temporomandibular joint Archives - Headache and Migraine News

18 April 2017

Migraine and TMD: A Complex Relationship (that should not be ignored)

James Discoveries & Stats, Information 3

Although it’s not news that there’s a relationship between migraine and TMD, it might be a surprise just how complex the relationship is.

TMD refers to temporomandibular disorder/dysfunction, actually a group of disorders that affect (but are not necessarily caused by) the temporomandibular joint (TMJ) and surrounding muscles, nerves, and tissues. TMD may be caused by an injury or a disease such as arthritis. There may also be a connection with structural issues, and even clenching and grinding of the teeth while you sleep.

TMD and Headache — Illustration courtesy Patrick J. Lynch

TMD is actually very poorly understood, and there is a lot of controversy about what causes it and how to treat it in specific cases. But when you think about the structure of the jaw, joint, and the trigeminal nerve system, which is all connected, it’s not surprising that researchers have been very interested in the connection between TMD and headache disorders. That nerve system may play a key role in starting headache pain in migraine disease. It seems that the way trigeminal pain is processed can become impaired, leading to a worsening of migraine. The new class of drugs (CGRP inhibitors) currently being developed play a role in controlling trigeminal pain messages.

A 2016 study concluded that the connection between migraine and TMD was complicated further because of other physical symptoms, and the presence of bruxism (clenching/grinding teeth during sleep). Researchers concluded that doctors need to treat both headache/migraine and TMD together.

A study earlier this year asked the question – can the presence of headache disorders, such as migraine, actually predict TMD? In other words, even though migraine may/may not directly cause TMD, does the presence of migraine or another headache disorder tell us that the patient has a good chance of getting TMD later on?

The answer was yes. Patients who had no sign of TMD, but who did have a headache disorder, were far more likely to end up with TMD. The headache condition also tended to worsen in patients who eventually had TMD symptoms. Patients frequently ended up with migraine and TMD.

Researchers again affirmed what I mentioned in our last podcast – headache conditions, migraine in particular, need to be treated (Migraine and Generalized Anxiety Disorder). If they aren’t, they may lead to other conditions. One of those conditions is TMD. And what if the presence of new TMD in turn worsens the migraine? That could may migraine more difficult to treat.

The relationship between TMD and migraine is complex. It’s not a simple case of one causing the other. There may be underlying causes of both.

Doctors and patients need to focus on treating both, and being aware of changing and worsening symptoms so they can be caught early. If migraine or TMD are ignored, or just treated with “painkillers”, patients may find themselves with more pain in the end.

5 October 2009

Taking Control of TMJ: A Review of the Book

James Resources 2

Most people will understand why we’re talking about a book on TMJ – that is, temporomandibular joint disorders, on a site about headache and migraine. What not everyone understands is the complex relationship that TMJ can have with various other disorders.

In his book Taking Control of TMJ, Dr. Robert O. Uppgaard does give us some insight into how issues in the TMJ, the jaw joints, can come from problems in the rest of the body, and can also cause problems all over the body. Headaches in the temple, migraine, fibromyalgia, whiplash, mayofascial trigger points – this is not a simple linear relationship, but a web of relationships that Dr. Uppgaard takes seriously.

Trigger point diagram from Taking Control of TMJ

At only 184 pages (included a glossary, index and appendices), there’s a lot of information packed in a small space, which most people will appreciate. And this isn’t just a book of information on TMJ disorders – it really is a workbook.

And I think that’s what I like best about Taking Control of TMJ – it’s very practical. It’s packed with tips and how-tos, diagrams and charts, but also simple checklists for you to work through.

The smallest tips can be the most helpful. For example, I always used to end up with migraine attacks on days I visited the dentist. Dr. Uppgaard’s tip, slipped in on the end of page 51? "Tell your dentist to allow you to exercise your jaws intermittently during dental work."

I wonder how much pain that simple tip could have saved me?

And how many books have I said that give vague instructions about how to do various exercises, leaving me with no idea if I’m doing it right? The clear and specific instructions, with diagrams, leave me with something I can actually use. Dr Uppgaard even gives examples of case histories and why, from his experience, these exercises can benefit you.

Here’s an example:

Exercise 2: Stretching the Jaw and Increasing Range of Motion

Purpose: This exercise helps you to relax the opening muscles, stretch the closing muscles, and remediate limited jaw opening.

Precautions: Do not do this exercise if your jaw is is acutely strained or if you experience grating, clicking, or popping.

The Exercise: Do the exercise for one to two minutes, twice a day. Use ice or moist heat, whichever feels comfortable to you, over the sore area of the muscle as you do this exercise.

Gradually increase your jaw opening by placing one knuckle or an object of equivalent size between the teeth.
Rest on knuckle or object for sixty seconds.
Increase to two knuckles and finally three, as you feel comfortable.

Of course all this is in a context of many exercises and tips and what needs to be used when and by whom.

Another thing I appreciate about this book is that it draws (selectively) from a wide range of other experts. There are other sources you can read for more information, of course, but a lot of the research from various other sources is right here in the 184 pages. You’re not left feeling like you have incomplete information.

Not that you’ll agree with every expert. There’s a difference of opinion, for example, on the significance of the origins of yoga. Dr. James Baltzell, the book’s expert on the topic, differentiates between yoga and religion, but doesn’t take into consideration the importance of yoga’s religious roots. In my opinion, it’s important to understand clearly where treatments come from and what they’re attempting to accomplish before choosing what to focus on.

That aside, the majority of the information here is excellent, and for such a short book the breadth of practical information is amazing.

As I started out saying, the connection between TMJ disorders and migraine or headache disorders is complex, and Dr. Uppgaard recognizes this. Now many people have had almost complete healing after dealing with TMJ issues, and the book has many amazing examples. On the other hand, for many people TMJ is one of a complex web of problems.

But the fact is, many people with chronic migraine or headache diseases have major TMJ disorder related problems and don’t realize it. By dealing with the issues that Dr. Uppgaard will take you through, I’m convinced many people can see a significant improvement.

This is one book I will actually be able to use, because it’s so easy to pick up and work with a few minutes at a time. Without presuming to be the solution to everyone’s problems, Dr. Uppgaard provides practical, easy to follow tips that more of us need to pay attention to.