent them. This means being aware of how you’re sitting or standing, including while at work.

Medications

As with all types of headaches, your caregiver may first recommend OTC pain medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs) or Tylenol acetaminophen. NSAIDs include:

• Aspirin
• Motrin; Advil (ibuprofen)
• Aleve (naproxen)

Notably, if these medications aren’t yielding results, your dentist or specialist can prescribe higher-strength versions of the above, or even other pain-managing drugs, such as opioids. In addition, other prescribed classes of medications for TMJ headache are:

• Benzodiazepines: Drugs used to treat anxiety and relax muscles, such as Ativan (lorazepam) and Valium (diazepam), may be prescribed to manage muscle tension, especially in cases of teeth grinding.
• Muscle-relaxers: Alongside benzodiazepines, muscle relaxers, such as Lioresal (baclofen) and Lorzone (chlorzoxazone), can also help. As above, they’re particularly effective if tooth grinding or jaw clenching is at the root of the problem.   
• Antidepressants: For some kinds of chronic headache conditions, certain types of antidepressants may help. Tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), are often prescribed.   

Medical Procedures

If medications and other approaches aren’t yielding results, a number of other treatments may be recommended. Generally reserved for difficult-to-manage cases, the most common of these are:

• Transcutaneous electrical nerve stimulation (TENS): Performed either in a doctor’s office or using a small device at home, low levels of electricity are delivered through the skin to nerves. This activity essentially scrambles their signaling, stopping the perception of pain.
• Ultrasound: This therapy relies on directed heat to reduce inflammation in the TMJ and the surrounding tissues. It uses sound waves to help ease soreness and restore mobility to the jaw.
• Trigger point injections: Trigger points are parts of the face and jaw where muscles are tense, which can be tender and sore. Injections of pain medication in these areas can effectively ease headache pain, providing temporary relief.
• Radio wave therapy: Radio waves directed at the TMJ create a low-level electrical current. This stimulates nerves and promotes blood circulation to the affected joint, helping with pain relief.
• Botox injections: Injections of Botox (botulinum toxin A) in strategic areas of the head and temples can relieve pain. While the effect eventually wears off after about three months, this therapy is highly effective in difficult-to-manage cases.

Dental Procedures

Since misalignment of the teeth can be a cause of TMJ headaches, some dental procedures may be called for. To correct your bite, a dentist may place a dental crown, put in a bridge, employ braces, or other means. Improving the alignment of your teeth eases the tension in the joint, reducing the prevalence of attacks or stopping them altogether.

Alternative Medicine

Alternative approaches may also help with TMJ headache. These include:

• Relaxation: Regular meditation or mindfulness work, as it slows heart rate, deepens the breath, and helps ease tension in the body. This can help with pain. Yoga, walks, or taking part in enjoyable activities are also good approaches.
• Acupuncture: This form of traditional Chinese medicine relies on the use of needles placed in certain parts of the body. Targeting these points may stimulate the release of chemicals that ease headaches and pain.  
• Biofeedback: This uses specialized devices that detect signs of stress and tension in the body. Patients using biofeedback can get a sense of when their stress is elevated and what is causing the elevation and triggering headaches. With this knowledge, they can alter their surroundings to prevent onset.

Surgery

Surgery for TMJ headache is a last resort. Surgery is highly successful, but it’s not appropriate for every case. Three surgical procedures considered are:

• Arthrocentesis: Usually done using only local anesthesia, the aim of this procedure is to reduce inflammation in the affected joint. The dentist injects a sterile solution into the impacted joint and cleans it out. Scar tissue is removed, if necessary.
• Arthroscopy: Arthroscopic surgery for TMJ involves the use of a specialized camera on an adjustable tube (called an arthroscope), which provides a live video feed of the surgical area. Performed under general anesthesia (in which you’re put to sleep) via an incision in front of the ear, surgical tools are used to remove inflamed tissues or realign the joint. Compared to open surgery, recovery from this type is quicker and easier.
• Open-joint surgery: Open surgery may be considered in cases in which there is excessive scarring or bone chips, the joint is worn, or there are tumors. As with arthroscopy, it’s performed with general anesthesia. However, this procedure is more invasive, and larger incisions are required. As a result, recovery takes longer, and there’s a chance of side effects.  

Prognosis

The severity of TMJ headaches can range a great deal, and much depends on what’s causing the pain. While some cases resolve on their own, others, such as those related to misalignment of the jaw, can become serious if untreated. The complications, which can affect physical and mental health, include:

• Bite problems (including overbite and underbite)
• Tooth erosion
• Sleep apnea
• Insomnia
• Depression
• Anxiety

Coping

Severe and difficult cases of TMJ headache can present coping challenges. Persistent pain can significantly impact mental health and can cause feelings of isolation and stigmatization.

Coping strategies include:

• Manage stress: Getting enough sleep, regular exercise, and eating well are among the ways that you can manage the stress that may trigger headaches.
• Track your condition: Especially if your TMJ headache is triggering migraines, it helps to track the condition. Keep a log of when the headaches start and be mindful of factors like what you’re eating and drinking, your medications, and levels of personal stress or strain.  
• Seek professional help: Sessions with a mental health professional can help you cope with the burden of TMJ headache and develop strategies for managing the emotional impact of living with pain.  
• Help from others: Don’t be afraid to get help from family, friends, or work colleagues, and try to enlist their support. Trusted people can be a source of practical and emotional support.
• Find community: It’s worth seeking out others who are or have coped with pain problems, as they can offer everything from practical advice to helpful tips to emotional support. Consider attending support group meetings or finding forums on social media.  

Summary

TMJ headache arises as pain in the temporomandibular joint (TMJ), which connects the jaw and skull, before affecting the face, temples, and head. This type of headache is caused by habits and disorders of this joint, such as bruxism (teeth grinding and clenching), and it can also trigger migraines.

While some cases of TMJ headaches require dental realignment or even surgery, most are treated with less-invasive methods and home remedies. However, if untreated, TMJ headaches and related disorders can affect mental health, as well as that of the teeth.

A Word From Verywell

When it comes to a condition like TMJ headache, the key is timely intervention. The sooner you seek help, the sooner you’ll be able to take care of the issue. It’s all too easy to brush off headaches or to suffer in silence, but since headaches can be signs of potentially dangerous conditions, they can’t be taken lightly. If you suspect you’re experiencing TMJ or another type of headache, it’s worth being proactive about seeking out care.