TMJ problems cause headache more often than they are diagnosed. In headache patients the trouble is usually in the chewing muscles, not the joint. So it lands in the temples, reads as a tension headache, and slips past a normal jaw X-ray.
Does your headache sit in the temple? Does it come with jaw tightness, or get worse after a meal or a stressful night of clenching? Then the jaw is worth examining before anything else is added to your treatment. It is one of the most commonly missed contributors to headache. It is also one of the few that is easy to check in a few minutes.
What is a temporomandibular disorder (TMD)?
Temporomandibular disorder, or TMD, is not one condition. It covers problems of the temporomandibular joint itself, problems of the muscles that move the jaw, or both. In headache patients the muscle form dominates. In a study of 132 people with migraine, myofascial pain (muscle pain) was the most prevalent form of TMD in both the episodic and chronic groups.1
That matters, because a muscle problem does not show up on a jaw X-ray. People are sent for imaging and told the joint looks normal. They reasonably conclude the jaw was a dead end. The joint was never the question.
Two different relationships, and the distinction changes the treatment
There are two ways a jaw problem and a headache can be connected, and they are not the same thing.
- The TMD is causing the headache. The International Classification of Headache Disorders recognizes this as a secondary headache, item 11.7, headache attributed to temporomandibular disorder.2 Treat the jaw and the headache should follow.
- The TMD and a primary headache coexist. Migraine and tension-type headache are truly comorbid with TMD. Having one raises the likelihood of the other.2 Here the jaw is a load on a system that already has a headache disorder. Both need addressing.
Efforts to find a distinctive fingerprint for the secondary type have largely failed. The most that can be said is that it tends to sit in one or both temples. It tends to look either migraine-like or tension-type-like.2 So the label cannot be settled from the description of the pain alone. That is exactly why the jaw has to be examined rather than asked about.
How common is TMJ in people with frequent migraines?
The association is strongest in the group that has the most to gain. One single-center study looked at 90 people with chronic migraine and 42 with episodic migraine. TMD was present in 60% of the chronic group against 21.4% of the episodic group.1 A separate study from the same group, in 63 chronic and 40 episodic migraine patients, found 47.5% against 28.5%.3
Both are modest, single-center samples. The exact percentages should not be read as precise. The direction is the consistent finding: the more frequent the headache, the more likely the jaw is involved. Frequent neck pain tracked the same way in the larger study. It was reported by 65.5% of the chronic group and 21.4% of the episodic group.1
The relationship also runs the other way. A 2024 systematic review of cohort studies found that headache frequency, tension-type headache, migraine and mixed headache were themselves risk factors for developing TMD.4 Neither is simply causing the other. They feed each other.
The chronification question
The bigger possibility is that untreated TMD helps push migraine from episodic toward chronic. This has been argued for over fifteen years. The proposed link is cutaneous allodynia, meaning tenderness of the scalp and face between attacks.5 The evidence that TMD drives this shift remains limited. It would be overstating it to say the case is settled.
But the practical conclusion does not depend on settling it. Take someone whose headaches are becoming more frequent. In that person, a treatable source of continuous input into the trigeminal system is worth removing on its own merits. If it also slows the shift to chronic, that is a second reason. See chronic or episodic migraine for why the 15-day line matters so much.
Why is a TMJ headache so often missed?
- Temple pain reads as tension-type headache. The temporalis is a chewing muscle. Pain from it lands exactly where people expect a stress headache to be. See migraine or tension-type headache.
- The jaw is not examined in a standard headache visit. Pressing on the masseter and temporalis and measuring jaw opening takes about two minutes. It is often skipped.
- Patients do not report it. People do not think of jaw clicking and morning tightness as headache symptoms. So they do not mention them unless asked.
- A normal joint image closes the file. As above, the common form is muscular. Imaging of the joint does not rule it out.
How can you tell if your headache is coming from your jaw?
None of this is diagnostic on its own. But it is worth arriving with the answers:
- Does the pain start or worsen while chewing, especially something tough?
- Is your jaw tight or sore on waking? That points toward clenching or grinding overnight.
- Can you fit three of your own fingers, stacked vertically, between your upper and lower front teeth? Less than that suggests restricted opening.
- Press firmly into the muscle at your temple and into the thick muscle at the angle of the jaw. Is one side clearly more tender?
- Does the jaw click, catch, or deviate to one side as it opens?
How are TMJ headaches treated here?
The jaw and the chewing muscles are examined as part of a headache assessment, not as a separate referral. Sometimes a muscle pain source in the temporalis or masseter is contributing. That is treatable. It is treated alongside the headache disorder, not instead of it. Treating both conditions at the same time outperforms treating either one on its own.2
Where the joint itself, the bite, or nocturnal grinding is the primary driver, that is dentistry and orofacial pain territory, and we will say so and point you there rather than treat around it. Bruxism’s exact role in headache remains unclear even in the specialist literature.6
Is the neck also involved? In frequent headache it usually is. If so, see is my headache coming from my neck and cervicogenic headache treatment.
Frequently asked questions
Can a jaw problem really cause a headache, or is that a myth?
It is a formally recognized diagnosis. The International Classification of Headache Disorders lists headache attributed to temporomandibular disorder as item 11.7.2 What is truly uncertain is how often a jaw problem is the only cause. It may instead be one contributor alongside a primary headache disorder. See migraine or tension-type headache.
My jaw X-ray was normal. Does that rule it out?
No, and this is the most common reason the diagnosis is missed. The form most often found in headache patients is myofascial. That is a muscle problem, not a joint problem. It does not appear on imaging of the joint.1 The exam is done with hands, not a scanner.
Should I get a night guard?
Possibly, but that decision belongs with a dentist, and a guard addresses grinding rather than headache directly. Bruxism’s role in headache is still not well defined.6 It is worth doing in parallel with headache treatment rather than as a substitute for it — contact us and we will tell you which order makes sense in your case.
My headaches have become almost daily. Is the jaw worth checking at that point?
That is exactly the group where it is most worth checking. One study found TMD in 60% of chronic migraine patients against 21.4% of episodic.1 Also check whether acute medication is keeping the pattern going. See medication-overuse headache.
Do you inject the jaw?
Where a muscle pain source is contributing, that is treatable. Any injection here is placed under imaging, not by landmark (by feel). See ultrasound and fluoroscopic guidance. Whether an injection is the right step depends on what the exam shows. That is why the assessment comes first.
What does a TMJ headache feel like?
It usually sits in one or both temples, where the temporalis chewing muscle lies. So it is easily taken for a stress or tension headache. It can also look migraine-like. Clues that point to the jaw are pain that starts or worsens while chewing, a tight or sore jaw on waking, and a jaw that clicks, catches or drifts to one side as it opens.
What is the 3 finger test for TMJ?
Stack three of your own fingers vertically and try to fit them between your upper and lower front teeth. If they will not fit, your jaw opening is restricted. That points toward a jaw problem. It is one piece of the picture, not a diagnosis on its own. So bring the result to your appointment along with any clicking, morning tightness or tender spots.
How are TMJ headaches diagnosed?
With hands, not a scanner. The doctor presses on the masseter and temporalis muscles and measures how far your jaw opens. This takes about two minutes. A jaw X-ray or joint scan is not enough. That is because the form most often found in headache patients is a muscle problem that does not show up on imaging of the joint.
Sources
- Latysheva N, Platonova A, Filatova E. Temporomandibular disorder and cervicalgia: pathophysiology underlying the comorbidity with chronic migraine. Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(1):17-22. doi:10.17116/jnevro201911901117
- Speciali JG, Dach F. Temporomandibular dysfunction and headache disorder. Headache. 2015;55(Suppl 1):72-83. doi:10.1111/head.12515
- Zenkevich AS, Filatova EG, Latysheva NV. Migraine and temporomandibular joint dysfunction: mechanisms of comorbidity. Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(10):33-38. doi:10.17116/jnevro201511510133-38
- Da-Cas CD, Valesan LF, Nascimento LP, et al. Risk factors for temporomandibular disorders: a systematic review of cohort studies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2024;138(4):502-515. doi:10.1016/j.oooo.2024.06.007
- Bevilaqua Grossi D, Lipton RB, Bigal ME. Temporomandibular disorders and migraine chronification. Curr Pain Headache Rep. 2009;13(4):314-318. doi:10.1007/s11916-009-0050-9
- Romero-Reyes M, Bassiur JP. Temporomandibular disorders, bruxism and headaches. Neurol Clin. 2024;42(2):573-584. doi:10.1016/j.ncl.2023.12.010
When the jaw drives the headache, treating the headache alone keeps failing. Jaw-related pain is part of the headache treatment in St. Louis we do, along with pain that lingers after dental work.