Key Take Home Ideas
The Temporomandibular Joint (TMJ)
Do you ever wake up in the morning with your jaw aching and a pounding headache? This migraine just might be associated with your temporomandibular joint (TMJ) and the muscles surrounding the joint that are associated with clenching and grinding. The TMJ is located where the lower jaw (mandible) connects to the temporal bone.
There is a strong correlation between clenching, grinding and the precipitation or triggering of headaches. Pain within the joint may or may not include clicking of the joint, tenderness, swelling, locking and difficulty chewing. Pain can also develop in the ear, neck, head, and back.
During waking hours, stress is a likely factor that contributes to clenching of the teeth. This happens typically when individuals are anxious, irritated or concentrating. Sometimes trauma can precipitate jaw pain.
Gum chewing is a major contributor to TMJ pain. Most people don’t realize the damage caused when they continuously chew gum. Gum chewing would be equivalent to doing bicep curls all day long. Your biceps would get sore. So too would your jaws through this continuous tiresome motion.
Often TMJ symptoms and migraines go hand in hand, and it is hard to differentiate between the migraine and the jaw pain. Each could be compounding the other painful condition. Women are more likely than men to have headaches and TMJ pain due to genetics and hormones.
Several remedies can be used to help alleviate the pain. Lifestyle changes are the simplest solutions. Do not chew on fingernails, pens, your lips, or cheeks. Even holding the phone against your head can add stress on the jaw. Avoid gum chewing and consuming sticky, crunchy foods. Don’t take a bite out of a whole apple. Cut up hamburgers and sandwiches. Avoid opening your mouth too widely. Reduce the width of your mouth opening while yawning. Relaxing your teeth and keeping them apart while holding your face in a neutral position can also help. Gentle jaw stretching exercises can make you feel a lot better.
When you sleep, you have no control over clenching. If you have a habit of clenching, you will clench while asleep as well. Dentists can produce custom made stabilization appliances (splints and nightguards) so that you are unable to clench or grind while asleep. Over the counter appliances are not recommended. These “do-it-yourself” remedies often do not result in a proper fit and often cause you to clench more. They can be highly uncomfortable as well.
Most situations do not require more aggressive therapy, and usually all that is needed are gentle, conservative treatments. Massage by TMJ experienced physical therapists can work wonders. A trained professional can administer intramuscular trigger point or joint injections to help with the pain. For more on nerve blocks visit https://americanmigrainefoundation.org/resources-support/what-are-nerve-blocks-for-headache/.
There could be more serious conditions than stress at play such as degeneration of the joint, arthritis, or inflammation. The key is to treat the TMJ condition before it worsens.
Morning headaches with serious jaw pain deserves TMJ attention. TMJ may be only one of the reasons for your morning headache. Nearly half of all Migraines are reported between 4 a.m. and 9 a.m. Frequent morning migraine is not typical. Overnight withdrawal from an overused medication often causes recurring morning headaches of migraine type. Obstructive sleep apnea (OSA) is also an under-diagnosed cause.
Obstructive Sleep Apnea (OSA)
Waking up frequently with headaches while not feeling refreshed are often tell-tale signs that you may have OSA. Individuals with sleep apnea feel fatigued and excessively tired during the day. Common symptoms of OSA may include snoring, morning headaches, trouble concentrating, anxiety, depression, increased blood pressure and gastroesophageal reflux. Any size individual may have OSA although the stereotype person is overweight. Sleep apnea is formally diagnosed by a sleep study, known as a polysomnogram, in a sleep facility. You could ask for an at home sleep study as these are increasingly possible.
OSA is a condition in which the upper airway is partially or fully blocked during sleep stages. Pauses in breathing occur because the airway has become narrowed, closed, or floppy. This most often happens while sleeping on the back; snoring may end by sleeping on one’s side. Various types of “sleep blocks” may prevent sleeping on one’s back. While most of us snore on occasion, frequent snoring is not normal and not healthy.
For serious OSA, the most common treatment is a healthcare provider prescribed face mask. This appliance applies Continuous Positive Airway Pressure (CPAP). Many have trouble sleeping with the bulky device and its effects on breathing. Dental mandibular advancement appliances are typically more easily tolerated than either the bulky mask or CPAP. For mild to moderate OSA, dental appliances can be just as effective.
Untreated sleep apnea can have major and severe health consequences. The patient undergoes repeated lengthy periods of a lack of oxygen to the brain and thus increases health risks such as cardiovascular disease, congestive heart failure, high blood pressure, stroke, diabetes, depression, weight gain, and obesity. Individuals have a 30% increased chance of having a heart attack or death with untreated OSA according to “Science Daily.” The Wichita clinic estimates that one in five American adults have some form of OSA. More men than women are likely to have OSA due to their nasal, mouth and neck anatomy and stature.
Combinations of care Summary
You now have a better understanding of what could be contributing to your headaches. While migraine is the most common severe headache, the TMJ and OSA are often overlooked when it comes to headache disorders. Once any TMJ and/or OSA are recognized and treated you could have a reduced likelihood of any headaches, including migraines. A combination of medical care can help address these issues.
Brigitte Lovell, DMD, Foothills Neurology, Phoenix, Arizona.