505 Wekiva Springs Road, Suite 100, Longwood, FL 32779
Temporomandibular joint disorder (TMD, TMJ or TMJD) is inflammation and pain in the area where the jaw meets the skull. It’s a common condition, with symptoms that include jaw discomfort or pain, headaches, tooth pain that’s unrelated to dental problems or ear symptoms that are unrelated to ear disorders. TMD can affect your ability to eat and talk and is a medical condition, not a dental disorder.
Along with TMD is myofascial pain, which comes from the muscle and the fascia (the connective tissue around the muscle). When a muscle undergoes repetitive strain or injury, trigger points can develop, creating muscle tension and pain. Muscle injury can develop from a physical injury, stress, poor posture and habits such as teeth clenching.
These trigger points can be localized in the muscle or referred to another area of the body. With referred pain, the sensation of pain can be felt far from the source. For example, a patient may feel tooth pain and believe it’s from the tooth, when it’s actually coming from the muscle. These taut muscle bands may eventually compromise adjacent nerves, and overworked muscles can lead to complications that are more difficult to treat.
Headaches have a variety of characteristics. They may be unilateral or bilateral, dull, achy, sharp or throbbing and can be in an isolated area or radiate to another part of the head and neck. They can be episodic or chronic, and range in intensity from mild to severe.
A thorough medical history and physical examination are required to diagnose and treat headache disorders. Since head and neck pain are influenced by a number of factors and involve nerves that interact with other areas, such as facial muscles and TMJ, headache treatment often involves multiple disciplines, including orofacial pain, neurology, physical therapy, primary care, otolaryngology, and psychology.
According to the International Classification of Headache Disorders (ICHD), there are four main categories: migraines, tension-type headaches, cluster headaches and other primary headaches. Secondary headaches are typically caused by medical conditions such as head and neck infections, hypertension, head trauma, and hemorrhage.
Migraine headaches are typically associated with nausea, vomiting and sensitivity to light and sound. They can be with or without aura and typically are on one side of the head. Auras can range from visual disturbances to alterations in speech. Migraines are usually throbbing or pulsating and aggravated by exercise or head movement. Migraine triggers include anxiety, stress, diet, alcohol, hormones, fatigue, weather changes, certain smells and light.
Tension headaches are often described as “band-like” in location, with dull pressure or tightness. These headaches are commonly triggered by stress, fatigue, sleep problems, hormones, alcohol and food.
Neuropathic pain is often a result of damage to or a disorder of the nervous system. It may be episodic or continuous and can be experienced as a shocking, stabbing, burning and/or aching sensation. Trigeminal neuralgia is the most common orofacial neuralgia, and involves the trigeminal nerve. It’s typically episodic and severe, lasting several seconds. Causes of neuralgia may include nerve compression, tumors, autoimmune diseases such as multiple sclerosis and other injuries causing nerve damage. Dental or orofacial surgery can also cause nerve damage and pain.
Neuralgia is often a diagnosis of exclusion, meaning that it’s diagnosed by ruling out other medical conditions. Magnetic resonance imaging (MRI) might be used to rule out any brain conditions, and dental X-rays and a CT scan could also be done. In addition, diagnostic nerve blocks may be used to target the cause of the pain.