#139 Are My Headaches Migraines or TMD?

If you read the scientific literature regarding migraine headaches one thing stands out.  All the studies admit the cause of migraine headaches is unknown.  There are plenty of theories for sure, but the scientists who study migraines do not know the mechanisms within the brain that are responsible for creating migraine headaches.   

There is plenty written about the circumstances that occur before or simultaneously with migraine headaches.  These include hormonal factors associated with the menstrual cycle, pregnancy, menopause, and hormonal contraceptives, and triggers like stress, caffeine, alcohol, certain foods, sensory stimuli, and weather changes.  But no one can say how these factors stimulate the symptoms of head pain, vision changes or aura, and nausea.  

It is interesting to note that a review of the scientific literature in addition to the public information about migraine headaches on the internet totally exclude TMD (Temporomandibular Joint Disorder) as a cause or having any relationship to migraine headaches. 

But we do know what causes TMD.  TMD is driven by chronic inflammation within the temporomandibular joint.  Chronic inflammation within the TMJ is the common denominator which drives all the symptoms associated with TMD including severe and recurring headaches.  Often the descriptions of headaches provided by patients with the diagnosis of migraines parallel or are identical to headache symptoms associated with TMD. It is no wonder that patients with TMD are often misdiagnosed as having migraine headaches.  Medical doctors (MD’s) are trained to think migraine headaches when a patient presents with bad, bad, recurring headaches.  They do not think about the possibility that the pain could be associated with some problem with the temporomandibular joint.  So, the patient with chronic inflammation within the TMJ gets misdiagnosed and ends up misdirected to a neurologist for treatment with various types of drugs and mistreated.  The medical doctors are not familiar with the other symptoms associated with TMD and miss the opportunity to make a proper diagnosis.  When taking a history from their patients with headaches, if they would only ask if the patient had any of the other symptoms of TMD like neck pain, earache, upper back and shoulder pain, they would more likely add TMD to their differential diagnosis.   

Once TMD is added to the differential diagnosis, a simple examination of the TMJ with finger pressure on the joint from the open to the closed position can rule in or rule out the diagnosis.  If the patient elicits pain on pressure on the joint from the open to closed position of the jaw, and has other symptoms associated with TMD, it is most likely the patient does not have migraine headaches but rather headaches associated with chronic inflammation within the joint. 

TMD is a disease that is easy to understand.  The TMJ operates like all the other joints of the body.  If it becomes damaged, the joint becomes inflamed in an attempt to heal itself. (Inflammation is the body’s response to damage, any kind of damage.) There are three types of circumstances which damage the TMJ. Clenching and grinding the teeth, (bruxism), acute trauma to the jaw, and functional malocclusion. If the joint is unable to be healed within a reasonable period of time, the inflammation changes characteristics and becomes chronic inflammation.  Chronic inflammation within the joint signals the brain and asks for help.  The brain attempts to help the joint by signaling the muscles that move the joint to contract and tighten up in order to hold the jaw still and allow it to heal.  The tight muscles pull on the bone and where the muscles of the face pull on the bone, it creates pain.   

When the joint does not heal with tight facial muscles creating headaches, the brain signals the muscles that move the head to contract and tighten. Where the neck muscles are attached to the bone, it becomes painful.  Neck, upper back, and shoulder pain is the second most common symptom of TMD. 

It turns out differentiating migraine headaches from TMD is a simple process.