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TMJ & Migraine: Are you clenching your way to a migraine?

Based on ongoing discussion in the Migraine.com Community, we’ve invited James P. Boyd, DDS to share his thoughts on TMJ & migraine. There are many theories which apply to migraine pathogenesis & treatment, the article below highlights opinions expressed by Dr. Boyd. Do not stop, start or change any treatment program without first discussing the benefits and risks with a healthcare professional.

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What is TMJ?
The term TMJ, or Temporo Mandibular Joint, refers to the hinge joint between your jaw and skull. At one time, the dental industry assumed that disorders of this joint were a cause of people’s head and neck symptoms. However, no study has ever shown a causative connection between the condition of one’s TM joint and their symptoms or lack of symptoms!

When discussing your signs and symptoms with a dentist, you’ll often hear him refer to “the occlusion” as an important component of your condition. In the dental world, the occlusion refers to the scheme in which your upper and lower teeth come together and the relationship of your upper and lower jaw while your teeth are together.

Dentistry assumes there are “ideal” occluding schemes and jaw relationships, and conversely, there are “mal-occlusions”…but here’s the problem… there has yet to be any research to show that your occlusion determines if you are symptomatic. We’ve all seen someone with a perfect bite and beautiful teeth, yet they are miserable, while someone who is in desperate need of an orthodontist can feel fabulous.



So what’s causing my symptoms?

Essentially, in regards to TMJ, one’s symptoms are far less determined by what one has, but by what one does. When someone has their jaw at normal rest, the teeth are not supposed to be touching. Actually, teeth are very rarely supposed to be touching. Occasionally they will glance off each other during chewing, and for an instant during swallowing. Some people, however, have their teeth “in occlusion” more often than not, that is, their teeth are occluding (or touching). Occluding requires a continuing contraction of certain jaw muscles including those which cover the side of your head-the temporalis

Jaw clenching can be so intense that “teeth grinding” becomes impossible. As long as the jaw is moving the temporalis is only mildly contracting. At stronger intensities, the jaw will stop moving as the opposing jaws are squeezed together. If the position of the jaw during the clenching event is not “ideal” (it might be shifted over to one side), then one or both jaw joints can be exposed to considerable strain and irritation

There is one more piece to this “clenching vs. grinding” puzzle. If the back molars are touching, jaw clenching is strongest. If only the front incisors are touching, jaw clenching is much weaker (30% of its maximum).

The purposeless touching of the teeth is called “parafunction”. The intensity, duration, frequency and jaw position during the parafunctional events determines the nature of your symptoms.

So how does parafunction tie in with migraine?

Migraine disease is a disorder of the trigeminal nerve system. The sensory component of the trigeminal nerve collects information from all three of its divisions. Information is categorized, with negative or “noxious” input being acted upon depending on its significance. For example, a taco chip that scrapes the roof of your mouth during chewing is not deemed to be worthy of responding to, while nearly the same act performed by a dentist with a similar feeling tool can elicit a protective response.

The decision of whether or not to respond to noxious input is called “modulation”. “Dysmodulation” occurs when an otherwise normal input is inappropriately acted upon. A migraine pain event results from “trigeminal sensory dysmodulation”, when normal sensations from certain triggers(particular foods, smells, etc.), cause the trigeminal nerve to secrete chemicals that result in the swelling and burning sensation around the brain, or sinuses, or throughout the mouth and jaw, that is, migraine pain.

So how does the trigeminal sensory system develop a case of dysmodulation?
Most probably, it is being exposed to an excessive amount of noxious input, called “nocioception”, which may be fatiguing the system and keeping it from behaving normally. That’s why when you visit a health care provider regarding your migraines, not only do they want to identify your triggers, they want to find what’s been making you “triggerable”.

Jaw clenching when you are asleep produces a massive amount of noxious input and the typical jaw-clencher wakes most every day with some degree of headache. In fact, many chronic migraine sufferers don’t mention the “daily background headache” to their doctors in fear of having them labeled as “rebound” headaches.

View Dr. Boyd’s YouTube video here: http://youtu.be/9nUpKtUzPo4

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Dr. Boyd designed and patented the NTI (nociceptive trigeminal inhibition) device, for the relief of his own chronic tension-type headache and frequent migraine attacks. The NTI specifically limits clenching intensity, and was approved by the FDA for the prevention of medically diagnosed migraine pain as well as migraine associated tension-type headaches.

As the founder of the Headache Prevention Institute in Michigan, Dr. Boyd has extensive experience treating patients suffering from chronic tension-type headache, migraine, and jaw disorders. He is the past Director of Research and Senior Clinical Instructor at the White Memorial Medical Center Craniofacial/TMD Clinic in Los Angeles, and is currently a practicing clinical consultant at the Neurology and Headache Center of Southern California in addition to pursuing medical research opportunities with the NTI.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Hope
    6 years ago

    I often clench and when I previously worked for a dentist he told me I had TMJ and put me on a very mild short course of Valium. I was very reluctant to take it but he assured me only at bedtime and a very minimal amount to break the cycle. I had to admit he was correct. I have repeated this once or twice since when I knew I was very stressed and grinding my teeth. I think my migraines were almost nil during that short period, funny I never associated that. Thank you for the enlightening info.

  • Allison
    6 years ago

    I’ve had chronic daily migraines almost 2 years. I also was diagnosed with occipital neuralgia. I noticed my TMJ acting up around the same time and ended up having surgery to repair the disc and put it back in place on one side a year ago. I’m in a full time splint now until my bite is realigned next week with crowns and equilibration then will wear it at night. Dr said any effect of surgery on my headaches would have been felt by now and there has been no change in headaches. I do think I clench still. I was really hoping this would be an answer. Any thoughts?

  • Amber Smith
    8 years ago

    My oral surgen made me aware that I am a “clincher”. I have noticed when I am more stressed I tend to clintch my back teeth together. I am in day 3 of a migraine that I think has been triggered by this. I have been trying to remind myself to relax, but it’s easier said then done. I figured this migraine was somehow linked to the fact I have been clintching, but wasnt positive. This article came at the perfect time for me! Thanks!

  • Migraine.com
    8 years ago

    Susie Britt McVay & Amber Smith – Dr. Boyd blogged on this topic as a guest expert a few months ago. You may want to take a look at the article: http://migraine.com/blog/expert-featured-article/guest-expert/tmj-migraine-clenching-your-way-to-a-migraine/

  • Susie Britt McVay
    8 years ago

    I am a clincher also. Be aware that it will eventually crack your fillings and your teeth. I am paying the price right now with crowns on my teeth (very expensive). Relaxing is the key. It’s hard, but soon it will become a habit, a good habit.

  • Laura Bagley Asher
    8 years ago

    I’m on my second NTI. My first one shattered after having it for several years. I won’t nap or sleep without mine. I kept chewing threw the bite guards, 4 of them in fact. The NTI is so much better since I can’t clench my jaw shut. Now if they could just make something like that so I could unclench my arms, shoulders, and back. : )

  • TMJ Hope
    8 years ago

    When you consider that just swallowing puts an enormous amount of force on the jaw joints, it isn’t hard to believe that clenching and/or grinding can cause severe facial pain or headaches. What we have seen is that many patients had NO idea how awful they felt until they start addressing their clenching. Not just headaches but body pain, too. In my opinion, the most important thing is just becoming aware of your situation….many patients I have talked to feel so much better after keeping up with a diary of their symptoms..it also helps the doctor figure out what is going on. Thank you so much for discussing TMJ disorder…. It is so much more common than people think!

  • terri
    8 years ago

    I was on Tegretol for migraine prophylaxis, which is supposed to be specifically for that nerve pathway. My TMJ was WORSE with that drug, and part of why I had to quit taking it. I went to Topamax. I had to quit Topamax for other side effects, but it did eliminate almost all of my TMJ symptoms! Go figure!

  • Buffy Marie Porter
    8 years ago

    I suffer from migraines.

  • Diana Lee
    8 years ago

    I know the NTI device has helped many, many people, so I’m thrilled to see the designer of the device sharing his knowledge with us here.

  • Jessica Madore
    8 years ago

    It’ figures that there aren’t any near me. But it may be worth it to see someone a little farther away. Thanks!

  • Jessica Madore
    8 years ago

    Thanks it sure will!

  • Diana Lee
    8 years ago

    Jessica, at the NTI website you can search for providers: http://www.nti-tss.com/. Hope this helps!

  • Jessica Madore
    8 years ago

    OK so I know I grind my teeth and I was treated as a teen for TMJ. Now that I’m older and my teeth have shifted and I know I still grind, ( my finance says so). How do I get this device and how much does it cost?

  • Jessica Madore
    8 years ago

    I suffer from TMJ and had 8 teeth removed at age 13 and wore braces for 5 years to correct the problem. Now at age 39 and after losing some teeth my bite is “off” again and I suffer daily headaches. My insurance does not cover a dentist to get a custom “bite plate” so here I suffer every morning. I still grind my teeth at night and while I have OTC devices to keep my teeth separated during sleep they all are too uncomfortable to get used to It’s about time someone started talking about this. I’ve been suffering for 26 yrs. Thanks!

  • Migraine.com
    8 years ago

    Jessica, If you decide to try it out make sure you let us know if you get results!

  • Jessica Madore
    8 years ago

    Thanks I will take that into consideration and talk with my dentist.

  • James P. Boyd
    8 years ago

    If your dentist is interested and would like to try an NTI device, I can arrange to have an NTI “kit” sent out to him (as a courtesy). Just sent me a private message and we’ll take it from there (this always extended to everybody!)

  • Jessica Madore
    8 years ago

    So if I shouldn’t be using a bite plate to relax the muscles then what can I do if my grinding is causing daily headaches?

  • James P. Boyd
    8 years ago

    A “bite plate”, whether provided by your dentist, or the OTC versions, provide you with a platform dedicated to be clenched on, and for many migraineurs, that’s the promblem!

  • Karen Spann Lee
    8 years ago

    What I’d like to know is if a person’s migraines are usually afternoon onset, can they be contributed to by TMJ clenching.

  • Karen Spann Lee
    8 years ago

    Thanks for the info! Maybe I’ll get that bite guard after all.

  • James P. Boyd
    8 years ago

    Nighttime jaw-clenching is a massive “noxious input” into your trigeminal nerve system, and its the trigeminal nerve that is responsible for producing migraine pain. A prominent theory now holds that if the trigeminal system has been “fatigued” by chronic noxious input, it raises the hosts “triggerability” to migraine events (for anytime). A simple evaluation for the probability of nighttime jaw-clenching is how you feel with you wake up. Do you wake with “a number”? That is, on a scale of 0-10, with 10 being the worst pain imaginable above the shoulders, how many mornings per week do you wake WITH A ZERO? Most clenchers assume that waking with a number (that is not automatically deserving of medication) is “normal”! It’s not…it’s just setting you up for later…

  • Karen Spann Lee
    8 years ago

    No, but I might when I’m asleep. Debating whether to get a guard to keep me from doing it. However, $400 for something I may or may not do, and it may or may not contribute to my migraines. So I haven’t rushed out and had one made.

  • Jeffery W. Lee
    8 years ago

    Do you clench your teeth when your stressed, I do.

  • Karen Stanley Haack
    8 years ago

    Still no allergist or immunologist as experts? shame.

  • Karen Stanley Haack
    8 years ago

    Very true…Thank you Dr. Boyd for caring for migrainers…I was diagnosed with TMJ and had teeth removed and braces…However I never had a migraine. The problem was the pain in the jaw when I ate. Your work is important and TMJ can be very painful.

  • Migraine.com
    8 years ago

    Karen-Dr. Boyd’s article is only the second in our Guest Expert series. As you can surely imagine, finding reliable experts in various fields and publishing articles can be a time consuming process. We hope to have additional Guest Experts on the site in the future and we appreciate your suggestions – and patience.

    We are grateful that Dr. Boyd took time out of his busy schedule to share his thoughts with the Migraine.com Community members interested in learning more about TMJ & Migraine.

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