#183 The Difference Between Migraine’s and TMD Headaches

Migraine is primarily a clinical diagnosis, meaning doctors identify it by reviewing your symptoms and medical history rather than using a single definitive lab test or scan. Medical professionals use standardized criteria from the International Classification of Headache Disorders (ICHD-3) to distinguish migraines from other types of headaches. It is interesting to note that the ICHD-3 does not include TMD headaches within their classification of headaches.  Dentists who treat Temporomandibular Joint Disorder (TMD) agree that headaches are the most common symptoms of TMD, yet medical doctors who treat headaches do not include TMD in their list possible causes.  This should tell you everything you need to know about why TMD is continually misdiagnosed as everything between Trigeminal Neuralgia and cervical disc displacement.  In modern America, anyone who has bad frequent or recurrent headaches refers to them as migraine’s whether that diagnosis comes from healthcare professionals or from self-diagnosis based on advertisements on day-time TV.   

Historically, the dividing line between migraine headache, and any other kind of headache is that migraines are associated with visual disturbances or “visual aura’s” .  Symptoms usually start in the center of the field of vision and spread outward. This includes shimmering, jagged zigzag lines that may resemble the walls of a medieval fort. Often a blind spot or area of partial vision loss occurs surrounded by flickering lights or colors. There are positive symptoms like bright flashes of light, sparks, stars, or colored dots, and negative symptoms like tunnel vision, blurry vision, or temporary total loss of vision in both eyes. 

On the other hand, TMD is a diagnosis that is made by physical findings consistent with every case of TMD, unlike the diagnosis of migraines which are substantiated only by history and symptoms.  The diagnosis of TMD is made by showing the physical presence of inflammation within the Temporomandibular Joint, (TMJ).  Chronic inflammation within the TMJ is the common denominator and always present in patients with TMD. Chronic inflammation within the TMJ has been proven to cause each of the disparate symptoms of TMD including severe frequent and recurring headaches similar, if not identical to migraine headaches.   

The diagnosis of TMD is primarily based on physical examination.  There are two physical signs that prove chronic inflammation within the TMJ.  The first is pain at the tip of the coronoid process of the mandible. The Coronoid Process is the insertion of the Temporalis Muscle; the largest muscle used in chewing and motion of the lower jaw.  A doctor will slide his finger inside the mouth of the patient and up the side of the mandible to press on the tip of the coronoid process.  If the patient has chronic inflammation within the TMJ, the patient will elicit a painful response 100% of the time.   The second and most valuable physical examination finding is done by placing pressure on the TMJ while the patient moves the lower jaw from the open to closed position.  A doctor will place his finger over the TMJ and ask the patient to open their mouth widely. As the ball of the ball and socket joint move forward, the doctor presses his finger firmly into the depression created.  He then asks the patient to close their mouth rapidly.  If the joint is chronically inflamed, the patient will elicit a painful response.  This proves the joint is inflamed.  Inflammation of the TMJ creates all the symptoms of TMD.  Doing this simple physical examination along with documenting some of the disparate symptoms associated with TMD proves the diagnosis. The physical exam proves the diagnosis. 

We know what causes TMD headaches.  The medical profession does not know what causes migraine headaches.  The medical establishment can only theorize about the cause of migraine headaches and prescribe various drugs for the problem and hope they work.  We know what causes TMD headaches and we know that decreasing the inflammation in the TMJ makes the headaches go away.   Maybe all migraines should be considered TMD unless proven otherwise.