Trigger Point and Nerve Involvement in TMJ/Headache
Do you experience migraines, headaches or face pain? There is a direct "cause and effect" link between jaw problems, face pain, and headaches. Jaw problems can, and often do, cause headaches and/or face pain through the trigeminal vascular complex, which consists of the trigeminal nerve system and related blood vessels.
The trigeminal nerve is the largest cranial nerve, and is one of the major pain signaling entities of the brain. The main function of the trigeminal nerve is to transmit feelings of pain to your central nervous system. In addition, it also conducts the motor functions of chewing, biting, and swallowing. Lastly, it controls arterial blood flow inside the brain.
These three (trigeminal) nerve branches, or pathways, join into a singular, large nerve root called the trigeminal ganglion, which is physically located next to the Temporomandibular joint (TMJ). It is this nerve root that enters the brainstem, and transmits pain impulses.
Trigger points (TrPs) within the muscles entrap nerves and blood vessels, causing pain. Pain in any of the branches or pathways can cause migraines and other types of headaches, as well as pain in the face, mouth, sinuses, eyes, teeth, head, face, ears, and neck. Once TrPs are treated and released, the muscles relax back to a "normal" state and release any entrapment of nerves and blood vessels, most times providing immediate relief of pain symptoms.
According to the National Institute of Dental and Craniofacial Research, the most common form of TMJ is myofascial pain. Myofascial pain is pain that originates from the muscles and connective tissue, caused by a trigger point(s). A TrP is an irritable spot in a muscle that is locked into a deep and painful spasm…a strong state of painful contraction. Once the muscle freezes in this state, it creates a self-perpetuating cycle of pain and spasm. TrPs within the muscles of mastication, otherwise known as the chewing muscles, are responsible for creating the myofascial pain associated with TMJ, headaches, and facial neuralgias. Inactivating the TrPs is the only way to achieve long-lasting pain relief. Myofascial pain and TrPs are one of the most overlooked problems when diagnosing head, face, and jaw pain.
Trigger points are palpable contraction knots or taut bands within the muscle and fascia that will ultimately change or alter muscle tension. These intense spasms cause the muscle to pull on bony attachments such as the TMJ and/or any of the eight cranial sutures in your skull. In addition to pulling on bony attachments, weakening the muscle, and decreasing range of motion, one of the most important side effects of TrPs are the referral of pain they cause. This means that pain is felt not only in the TrP, but also in areas remote from the site of the TrP. This is known as referred pain. By eliminating the TrPs in the muscle, you also eliminate the pain in the faraway area as well. The good news is that these pain patterns are predictable and they are the same for all people. Drs’ Janet Travell and David G. Simons, MD published, Myofascial Pain and Dysfunction: The Trigger Point Manual, in which they diagrammed and described these pain patterns all over the body including inside the mouth! Their research has enabled healthcare professionals from many disciplines to track the pain patterns of their patients, and help eliminate the pain by treating the source of where the pain originates. In the case of head, face, and jaw pain, it’s important that we also treat the TrPs in the muscles of the neck and shoulders, as they too, refer pain into the head.
Not only is it vital to inactivate the TrPs and release the entrapment of blood vessels and nerves, but also to teach the patient about perpetuating factors that continue this pain/spasm cycle, such as poor posture, etc. Patients should also be taught how to self-treat so they know how to eliminate their own pain when a TrP comes back. Inactivating a TrP requires the application of direct, sustained pressure to the TrP until it moves, melts or disappears, and any tenderness involved is gone. Professional clinicians refer to this treatment protocol as ischemic pressure. This simply means that you are removing the blood flow for a period of time, and once the TrP is released, allowing the blood flow to come back and return muscles, nerves and blood vessels back to normal function.
There are many self-help massage tools on the market today, and the one for the use of self treating intra-oral TrPs is known as the MyoFree® Solution. You can find such tools by searching the Internet with keywords such as self-help massage tools, intra-oral therapy, etc. The products I use are made by the Pressure Positive Company and the tools come with instructions. These are effective and reliable tools to have in your self care therapy arsenal to help to keep you functioning pain free.
Yours in health,
Gail Falzon, RN
The “X’s” represent the TrPs and the red shaded areas are the pain referral patterns.
This research is a review of the literature and is not a claim about the function or performance of any products sold by Pivotal Health solutions.
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