This is a frequent question I hear from patients who have chronic headaches. The answer is always a qualified yes. The TMJ (Jaw Joint) is the TemporoMandibular Joint, TMD stands for TemporoMandibular Disorder.
TMD includes the TMJoint, the muscles, the teeth, the sinus linings, the tongue, airway, tongue, ears and most importantly the Trigeminal Nervous System.
I will explain what the connection of TMJ to Headaches initially annd at the end of this article how TMD treatment with a Diagnostic Physiologic Orthotic is an essential component in the diagnosis and treatment of all headache patients.
All headache specialists agree that the Trigeminal Nervous System is involved in almost 100% of all headaches. Specifically, two components of the Trigeminal Nerve are of critical importance to headache patients. The first is the Tigeminalvascular System which is the critical nervous component of all Migraine and Vascular Headaches as well as all autonomic Cephalgias. It controls the blood flow to the anterior two thirds of the brain thru the meninges or dura of the brain.
Most migraine preventive and treatment medications address the TrigeminoVascular System.
The second Trigeminal component is the Trigemino- Cervical Complex which is connected to almost all types of headaches including tension headaches, cervicogenic headaches and chronic daily headaches and more importantly is responsible for central sensitization. Central Sensitization is the key connection that connects headaches and Fibromyalgia and other chronic pain syndromes.
The information below is in technical language but I feel quoting it will be valuable for patients in spite of technical language. I will elucidate it as well.
“The nociceptive inflow from the meninges to the spinal cord is relayed in brainstem neurones of the trigemino-cervical complex (TCC). Two important mechanisms of pain transmission are reviewed: convergence of nociceptive trigeminal and cervical afferents and sensitization of trigemino-cervical neurones. ” (Schmerz. 2004 Oct;18(5):404-10.)
The same article also stated “These mechanisms have clinical correlates such as hyperalgesia, allodynia, spread and referral of pain to trigeminal or cervical dermatomes. Neurones in the TCC are subject to a modulation of pain-modulatory circuits in the brainstem such as the periaqueductal grey (PAG)………….. The review focuses on TCC neurones as integrative relay neurones between peripheral and central pain mechanisms. The understanding of these mechanisms has implications for the understanding of the clinical phenomenology in primary headache syndromes and the development of therapeutical options.”
This complex material talks about nociception or pain impulses into the Central Nervous System thru the Trigeminal nerves and how it causes referred pain and hyperalgesia, an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves.
Dermatones are actually road maps of where different nerves go, understanding where nerves come from and go to is essential in diagnosing what processes are causing pain.
Peripheral treatment of Migraine, Tension Headache, Chronic Daily Headache and Chronic Migraine with Botox is currently in vogue and should be considered an important diagnostic procedure as well as a treatment procedure. When Botox is administered to Trigeminally innervated muscles and gives substantial relief it should be considered diagnostic proof of a TMD problem. This is especially true of MPD or Myofascial Pain and Dysfunction problems. While there is nothing wrong with injecting Botulinum Toxin every three months into headache and migraine patients if it relieves their symptoms and improves their quality of life it is ridiculous to ignore the underlying causes necessitating use of BOTOX. Our bodies are not designed or evolved to require BOTOX injections but need them due to failure to achieve healthy homeostasis of physiologic systems.
The Trigeminal Nerve is often called the Dentist’s Nerve, it innervates all of the pulpal tissue of the teeth as well as the periodontal ligaments (PDL). The PDL has at least 29 known nerve receptors and is the largest input to the proprioceptive system of the human body. The Trigeminal dwarfs input from the middle ear especially after impulses are amplified inthe Reticular Activating System of the brain.
The trigeminal nerve also innervates the Jaw Joints or TMJoints, the joint capsules and the retrodiscal lamina of the TMJoints where most primary TMJ pain originates. Referred pain to the TMJoint can come from Trigeminally innervated masticatory muscles including the masseter muscles, the temporalis muscles, the medial pterygoid muscles the lateral pterygoid muscles, the diagatric muscles and the very specialized muscles that tense the ear drum (Tensor Veli Tympani) and the muscle that opens and closes the eustacian tubes the Tensor Veli Palatini.
Referred pain to the TMJoint area can also be referred fron neck and shoulder musculature via the Trigemino-Cervical Complex.
The tongue is also innervated by the Trigeminal Nerve and an extremely important function of the Trigeminal Nerve is to maintain a patent airway. The National Heart Lung and Blood Institute (NHLBI) of the NIH wrote an incredily important report “The Cardiovascular and Sleep Related Consequences of TemporoMandibular Disorders” It emphasizes the effects of airway on a wide variety of problems. Sleep Apnea is a TMD problem or Jaw Problem, the most important function of our jaws, teeth tongue and muscles is to maintain an airway, essential for life.
Forward head posture is implicated in almost all chronic head and neck problems and is actually largely a response to diminished airway. A more accurate description would be a forward neck posture with excessive rotation at Atlas-Axis-Occipital Joints. This airway head position connection is the link to all chiropractic patients and TMD patients. As long as forward head posture is uncorrected adverse mechanical forces will be affecting the spine and posture. Atlas Orthoganol Chiropractic and NUCCA Chiropractic address this connection.
The effect of the Trigeminal nerve including TrigeminoVascular and Trigemino-Cervico Complexes is that of input into our CNS or Central Nervous System. In computer language chronic pain is an I/O error or input/uotput error. In English, GARBAGE IN-GARBAGE OUT! Our Brain is our computer and nociceptive and garbled input to the body creates biochemical changes in our brain, at one threshold they cause pain at a higher or more continuous level they cause chronic pain and at their worst they cause Central Sensitiztion or a meltdown of normal fuction with creation of Hyperalgesia (increased pain response) and Allodynia (inappropriate pain response). The use of Botox TOXIN is to disconnect the Trigeminal Nerve from the Trigeminal Muscles. If it improves headache it is proof of the TMD disorder.
The most Ethical approach to these problems is the use of a Physiologic Diagnostic Orthotic to correct physiologic function of the masticatory system, decrease trigminal nociception, to create homeostasis of the proprioceptive systems, decrease Central Sensitization, correct airway and posture and to remove adverse mechanical forces to the cervical spine and to the entire spinal structure.
When the diagnostic orthotic is used many patients respond extremely favorably and utilization of dangerous medications is reduced or eliminated. The frequency of physical therapy, massage therapy, chiropractic and osteopathic adjustments is reduced and the overall quality of life is improved.
Patients who respond positively can move onto definitive treatment or have long term removable orthotics made.
The adaptability of the human body is great and the joints and muscles can adapt to less than perfect physiology and position but this results in excess nociception into the CNS and can result in Central Sensitization.
There are many aspects to treatment of TMJ disorders and this article is meant to address just the treatment effects of diagnostic orthotics.
Each patient is in essence a clinical study of one. This is evidenced based medicine but it is the evidence obtained by evaluating and treating a single individual. There is an enormous benefit to prospective studies involving hundreds of patients to give us evidenced based approaches to fit populations. Unfortunately, the field of TMD has so many variables that the most efficatious method to study an individual is to do a clinical study that includes all of the variable unique to this specific patient. In utilizing a Physiologic Diagnostic Orthotic we accomplish that goal.
The patient can discontinue the non-invasive treatment at any time but if treatment improves symptoms in a life changing way the patient can elect to make definitive changes utilizing a position that has been shown to be effective and therapeutic.
