Tension Headaches and TMJ

Condition & context

Tension headaches and jaw tension frequently occur together. Someone who clenches or grinds at night may wake with pain through the temples or head; someone who spends the day tightening the jaw, neck, and shoulders may develop the familiar pressure of a tension headache by afternoon.

The relationship is not always straightforward, but the jaw, temples, neck, and base of the skull are closely interconnected. When more than one area is involved, treating them together can be more effective than focusing on the site of pain alone.

Acupuncture has a substantial body of research behind it for frequent tension-type headache. A Cochrane review of 12 randomized trials involving more than 2,300 people found that acupuncture reduced headache frequency and concluded that it can be a useful preventive treatment for people with frequent tension-type headaches. More recent systematic reviews have continued to support its use, although the quality of the evidence varies. The UK’s National Institute for Health and Care Excellence (NICE) specifically recommends considering a course of acupuncture for the prevention of chronic tension-type headache.

What we treat

• Tension-type headache — pressure or aching across the forehead, temples, sides, or back of the head
• Headache with a cervical component, including pain that begins at the base of the skull and travels forward
• Jaw pain and TMJ dysfunction, including pain with chewing, limited opening, clicking, or intermittent locking
• Daytime clenching and nighttime bruxism
• Facial, temple, and jaw aching
• Ear discomfort or a sensation of fullness when ear pathology has been ruled out
• Headaches associated with prolonged desk work, posture, or muscular fatigue
• Jaw and headache patterns that become more pronounced during periods of stress
• Muscular jaw pain following dental or orthodontic work

Why jaw and head pain are so closely associated

The jaw, temples, neck, and base of the skull are closely connected, both mechanically and neurologically. This is one reason jaw tension, neck pain, and headache so often occur together — and why the place where you feel the pain is not necessarily the only place we need to treat.

The masseter and temporalis muscles can become persistently overactive with clenching and bruxism. When these muscles are painful or overloaded, symptoms may be felt not only in the jaw itself, but through the temples, face, teeth, and around the ear. The muscles and joints of the upper neck can produce their own patterns of referred pain, often felt at the base of the skull, across the head, or toward the forehead and eye.

There is also considerable overlap in the nervous-system pathways that carry sensation from the jaw, face, head, and upper neck. This helps explain why a problem originating in one region can be experienced as pain somewhere else — and why jaw dysfunction, neck pain, and headache can become part of the same clinical picture.

This is why our assessment extends beyond the location of the headache. We assess the jaw and muscles of mastication along with the neck, shoulders, suboccipital region, and upper cervical musculature, looking for areas of tenderness and persistent muscular tension and for patterns of referred pain that correspond to the patient’s familiar headache or facial pain.

Chinese medicine provides another way of understanding these relationships through the channels that traverse the jaw, face, head, and neck. In practice, we use both perspectives: the anatomical and musculoskeletal pattern helps guide local treatment, while the broader Chinese medical diagnosis helps us understand why the pattern may be persisting in the individual patient.

What treatment involves

Treatment generally combines acupuncture with manual therapy, with the balance depending on what we find.

Acupuncture may be used directly in involved muscles such as the masseter and temporalis, as well as through the neck, shoulders, scalp, and suboccipital region when indicated. Distal acupuncture points are selected according to the headache pattern and the broader Chinese medical diagnosis.

Manual therapy is often an important part of treatment. We use therapeutic massage and tui na to address muscular restriction and restore more comfortable movement through the jaw, neck, and shoulders. Cupping and gua sha may also be incorporated when appropriate, particularly when there is significant tension through the cervical and upper back musculature.

When a muscle such as the masseter has been chronically contracted, local acupuncture can sometimes produce a noticeable change quite quickly. But reducing muscular tension is only one part of treatment. We also look at what may be perpetuating the pattern — including bruxism, daytime clenching, sleep, stress, prolonged computer work, cervical dysfunction, and habitual patterns of muscular guarding.

Chinese medicine allows us to treat both levels at the same time: the specific musculoskeletal pattern producing pain and the broader pattern in which that tension is occurring. Treatment is therefore individualized rather than based on a standard set of points for TMJ or tension headache.

Treatment frequency depends on the severity and chronicity of the problem. We generally begin weekly and space treatments farther apart as improvement becomes more stable.

Working with your dentist and your physical therapist

TMJ problems often benefit from more than one kind of care.

Dentists can assess the teeth, joint, bite, and consequences of grinding or clenching, and determine whether a night guard or other dental treatment is appropriate. Physical therapists with experience treating TMJ and cervical dysfunction can be particularly helpful when joint mechanics, posture, movement patterns, or rehabilitation need more focused attention.

We are happy to work alongside both.

Some patients also receive Botox in the masseter or other jaw muscles for bruxism or jaw pain. Acupuncture and manual therapy can still be used as part of the overall treatment plan, with appropriate timing and modification around recent injections.

When to see someone else first

Not every headache or jaw problem should be treated initially with acupuncture.

Seek prompt medical or dental evaluation for a jaw that suddenly locks and cannot open or close normally, a sudden change in the way your teeth meet, significant facial swelling or fever, or jaw pain following an injury.

New, severe, or unusual headaches also require appropriate medical evaluation. See our migraine page for headache warning signs that warrant urgent care.

Common questions

How soon will I feel a difference?

Muscular tension can sometimes respond quite quickly, and some patients notice a change in the jaw, neck, or headache pattern within the first few treatments. Chronic patterns generally require a course of care.

Does needling the jaw hurt?

The sensation varies. Needling a very tight masseter can produce a brief, deep ache or muscle response, but it generally passes quickly. We adjust the treatment to your comfort level. As with other facial needling, occasional minor bruising is possible.

Is this a migraine or a tension headache?

Migraine and tension-type headache are different conditions, although they can coexist. Your symptoms, headache pattern, associated features, and history help us distinguish between them. If migraine is the primary problem, see our migraine page.

I already wear a night guard. Should I keep wearing it?

Follow the recommendations of the dentist who prescribed it. A night guard can protect the teeth from the effects of grinding or clenching, while our treatment focuses on the muscular tension and broader pattern associated with it.

Can acupuncture help with clicking?

Sometimes, particularly when muscular tension is contributing. Clicking can also reflect changes within the TMJ itself, so it is less predictable than improvement in pain or muscular tension. Persistent or significant joint symptoms may require dental or TMJ evaluation.

Can I have treatment if I’ve had Botox in my jaw?

Usually, yes. Tell us when and where you were injected so we can plan the treatment appropriately.

Does acupuncture help ear fullness?

It may when jaw or surrounding muscular tension is contributing to the sensation. Ear fullness can have many other causes, however, so new or unexplained ear symptoms should be medically evaluated rather than assumed to be coming from the jaw.

Will the results last?

That depends partly on what is driving the tension. When the underlying pattern can be changed, improvement may be quite durable. When clenching or muscular tension repeatedly returns with stress, work demands, sleep disturbance, or an ongoing mechanical issue, occasional maintenance treatment may be useful.