Back to Back Issues Page
HeadWay, Issue #051 -- TMJ, TMD and classification finale
October 22, 2007

*Please note: URLs may wrap onto the next line. To visit the website, cut and paste the entire URL into your address bar on your browser*

In this month's issue:

Headache classification finale

Headache, migraine and TMJ

Say what?!  MRI

Headache classification finale

It's time for the final part of our series on headache classifications. This includes cranial neuralgias, central and primary facial pain and other headaches.

There are two main categories here, so I'll talk about each one...

Cranial neuralgias and central causes of facial pain

This category has a lot to do with the nerves that cause pain in the head and neck. The nerves, such as the trigeminal nerve or occipital nerves, are bothered somehow, and this leads to pain.

Sometimes the cause is obvious. Herpes zoster is one example. Commonly called shingles, it's a problem that people get if they had chicken pox when they were younger. Other times, there's no apparent cause for the pain that seems to shoot up the nerves.

Some examples of this kind of pain would be: trigeminal neuralgia, glossopharyngeal neuralgia (stabbing pain in ear, base of the tongue, and close areas of the jaw and mouth), occipital neuralgia, and other rare neuralgias.

This also includes headaches that come along when the nerves are stimulated by an outside force. Take for example external compression headache - a headache coming from the tight pressure of a hat or swim goggles (for example). There's the very common cold stimulus headache. This could come from going outside in cold weather without a hat, or from eating ice cream (the ice cream headache is now called "headache attributed to ingestion or inhalation of a cold stimulus").

There's also the ophthalmoplegic "migraine", face pain attributed to multiple sclerosis, and burning mouth syndrome.

There are others, but that gives you an idea. The pain often relates directly to the location and influence of specific nerves.

Other headache, cranial neuralgia, central or primary facial pain

his is simply the place to put all the headaches that don't fit anywhere else. Either it's a headache not elsewhere classified (none of the other desciptions fit) or a headache unspecifies (Uncle Joe refuses to go to the doctor, so there's no way to know what kind of headache he has).
I hope you've found this series helpful - maybe some of you realized what kind of headache you had for the first time, or got clues to investigate further. For more on the headache classifications, you can read The International Classification of Headache Disorders here, thanks to the Migraine Aura Foundation.

Headache, migraine and TMJ

We've talked about headache, migraine and TMJ before, but I continue to get requests to write about it. TMJ headache is really a major problem, and worth discussing.

TMJ is actually the short form name for a joint, the temporomandibular joint. When people talk about TMJ problems, they're usually actually talking about TMD, temporomandibular joint disorder. This name refers generally to pain in the jaw joint, and may have a number of different causes. There's no doubt that there are many approaches to treatment. There could be actual damage to the joint, or not. Headache is a common symptom, and TMD may also trigger migraine attacks. TMD can even cause tooth aches and hearing problems.

A doctor or a dentist often looks for clicking or grating noises in the jaw, tenderness and pain, alignment and limited movement. Sometimes an x-ray or other imaging tests are helpful.

Sometimes problems with tooth alignment cause problems (See Dr Leader's article on Tooth Malocclusion). Sometimes grinding your teeth at night will be a major cause. The muscles can tense up and cause pain that flares up at times into a major headache attack.

How can I treat it?

There are a number of treatments.  Dr Gregory White has a brief summary of TMD treatments here.  Self care is a common one.
  • WebMD's article includes some helpful TMD self treatment.
  • Taking Control of TMJ is a book by Robert O. Uppgaard that really helps you evaluate and attack your TMD symptoms at a deeper level
  • The NTI Tension Suppression System has helped a lot of migraineurs, and the idea continues to be developed.
  • Other treatments involve work on the teeth, and even surgery in extreme cases.  Medication has not proved very helpful with TMD.

  • Sometimes TMD has a number of causes.  One of these treatments can bring a great improvement, but total improvement may involve more than one approach.

    Interestingly, TMD is a link between migraine and fibromyalgia.  Both TMD and migraine are common in fibromyalgia, according to Dr. Gary S. Sy (Medical Director of Life Extension Medical Center in Manila).

    Say what?!  MRI

    TMD, Chiari Malformation, and headache.  These things may all cause your doctor to ask for an MRI - but what is an MRI?

    MRI stands for Magnetic resonance imaging.  An MRI can "see" your brain and other soft tissues, and take cross-sectional pictures.  Usually you lie on a movable table that slides into a tunnel, then the pictures are taken and interpreted by a computer.  The machine uses a magnetic field or radio waves, which are totally painless (you don't feel them).

    Read more about the MRI at the Mayo Clinic.

    Have a comment?  A suggestion for a future topic?  Drop by the HeadWay MailRoom and use your password, nomoache!

    Back to Back Issues Page