Video introduction: What is TMD, TMJ, how common is it and why is it associated with headache and migraine?
Dr. Paul Mathew is a headache specialist and fellow of the American Headache Society. He’s also an Assistant Professor of Neurology at Harvard Medical School, where he serves as the Director and Founder of the Advanced Neurology Clerkship.
Contents
Transcript
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Dr. Mathew: First, we have to start with the terminology. TMJ, 100% of people have TMJ because TMJ stands for temporomandibular joint, and all of us have a jaw joint. The term that they probably mean is TMD, Temporomandibular Disorder. Probably one of the more prevalent studies conducted in the UK showed that 26% of people complain of some form of oral facial pain. Six percent of people actually complain of temporomandibular disorders. It is quite prevalent. It is more common in women, 1.7 times more common in women than men. It tends to affect people in the 18-45 range, so it’s a really large age range of people that are affected by this disorder.
Many people have stiffness, tightness in this area, even a little bit of pain and don’t even know why they have that problem. The reason is many of them will clench or grind in their sleep. The temporomandibular joint is a very complex joint; there’re many muscles that actually work in order for you to open and close your jaw, and people take it for granted, because of its complexity. It allows you to phonate and make different sounds, to chew, to do all these different things. In the joint, are multiple tendons, so tendons are things that connect the muscle to bone and ligaments are things that connect bone to bone. There’s a lot of tendons, cartilage and things that are in the joint, that kind of work in orchestra to do those functions of the jaw.
TMD tends to occur more often in people with migraine, tension-type headache, as well as chronic daily headache, which is why it’s really important for headache specialists to be aware of TMD and how common it is.
Carl Cincinnato: Why is there an association with headache and migraine?
Dr. Mathew: My belief, and the belief of many headache experts, is that any type of stress, whether it’s emotional or physical, can actually contribute as a trigger to developing migraine or other headache disorders. If you’re constantly clenching and have this tightness, no muscle acts by itself in a silo. When you have dysfunction of one muscle group, some of the adjacent muscle groups will also kind of take on some of that tension and stress and will also malfunction, causing pain and tightness and things like that. Interestingly enough, the temporalis muscle, which is this muscle up here [pointing to temple], it’s kind of broken down functionally into two segments. There’s the anterior temporalis, which tends to help close the jaw, but also brings it forward, and then there’s the middle and the posterior, which actually does the final elements of closing and brings the jaw back a little bit.
People that work at a desk are constantly in this kind of a position, and in that kind of situation [crouching over a computer screen with poor posture], the TMD would more likely affect the anterior section. People that grind and clench in their sleep, gravity is affecting it, and they’re more likely to have problems in the middle and the posterior section.
Teeth clenching occurs when the bottom and top teeth clamp together. Grinding occurs when the teeth move horizontally or back-and-forth whilst the teeth are clenched. Bruxism is the medical name given to either clenching or grinding during the day or night.
People who grind their teeth are three times more likely to experience headache according to the Bruxism Association in the UK. Most of the population will grind their teeth some point in their lifetime.
Clenching and grinding occur naturally when eating but some people may also clench or grind involuntarily and excessively throughout the day and/or night.
Teeth are not designed to be in constant contact. They can briefly touch when you swallow or chew but if they are in contact too often it can wear down tooth enamel. Enamel is the outer part of the tooth which protects the inner structure. The risk of tooth decay increases without the protection of the enamel.
How Many People Clench Or Grind Excessively?
Prevalence peaks in childhood and reaches its lowest rates in those over 65 years old. It is estimated that 8% of the adult population grind or clench their teeth at night. [i] [ii] During the day, 20% of the general population report awareness of clenching their teeth. The same study also found that this was more common in females. [iii]
Bruxism tends to decrease with age.
Symptoms Of Clenching & Grinding (Bruxism)
Signs you may have bruxism include:
It’s easy to understand how the jaw might lead to headache and migraine when you to see how far reaching the jaw muscles stretch.
- Headaches, earaches, migraine, sinus pain: Headache around the temples or even an earache can be a sign of excessive clenching or grinding especially in the morning. In those with a history of migraine, a bruxism episode can trigger a migraine attack.
- Tender jaw or facial muscles or joints: Soreness, tenderness, and fatigue can be caused in the muscles and joints around the jaw and face.
- Stiff neck: Muscles around the jaw from clenching and grinding affect muscles in the surrounding areas including the neck. A stiff neck may not be an obvious sign of clenching or grinding but it is one to look out for, especially if other symptoms are present.
The muscles in the jaw affect many other MUSCLEs around the head and neck.
- Dental wear: Chipped, cracked, sensitive and even lose teeth are not uncommon from the wear and tear that excessive clenching and grinding can cause. Extreme pressure can be exerted whilst clenching and grinding teeth, particularly at night when you are not consciously able to control the force of clenching or grinding. Teeth can also be worn down and shortened if left untreated.
- Enlarged jaw muscles: The act of clenching and grinding can be so strenuous over time that the patient may notice enlarged or overdeveloped jaw muscles.
- Reduced oral function: In severe cases bruxism can compromise basic oral functions such as chewing, speaking and swallowing due to pain and tightness (limited opening of the mouth). [iv]
- Your partner tells you: Most people are not aware that they are clenching or grinding – it is often a bed partner who hears the grinding at night or the dentist who can see the visible signs of enamel destruction due to excessive clenching or grinding.
- Bruxism is typically diagnosed by a dentist after a clinical evaluation. Other physicians who might diagnose bruxism are a maxillofacial surgeon, headache specialist, or sleep specialist. An overnight sleep study may also be warranted if there is suspicion that a sleep disorder is involved.
What’s The Difference Between Grinding, TMJ And TMD?
TMJ is an abbreviation for the TemporoMandibular Joint which connects the jaw (mandible) to the skull. TMD is an abbreviation for TemporoMandibular Disorder. TMD is a broad term that often includes clenching and grinding, even though there may be no problem with the actual joint in cases of clenching and grinding. In severe and long-term cases, clenching or grinding may lead to joint damage. [v]
The Temporomandibular Joint (TMJ)
The presence of popping and/or clicking of the joint is suggestive of a physical problem with the joint. Milder cases involving popping and/or clicking tend to resolve spontaneously, but moderate to severe cases may require physical or surgical intervention.
How many people have TMD?
TMD is quite common but in the vast majority of cases symptoms and clinical issues are mild. Only 4-7% of the population will have any symptoms of sufficient severity to warrant seeking medical advice. [xix]
What causes clenching or grinding?
At night whilst sleeping there could be many different or multiple causes:
- Intense concentration: The American Academy of Oral Medicine suggests that concentration itself is sufficient to trigger bruxism.
- Stress, Anger or Anxiety: Emotional stress is believed to be a common trigger for grinding or clenching teeth. This may lead to bruxism during the day and/or at night.
- Allergies or blocked nose: Not being able to breathe through your nose due to allergies or being in a stuffy or dry room may contribute to more mouth breathing, which triggers the autonomic nervous system when sleeping. When this is switched on, muscle activity is under less of your voluntary control, and bruxism may be more likely to occur.
- Smoking: Bruxism is twice as common in smokers than non-smokers. [v]
- Excessive Alcohol or Caffeine: These substances can reduce the quality of your sleep and trigger bruxism.
- Illness: Physical illness and poor nutrition can be a contributor.
- Dehydration: Insufficient fluids throughout the day may worsen bruxism.
- Sleep Disorders: Sleep bruxism is considered a type of sleep disorder. It can also be associated with other sleep disorders such as sleep apnea and snoring. When the body approaches deep sleep, muscles are required to fully relax. This can cause problems in some cases to maintain fully patent airways (i.e. an open path between the lungs and the outside air). For example, the tongue when fully relaxed expands significantly. Another potential airway impediment is the relaxed jaw.
- According to Dr Mark Burhenne, researchers discovered those with a partial blockage in their airways would grind or clench to re-open the airway in their sleep. Once the patients were able to keep their airways open all night the grinding stopped.[xx]
- Airway obstruction could be a root cause of sleep bruxism. A sleep study might be warranted for some patients. If you have sleep apnea, a night guard could be making both the sleep apnea and bruxism worse.
- Teeth misalignment: a poor bite or malocclusion has historically been thought to play a role in bruxism but a number of studies have failed to demonstrate the link. That said, poorly designed filings that sit too high may also contribute to grinding.
- Genetic factors: If family members clench or grind then you are more prone to develop the habit as well. [vii]
- Medications: Bruxism can be a side effect of some medications. The most common types of medications listing bruxism as a potential side effect are the second generation antidepressants (including SSRIs and SNRIs) and antipsychotics. [viii]
- It’s a symptom of another condition: in some instances bruxism has been associated with other neurological disorders. Drug resistant Temporal Lobe Epilepsy, Dystonia, Alzheimers, Stroke, Traumatic Brain Injury and Huntington’s disease have associations with bruxism. [viii]
These factors can also play a role in bruxism during the day. Daytime bruxism is often seen as a habit in response to stress and anxiety. [vi]
How To Treat Clenching And Grinding?
Studies have acknowledged that treating daytime bruxism is challenging due to increased levels of anxiety and somatic symptoms reported in these patients. [viii]
Somatic symptoms refer to psychological distress of some kind expressing itself as physical symptoms in the body. Despite the absence of a physical cause, somatic symptoms such as pain, nausea, and clenching are real, and not falsely purported.
Most people will experience somatic symptoms at some point. For example, a nervous public speaker may feel nauseous and even vomit from the fear of speaking in front of a large audience.
Few high quality studies have been conducted to evaluate treatments directed at clenching or grinding during the day.
Without evidence-based treatments for daytime bruxism only general suggestions can be made cautiously, which are listed below. There have been several randomized control trials evaluating the treatment of sleep bruxism. Evidence supporting the treatment is mentioned where available:
1) Good sleep hygiene: treating clenching and grinding at night often begins with practicing good sleep hygiene. (6) This includes restricting caffeine, smoking and drinking alcohol at night. Limiting physical and mental activity before going to bed and ensuring optimal sleeping conditions in the bedroom can also assist. The bedroom should be dark and quiet. A TV and other stimulating electronic devices in the bedroom can be detrimental to sleep quality.
- One randomized controlled trial evaluated the effect of 4 weeks of sleep hygiene with relaxation techniques for sleep bruxism but failed to find significant changes. [ix] Despite this result, practicing good sleep hygiene is a good idea. Alcohol, tobacco and coffee consumption before bed are known risk factors for sleep clenching or grinding. [x] Sensitivity to stress is also commonly reported in patients. [xi]
2) Mouth guard: Also known as a night guard or occlusal splint, these devices are considered to be the first line of defence for preventing further tooth wear and grinding noises at night.
- A mouth guard is one of the best treatments available to help relieve the strain from strenuous jaw clenching and grinding. It helps prevent sore jaw muscles and joints.
- Custom mouth guards that are molded to a person’s bite are a more comfortable and effective option. Non-custom (store bought) night guards can be uncomfortable or even painful to use. In addition, non-custom night guards can exacerbate occlusal issues and cause shifting of the teeth within the gums, which can lead to gaps forming between teeth.
- It tends to improve the severity of clenching but may not have any lasting effects on reducing the frequency of clenching throughout the night. [viii]
- In rare cases, occlusal splints may interfere with breathing airways during sleep in those with obstructive sleep apnea (OSA). If you have OSA, then special care is required when the splint is devised. [xii] Those with OSA may benefit from a mandibular advancement device which can help with both OSA and bruxism.
3) Mandibular advancement devices: These devices are typically used for the management of sleep apnea and snoring. Like the night guard, these devices are inserted into the mouth at night to wear whilst sleeping. The mandibular advancement device brings forward (or advances) the lower jaw (mandible) by around 8 to 10mm. This helps keep the airways open.
- The Bruxism Association of the UK indicates that these devices have often shown more positive results for bruxism but with the cost of some discomfort whilst wearing the device.
4) Stress management: Two commonly suggested techniques for stress management are Cognitive Behavioral Therapy (CBT) and Biofeedback. Whilst these have been reported as helpful for stress management, initial studies of CBT and Biofeedback for bruxism did not correlate with any improvements on their own. CBT and biofeedback tend to be most effective when done in combination with other strategies to reduce the frequency and severity of bruxism.
5) Regular Exercise: Exercise has been proven to help better manage stress. It releases endorphins, it can relieve minor aches and pains, and it provides a sense of well being. This may assist those with bruxism.
6) Behavioral Therapy: Bruxism, particularly daytime bruxism is a habit that we can slip into subconsciously over time. By the time we become aware of it, we may have already become deeply rooted in this behavior. Behavioral modification and habit reversal may offer helpful techniques to break the stubborn habit. In more difficult cases psychological counseling can be helpful.
7) Botox: Recent studies have reviewed Botox as a treatment option for bruxism. Results indicated that the force and strength of the activity were reduced significantly but no change in frequency was found. [xiii] In addition, it is expected that as the effect wears off from Botox around the 12-week point the force of the clenching and grinding return.
8) Electrical stimulation: Like Botox, Electrical Stimulation has been trialed with bruxism. Results from two experimental studies found a reduction in the frequency of bruxism during sleep but with no change in pain or muscle tension. This suggests that whilst the frequency is reduced the severity and force of clenching and grinding is not. Another study confirmed this result as well as finding that the benefits were realized only whilst the device was being used. Results did not continue after the device was stopped. [xi]
9) Hypnosis: This is one alternative approach which has been suggested by some dental organizations although it lacks clinical evidence.
10) Physical therapy: may be used to relieve some of the tension and stiffness caused by excessive use of the jaw muscles.
11) Meditation: This and other relaxation techniques can produce a greater sense of self-esteem; help manage anxiety, stress, and control over one’s body. There is no strong evidence in the literature regarding its efficacy. Its use may be more beneficial to those with stress or anxiety-related causes.
12) Medications: Muscle relaxants may be suggested by the physician to use modestly for a short period. Caution should be exercised so as not to develop any dependencies or damage internal organs from excessive use.
The drugs investigated for sleep bruxism were found in small and often experimental studies with short treatment periods. Caution should be exercised when interpreting these results. Due to a lack of quality of evidence, none of the below are recommended as standard treatments. On the other hand, a trial of one of these medications may be reasonable if the patient has more than one problem. For example, amitriptyline is frequently used for migraine prevention and might be a reasonable choice for someone who also suffers from bruxism.
- Despite its seemingly positive initial findings, Levodopa is not considered a treatment. There is not enough reliable evidence supporting its use. [xiv]
- Clonidine was found to have significant side effects which included morning hypotension, REM sleep suppression and dry mouth. [xv] An independent Cochrane review of Clonidine found no significant reductions in frequency of bruxism when compared to placebo. [xvi]
- The study on Clonazepam was a small (n=10) single blind non randomized trial. Therefore the results cannot be drawn as conclusive. High quality, double blind, randomized control trials are required with larger sample sizes and longer durations are needed. [xvii]
13) Supplements
Magnesium: A deficiency in magnesium can result in anxiety, irritability, insomnia, restlessness, and hyperactivity. A regular dose of a high quality chelated form magnesium may assist these symptoms and potentially reduce clenching or grinding activity. Magnesium can also be useful for reducing migraine attacks, constipation, and muscle cramps.
Vitamin C: Stress management is a key component for many with bruxism. Vitamin C may complement stress management efforts by supporting our adrenal glands which affect stress responses. Vitamin C is also essential to make dopamine which is used to regulate mood and help prevent illness. Illness is another potential trigger of bruxism so this may have some synergy in prevention. Further research is warranted to substantiate this hypothesis.
B-Complex vitamins: Deficiency in B-vitamins can lead to psychological stress, depression, and anxiety. The efficacy of a B-complex has been demonstrated in overall health and wellness. Beginning the day in a balanced state of mind sets you up for success.
Valerian root: This supplement has been used for centuries as a natural sedative. It has anti-anxiety properties and has been shown to improve quality of sleep without side effects. [xviii] Since bruxism is considered a sleep-related movement disorder, Valerian root may be beneficial.
There is weak evidence from studies supporting the above medications and vitamins. They may be helpful but randomized clinical trials are required to establish their true efficacy in treating bruxism. Without these studies only tentative suggestions can be made based on hypothesis.
Conclusion
This article was written because clenching has become one of the most significant contributors to my own migraine condition. I’ve had countless headaches and several migraine attacks from clenching during the day and probably more that I’m not aware of from the night before.
I’m disappointed to say that there is no single successful treatment that addresses the root cause of clenching or grinding. Therefore the first clinical focus of bruxism is often to prevent further dental wear, grinding noise and relieve any muscular and joint discomforts or dysfunction.
One of the best ways to do this and protect your teeth is with a custom-made night guard (occlusal splint) of some kind. This also helps relieve the extreme pressure on your teeth as well as the fatigue and soreness in your muscles and joints. I have found it very helpful.
With the urgent symptoms covered, you can then begin working on the root cause.
The best treatment strategy will be those which best address your potential causes. The best results can often occur with combination therapies. Adding different modalities as needed if a night guard alone doesn’t deliver. For example, incorporating lifestyle changes, a nightguard, supplements, and medication or Botox.
Could it be due to a sleep disorder, stress, anxiety or lifestyle factors or all of the above? I’m still working it out personally and combining complementary strategies. Are you aware of clenching or grinding? I’d love to hear from you in the comments.
Further reading:
Unlocking the lock jaw: Temporomandibular Joint (TMJ) dysfunction
Life is stressful enough even without the migraine attacks. Better manage stress with these 5 tips designed for busy migraine patients. Available for a limited time.
Article References
[i] Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep. 1994;17(8):739–743. [PubMed]
[ii] Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest. 2001;119(1):53–61. doi: 10.1378/chest.119.1.53. [PubMed] [Cross Ref]
[iii] Jensen R, Rasmussen BK, Pedersen B, Lous I, Olesen J. Prevalence of oromandibular dysfunction in a general population. J Orofac Pain. 1993;7(2):175–182. [PubMed]
[iv] Tan EK, Jankovic J, Ondo W. Bruxism in Huntington’s disease. Mov Disord. 2000;15(1):171–173. doi: 10.1002/1531-8257(200001)15:1<171::AID-MDS1031>3.0.CO;2-Y. [PubMed] [Cross Ref]
[v] Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC (September 2010). “Bruxism: a literature review”. Journal of Indian Prosthodontic Society. 10 (3): 141–8. PMC 3081266 Freely accessible. PMID 21886404. doi:10.1007/s13191-011-0041-5.
[vi] Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain. 2009;23(2):153–166. [PubMed]
[vii] “International classification of sleep disorders, revised: Diagnostic and coding manual.” (PDF). Chicago, Illinois: American Academy of Sleep Medicine, 2001. Retrieved 16 May 2013.
[viii] Guaita, Marc, and Birgit Högl. “Current treatments of bruxism.” Current treatment options in neurology 18.2 (2016): 10.
[ix] Valiente López M, van Selms MK, van der Zaag J, Hamburger HL, Lobbezoo F. Do sleep hygiene measures and progressive muscle relaxation influence sleep bruxism? Report of a randomised controlled trial. J Oral Rehabil. 2015;42(4):259–265. doi: 10.1111/joor.12252. [PubMed] [Cross Ref]
[x] Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest. 2001;119(1):53–61. doi: 10.1378/chest.119.1.53. [PubMed] [Cross Ref]
[xi] Manfredini D, Landi N, Fantoni F, Segù M, Bosco M. Anxiety symptoms in clinically diagnosed bruxers. J Oral Rehabil. 2005;32(8):584–588. doi: 10.1111/j.1365-2842.2005.01462.x. [PubMed] [Cross Ref]
[xii] Gagnon Y, Mayer P, Morisson F, Rompré PH, Lavigne GJ. Aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: a pilot study. Int J Prosthodont. 2004;17(4):447–453. [PubMed]
[xiii] Lee SJ, McCall WD, Jr, Kim YK, Chung SC, Chung JW. Effect of botulinum toxin injection on nocturnal bruxism: a randomized controlled trial. Am J Phys Med Rehabil. 2010;89(1):16–23. doi: 10.1097/PHM.0b013e3181bc0c78. [PubMed] [Cross Ref]
[xiv] Lobbezoo F, Lavigne GJ, Tanguay R, Montplaisir JY. The effect of catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Mov Disord. 1997;12(1):73–78. doi: 10.1002/mds.870120113. [PubMed] [Cross Ref]
[xv] Huynh N, Lavigne GJ, Lanfranchi PA, Montplaisir JY, de Champlain J. The effect of 2 sympatholytic medications—propranolol and clonidine—on sleep bruxism: experimental randomized controlled studies. Sleep. 2006;29(3):307–316. [PubMed]
[xvi] Macedo CR, Macedo EC, Torloni MR, Silva AB, Prado GF. Pharmacotherapy for sleep bruxism. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD005578. DOI: 10.1002/14651858.CD005578.pub2
[xvii] Saletu, Alexander, et al. “On the pharmacotherapy of sleep bruxism: placebo-controlled polysomnographic and psychometric studies with clonazepam.” Neuropsychobiology 51.4 (2005): 214-225.
[xviii] Lindahl, Olov, and Lars Lindwall. “Double blind study of a valerian preparation.” Pharmacology Biochemistry and Behavior 32.4 (1989): 1065-1066.
[xix]Wright, Edward F. (2013). Manual of temporomandibular disorders (3rd ed.). Ames, IA: Wiley-Blackwell. pp. 1–15. ISBN 978-1-118-50269-3.
[xx] Burhenne, Mark. ‘The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness’ Jan 13, 2016.
I have had this for years. A dentist noticed it first. My teeth are flat as a board. I eventually had to get upper dentures & my bottom jaw teeth removed because I literally couldn’t afford the replacement of crowns I even broke them. Therefore obviously all I have is my bottom front teeth. This is the first article I’ve seen on clenching. I am going to try the vitamins I will check with my PCP first I also am a stage 4 melanoma survivor 7 years so far. But I was told about my teeth probably 30 years ago. I wake up with a migraine almost every morning.
Hey Leigh, glad this hoped. Definitely speak to your healthcare provider first about the vitamins. They were at the bottom of the list for a reason, but you never know.
Ive suffered frim bruxism for 40 years. I now wear dental aligners at night after having my teeth straightened. I wake often and find that I’m grinding the heck out of my aligners! I’m disappointed that there is so little research on this condition.
I was diagnosed with TMD in the early 80’s. I’ve had varied success with many of the things mentioned in this article, but I am currently trying Botox and it seems to have helped the daily headaches, or at least made them more tolerable. Even with the Botox, I still have serious difficulty with noise and have to use earplugs at movies and in loud crowds and restaurants.
Botox for migraine and botox for jaw clenching are two different procedures. Unless your doctor gave you some bonus injections for the jaw…. it’s more likely your botox was for migraine from what you described.
Thanks for pulling all this info together. Every now and then I search the web to determine any new info as I have been a bruxism and migraine sufferer since the early 1970’s….yup I was 6. Botox in my mandibular muscles and temporalis muscles every 12 weeks has helped immensely and I have been doing this for almost two years now. However my dentist, who performs the injections, made it clear to me that Botox does not help migraines at all. It helps bruxism headaches. However, people often confuse bruxism headaches with migraines as both are so painful. Now I usually only have a migraine once a month with my hormone fluctuations and my sumatriptan normally helps that.
Hi Susan, my pleasure 🙂
To clarify what your dentist said. Botox injections using the migraine protocol (https://migrainepal.com/botox-for-migraine/) has been proven to be effective for a significant proportion of eligible patients.
Botox injections for your jaw don’t directly affect migraine, but it may help significantly reduce tension and stress in the jaw which could be triggering attacks. Indirectly reducing migraine attacks.
I have suffered with daytime grinding for years.
Recently I’ve been having optical migraine which this condition may have caused, so I have an old night guard I’m trying to see if it helps.
Also get constant tension/ache in my face and eyes all day.
Can anyone offer me advice?
I’ve been on warfarin for 30yrs.
Why do you have constant tension/ache in your face and eyes all day? That alone is enough to trigger migraine. If it’s due to the grinding then addressing that as much as possible would be where I would start. A night guard is a good option but an old one may not be useful. Teeth move over time so you may need to check it first.
I’ve been clenching for years, I’ve suffered countless migraines. I had a mouth guard made but I’m chemically sensitive and reacted to it unfortunately. What helps me the most is to try to be very aware of it and to consciously relax my jaw muscles as well as any other stress. I constantly have to work on keeping my anxiety level down through therapy, meditation, prayer, exercise and good eating and sleeping habits
I try to be aware of it during the day but at night…. I can’t survive without my night guard. I’m pretty sure they have different materials. That might be worth asking at your next dentist visit.
I experienced bruxism while using Xyzal, the newer antihistamine since their Zyrtec version. Supposedly, Xyzal is not supposed to cross the blood brain barrier, but it must with me. Zyrtec didn’t cause bruxism, only Xyzal. By the 3rd day on Xyzal, I woke at 4 am, feeling my teeth were locked, my upper jaw forward. My sleepiness might have exaggerated what I thought, but the strain and tightness of jaw muscles extending up the sides of my head lasted all day. Additionally, left side jaw hurt deep in or under the in the teeth, upper and lower. Some milder symptoms around the jaw hinge and some pain in my teeth happened on the first and second day, but the clenching made me aware. I quit the Xyzal, but the jaw tightness and headache took 3 days to go away, the teeth pain stayed for a week or so.
Clenching could be a side effect of some medications so check the drug treatment info leaflet. To stay with you for a week must have been some heavy clenching that night.
I have been wearing an occlusal splint since 1994 and have had to replace it once. I also have a REM sleep disturbance and I find when that is under control, I don’t grind my teeth nearly as much at night (I take a low dose of Gabapentin to manage it, 300mg or half a tablet). I don’t grind my teeth during the day.
Thanks for sharing Eieen – I didn’t know Gabapentin could help with clenching or REM. I’ll look into that.
I’ve had the disc in the. TMJ removed. It has calcified and formed a "rock" Surgeon’s description
After 6 months I now have a top splint and the difference is amazing, as my bottom teeth were being badly a aged by the grinding. Morry Cameron
Great news! I’m glad you got that sorted Morry.
I have been grinding and clenching for years as well. My migraines have been awful because of it and a hormone imbalance. I agree with all of the therapies you mentioned but one that has helped me the most has been accupuncture. I also use a theracane to work out the tension in my neck and back.
Kelly
Good to hear you’re finding some relief Kelly. I’ve got one of those cheap spikey balls which I lean against the wall on to help with knots in the back and shoulders. Haven’t tried the theracane yet.
Hi carl, so the clenching has effected your neck and back?
Hi David, I’m not sure. I suspect it’s the other way around. My poor posture has affected by clenching.
I recently was diagnosed with TMJ and had a mouth guard made at the Dentist. That and a combination of a medication change have reduced my chronic. migraines considerably.
That shows how complex and inter-connected migraine can be. Best not to put off the dentist visit. Thank you for sharing Deborah.
Ive had migraines since I was 13 im now 50, take zomig which work quiet well but I still have two to three days in.bed a month, and I’ve been having botox but in my head and neck, which has helped the severity and has reduced the length of time they last for. Ive been to a specialist dentist just recently who said my teeth are very damaged from grinding and clenching and to get a splint €800 he said so I will do that but it has to wait for a bit. I wake with most of mine but some come on during the day, I clench my jaw most of the day as well id say. I feel I spend my life getting one or getting over one. I would love to b involved in a study if there is ever one done in Ireland
Hi Janette,
To find out about studies in Ireland for migraine I’d suggest 2 resources:
1) clinicaltrials.gov (US-based but includes trials from all over the world)
2) Migraine Association of Ireland
I hope that helps!
Carl
Hello, I’m in my mid thirties now and I’ve been having bruxism related headaches for almost 5 years now. it was less common a few years ago, it would only happen after a night of drinking. o would have a headache for 2-3 days and eventually it would go away. for the past 2 years though it’s been happening frequently and it s becoming antagonizing and a real source of stress. the headaches are so severe that I wake up feeling really depressed. I’m constantly tired and drained of energy. I used to love sleeping and now it’s becoming the cause of my pain and discomfort. I moved one year and a half ago to another country. unfortunately I suffer from rhinitis allergy and i think it’s affecting my sleep and this is why I’m clenching my teeth more often and thus the constant migraines. I don’t know what to do. it’s really depressing me. I don’t go anymore and I’m constantly in a bad mood. the headaches are so severe that I feel like nails in my head sometimes and what’s really frustrating is that no one really seems to understands how painful all this. neither friends nor doctors.
My first step would be to get a night guard from the dentist. That will address the regular headaches.
Then things like regular exercise, meditation, physical therapy and other items that you might think relevant which were covered above etc. to address the underlying cause.
It is serious.
It is challenging.
And you should do something about it.
Good luck LouLou!
Kind regards,
Carl
Hi carl , have you ever heard of bruxism cause intercranial pressure or neurological problems?
I suspect they are related. I.e. bruxism could certainly be a symptom of a neurological disorder.
What does that mean? Trying to find out why my head hurts so above the ear! Severe pain
I came to your site because I have been grinding my teeth at first it began at night when I was younger. Now, I grind during the day and have been for quite some time now. I have had severe migraines since I was 13, I am not 45. I am now wondering if the root for those migraines are from my grinding my teeth so much. I am now just started to take Magnesium 400 mg a day and also B-12 along with D3 1000iu along with a multi-vitamin in hopes that that would help. I have only been taking these for about 3 days consistently. I do know, however, when I took it is like an energy shot drink but it is a shot of B-12 I believe like 10,000 mg and that helped quite a bit with my migraine. It wasn’t as strong of migraine. I am going to be looking into getting a mouth guard for at night and also when I am home during the day. Because it seems like I am doing most of my grinding during the day and before bed. I don’t know how much I do in my sleep though. I do know I do not sleep well at all and my stress levels are extremely high.
I am going to try and take some of the suggestions like trying to fit a fitness regimen in 3 -4 times a week to start out with and see how this helps it along with the vitamins that I am taking.
I do appreciate you sharing what you have learned with us. So, thank you so much for that.
I have heard from a lot of sources that the Magnesium and also the B-12 helps tremendously with migraines and also tension headaches. I hope that this information is helpful to some. Have a Blessed day. Hugs and <3 to you.
Hi R.Page,
I also take magnesium and exercise regularly and it helps greatly but I still need to do more. Grinding for me is "loading the migraine gun", I only need one other significant trigger when I’ve been grinding and it leads to an attack. The night guard is really helpful. You can get clear ones that are subtle which I sometimes use during the day.
I hope you find reprieve soon, it is awful and can be very difficult to break.
Good luck!
Carl
Thank you for all the useful information Carl. I found your website through the world summit info. I wanted you and everyone struggling with TMD to know of another option that I am considering. It’s called DTR (disclusion time reduction). You can find a lot of videos online documenting successful outcomes in just a couple of appointments. Only a few dentists in the US perform it but it’s supposed to help most people with TMD and in some cases immediately. The idea behind is that anytime you get any dental work done it changes your oclusion causing your jaw to shift and your jaw muscles to spasm constantly. Guided by computer technology through DTR the dentist file down or add milimeters to fix the malocclusion and bring back balance to the bite. The muscles relax and therefore all other symptoms, including migraines and neck pain, are reduced or resolved.
I saw a DTR specialist and she recommended braces first to fix another issue I have, but I am planing on getting DTR when I am done with braces. The only downside is that is pricey and not covered by insurance. I would love to hear if any migraneurs have had positive outcomes. Thanks again,
Maria
Hi Maria,
It’s not something I’ve heard of. Please keep us informed and let us know how it goes.
Take care,
Carl
I came to the site with related issues tied to the mandibular (jaw) area and was asked by my Dr.’s if I had TMJ or grind my teeth. I don’t. I suffer focal seizures but the "triggers" are similar to what you describe and the medications prescribed for your condition are related as well. This is because it ties into the Trigeminal nerve system of the face which provides some muscle control, pain receptors, and temperature control for the body and is the "trigger" system on how the brain receives feedback through the cranial nerve. After finding no relief for myself, I began seeing an acupuncturist who has been able to help me. I see someone mentioned an acupuncturist previously, but you glossed over it Carl. So I thought I’d mention that my treatments consist of needles in the TMJ joint and in and around the scalp that control the jaw. Although I don’t grind my teeth, all these pressure points were very sensitive when the Dr. pushed on them. I was very surprised and even more surprised that they provided relief of my symptoms. Carl, if you’re still looking for relief, I suggest you give a qualified acupuncturist a try with 10 visits and evaluate your level of pain afterwards and report back to the group. Kind Regards!
I’ve tried acupuncture before for my migraine condition and didn’t get results personally although others that have. Acupuncture might provide muscle/tension relief but I’m not sure how it would address the root cause of grinding or clenching which what I’m working on and making slow progress with.
I am so happy to have come upon your article. I have been grinding my teeth at night since I was a teenager. Now at 55 and being menopausal I am experiencing terrible headaches at least 2 to 3 times a month and they last on the average 2 days. Being a massage therapist I know what’s going on and the related muscles to work on and the trigger points involved. Although working on myself is a bit hard. There is a silver lining though. I have some clients with the same issue and can help alleviate their pain. I find that the night guard helps and staying hydrated. I have been taking melatonin and black cohash at night. I’ll be looking into the meditation! Stress is a beast….
I agree Heidi, it is tricky. Grinding has been a notoriously stubborn habit to kick.
I woke up with a tension headache 20 years ago and it has never gone away since. Not even for 5 minutes. I know my constant clenching due to anxiety is a major contributor, but I have no idea how to not feel anxious. I’ve tried everything.
Hi Deleah, after years and years it can be very difficult to change something. But if we know it’s not helpful it may really be worth seeking external help. For anxiety, a good pain counselor or psychologist are well positioned to help.
It is estimated that 8% of the adult population, i am really conscious about this %.
It is surprisingly high, I agree.
Great information Carl. I have this headache since my previous job which is work related stress and during the same time I developed grinding my teeth which continued on until today.
If I have those mouth guard, is it going to ease the headache from bruxism. The headache sometimes mild and sometimes terrible. I try to consciously aware my teeth, but somehow, I forgot how my jaw relaxes before the bruxism started, and it just awkward.
Anyway, this one is great article.
P.s. sorry for the words, English my second language.
Hi Has Hashim,
Great question. I have a similar situation. I got really busy a few years with work and stressed. Since then I grind my teeth. The mouthguard for me has been essential, otherwise I would wake with daily headache and sometimes migraine. I would highly recommend it to address your symptoms.
To address the cause, it’s really about developing what experts believe to be your underlying stress or habit. Both have proven difficult for me despite good sleep and exercise habits. I do meditate and when I’m compliant my grinding does improve. Haven’t stopped it yet though. Just keeping it at bay. I hope that helps.
Great article you have written! what do you think, is yoga good for preventing headache? I usually got headache while working. That’s why I am asking. I want to get rid of it naturally. Your written is also well described and informative.
Hi Neil, thank you for your feedback. Yoga is a gentle form of exercise which suits many people with chronic pain. It can also be relaxing and a rejuvenating time away from the stresses and pace of life so in that sense, it can also be helpful. I’d consider it a useful part of regular movement and exercise which is an important pillar of migraine management and prevention.
Hi I only just came across your article after yet another visit to the doctor who again sent me away saying nothings wrong and they can’t do anything. My neck pain and tension headaches are getting worse, and I also have sinus problems. My dentist has been most helpful and I have used a mouth guard on and off for years, it helps with grinding at night but still find I wake up with my jaw clamped shut and I am now also getting numbness in my hands as I am clenching my fists too! I need to relax but easier said than done with a full time job, renovating a house and two young children! Massage helps but don’t have the time or money to do this regularly. Being in pain all the time is getting me down I am going to try some of your tips.
Hi Susan, I hope this article helps. It is much easier said than done. Moving house alone is one of the most stressful things we do, let alone having two kids, sinus issues and regular headaches. Good luck! I wish you all the best.
Oh great article! Reading at 6am after waking again with bad headache around my eyes, temple and mild earache! So i need to make a list!
I have aches & pains in my right arm, hip & groin which has stopped me going to the gym, this is depressing me! (due to see a physio soon ) so im waking in pain from that & now my jaw is all clenched! Definitely think this jaw clenching is anxiety from my aches & pains which are worse when rested/asleep & its connected!
Plan: Visit dentist, go back to the gym, take vitamins, meditate & maybe go to doctors so he can convince me I’m not falling apart! Lol!
Good plan Andrea. You are not your migraine disease. It is not your fault but there are things we can do that do make a big difference. Food may be playing a role as well in our ability to handle stress but there isn’t good evidence. General rule of thumb is to avoid proceed foods as much as possible (without getting disappointed you are not perfect – no one is with their diet). I’d also add sleep. That’s a big factor for me personally.
Has anyone heard of a treatment for Bruxism called Cerezen ? It’s earplugs that are supposed to stop your jaw from clenching
Hi Jules, I hadn’t heard of it until you mentioned it and I looked it up. It does look interesting, it appears to work by giving the user feedback in the ear when the jaw is not in its correct position, thereby encouraging healthy habits over time. It seems to have positive reviews from users and could be a useful tool.
I’ll try to make this short. Teeth cleaning, headaches for over month straight, high BP, pains turned to sweeping/whooshing in head brought on by something as simple as a laugh, word or turn of head. They were instantaneous stabbing pains and I never knew where they’d be. Other symptoms include vertigo, completely felt lifeless (couldn’t cook for couple weeks, couldn’t clean house for months, no energy whatsoever. Had PT, at one session PT touched underneath my jaw, hit a spot and the pain was excruciating. Neurologist gave 13 shots in head neck area. Once pain was so bad I couldn’t drive. Have been to ER for BP 196/120+
After all the blood tests and different Dr’s the pain has lessened but still persists on being my daily visitor. Also saw eye Dr. had pains in the temporal region. Yesterday I saw my periodontist and he believes my bite splint is off. After examining it, he said I need a new one. Filed the old one down and I used it last night. Had a few head pains today. Praying the adjustment and new splint will take care of my problem as it’s been ongoing since the end of January. Ran into another lady that had all the same symptoms and she said it also started after a cleaning at dentist. My dentist said no that’s not what caused all my problems. Curious to know if others have any of these symptoms and reasons why. Thank you for your patience in reading my lengthy post.
Hi Cyn, there could be any number of causes for migraine to progress or get worse. The teeth feed into a nerve which affects migraine (called the trigeminal nerve) so it is possible that an uncomfortable stimulus in the jaw could be triggering or making you more vulnerable to migraine. But with other health issues that you mentioned it could be an aggregation of all those factors leading to central sensitization. Dr Dodick from the Mayo Clinic talks about this in more detail in his talk. You can preview it here: https://www.migraineworldsummit.com/2019-david-dodick/
I have been suffering from tmj daytime clinching for about 6 years. Drs all brush me off but my dentist said for sure it’s tmj and i need a guard. I got a mini guard my pain is always on the side i clinch on only. I get pressure behind me eye my brow area i hear clicking and popping also. I just knew something was wrong with my head but they said no it’s all related to tmj
Hi Tiffany, I’m still grinding and it is a really difficult habit to crack (no pun intended). I don’t see any reason why it could not be both. TMJ and migraine is related. One could feed off the other. If so, if you can improve one the other may also improve.
My teeth clenching seems to coincide with my thyroid being underactive (I have Hashimoto) whether that is due to vitamin deficiency or stress hormones I don’t know. I’m working on getting my thyroid levels back to normal without medication – I’ve done this before by going on a gluten free diet and the clenching stopped or improved as I didn’t notice myself doing it. My levels have recently gone up after a bout of shingles so just hoping I don’t have to go on medication now. Can’t see anyone else mention thyroid disease on here but thought this may help if someone is undiagnosed.
Hi Vick, that’s very interesting how you describe the interplay between your diet, thyroid and consequent clenching. Thank you for sharing!
I have been a teeth clencher for years (now 40) and have ‘impressive’ (according to my dentist) tori because of it.
I know too much caffeine can kick things off, but being English I can’t quit tea 🙂
Reading all your information, and the comments, I’ll be asking about a mouth guard next time I go to the dentist.
Woke up today feeling like I’ve been punched in the head. Think I need to be more proactive, instead of just living with it.
Me too Step… I’m still struggling to kick this habit. But the night guard helps manage the side effects.
Not sure if you’re still replying to these messages, but I’ll try anyway. 2011 was diagnosed with Bruxism by a neurologist. He put me on many different antidepressants, and sent me on my way. I got a mouth piece but the cheap kind, not the custom made. Ended up throwing it out. Over the years, I took various medications and OTCs to deal with the headaches. Fast forward nine years, I couldn’t take it anymore. Decided to see a dentist that makes splints. But he tells me he doesn’t think my headaches are caused from bruxism. He tells me I have wear on my teeth for sure, but not enough that would suggest everyday headaches. Tells me I should have a sleep study done, instead. So I had a sleep study done, (my second) and results showed very minor sleep apnea. At this point, I decided to go the Botox route. Unfortunately, insurance told my I had to try Aimovig first before they would approve Botox.
So again I was at a dead end. I decided to look through my old medical files, and see which medication worked the best for me over the years, and maybe go back to that. Nortriptyline had yielded the best results by far. So now I’m back on that, and even though it’s not 100% pain proof, it’s better than where I was. (Everyday headache)
One thing that has always bothered me about my diagnosis: Rarely, if ever, would I get sore jaw muscles or sensitive teeth, just terrible headaches in the morning that would sometimes ease up during the day, only to come back after work. I got all the other symptoms though. Somewhat chipped teeth, occasional ringing in ears, morning headaches and when I open my mouth very wide, a slight popping noise from the right side of my jaw.
Crazy how this has stayed with me for nine straight years and counting! I’m glad I came across these comments. I had no clue there was a difference between Botox for migraines and Botox for Bruxism. I’m going to see a new neurologist soon, hopefully he can point me in the right direction.
Hi Dave, yes I’m still responding. Glad to hear this article helped. You might also find this article helpful if you are waking up with headache or migraine: 15 Reasons Why You Wake Up With A Migraine
Hi Carl,
I have been suffering with morning tension headaches and chronic neck pain for over 38 years. I suffer from sleep bruxism. I also have mild sleep apnea and have tried CPAP for 3 months, but it didn’t help. I tried Cerezen for 3 months and they did not help either. I have had my teeth straightened with Invisalign, tried Amitriptyline, Gabapentin, Tizanidine and other drugs. I have tried all kinds of supplements like Magnesium, Turmeric, high dose Vitamin D and others with little results. I have tried Botox in the masseter with the migraine protocol twice and it actually helped, but I stopped doing it because I was afraid of bone loss in the jaw due to Botox (there are some studies they say it can cause bone loss). Nevertheless, I am ready to try Botox once again in a month or so as I feel it is the only option. Then something very strange happened…..I went back to CPAP and went 6 days without a headache. Then I got sick and had to stop CPAP, but I plan to go back once I feel better. I feel that the best options are as follows:
1. Try Botox – especially in the masseter muscle if you have bruxism – I have been to headache specialists and they love using this treatment – however, this is only a treatment for the symptoms – it is not a cure and you will have repeat the injections every 3 months.
2. Check for sleep apnea – here is the REAL KICKER about this – I started out with using an APAP machine (it automatically adjusts pressure due to variations in breathing) and IT DID NOT HELP FOR 3 MONTHS STRAIGHT. If you get diagnosed with sleep apnea, they will probably give you an APAP machine. MY ADVICE: GET AN APAP/CPAP MACHINE LIKE THE PHILIPS DREAMSTATION (you can switch it from APAP to CPAP. I only got my 1 week improvement in headaches with I switched to CPAP and started adjusting the pressure. I believe APAP increases and decreased pressures too dramatically to help. MY BEST RESULTS were CPAP mode, 6.0 pressure (be aware you will have to adjust the pressure until you get the results you need)
3. Look into getting a MAD device (I have NOT tried this, but it hear it can help even though it may cause jaw pain)
I really believe my headaches are coming from UARS (upper airway respiratory syndrome). This is treated with a CPAP machine or a MAD device.
Will the CPAP work or will I have to got back to Botox? We will see. At this time, these are the TWO best options for chronic daily headache and bruxism.
Hi Paul, thank you for these detailed tips. I really appreciate it and they make sense. I’ve had a sleep study done and they found no need (fortunately) for any device or sign of sleep apnea. I find my symptoms improve significantly if I exercise and meditate daily. Doing that is not without its challenges but it is also good for a variety of other reasons so that keeps me motivated.
Hi.Carl,
I have been diagnosed with TMD and once the Covid—19 lockdown is over I will be going to the dentist for a custom made night guard.
I have a terrible habit of clenching my jaw when I’m awake, particularly the left hand side. My jaw joint is stiff and clicks and now I’m aware I’m trying very hard to consciously relax my jaw.
My pain is in the left hand side of my neck. The pain is excruciating and has resulted in several trips to the dentist and the dr who prescribed 2 x antibiotics (diagnosing a possible tooth infection), amitriptyline and now naproxen.
None of them made any difference although with amitriptyline it helped with my sleep (my sleep is poor), I suffered with constipation.
I was referred to the maxi facial unit at the hospital who diagnosed TMD and they have referred me for physio too (not started that yet). The hospital also referred me for a mri which I’ve had and I’m now awaiting the results.
I use cold and heat compresses to soothe the pain in my neck, tiger balm, voltarol but the pain does not go away. I have even bought a neck brace that lengthens the neck but it’s too soon for me to feedback on it’s effectiveness.
I do intend on getting the mouth guard and trying acupuncture as well as buying magnesium supplements. . I’m very active, I walk a lot and run two or three times a week.
I have a stressful job in a college and in the latter part of last year I suddenly lost my partner so stress and anxiety are a huge part of this for me. I need to consciously reduce my stress levels and hope I clench less. I’m obviously still waiting for the mri results too so whether something else is at play here I don’t know.
Many thanks for your article – it’s very interesting and good luck with your studies.
Kind regards, Nicola
Hi Nicola, thank you for your comment. Given your circumstances, I think it is very understandable that grinding/clenching has developed. You are going through a lot. I hope you find some relief soon!
I have suffered with morning headaches for the majority of my life but especially after entering medical school. Majority of my headaches would be posterior with referral frontally And especially retro-orbitally. I was certain I had a sinus issue yet ENT said they found nothing wrong. I thought maybe allergies but no. A preceptor mentioned my neck and yes posteriorly especially what I was thinking were the occipitals were always so tender and seem to be the origin of the headaches (though could also be the posterior temporalis). I finally got a custom night splint and wow what a difference. Headaches seem to be coming back more frequently lately and I wonder if the night guard is wearing out? Does this sound like TMD? If so, I can understand the posterior temporalis as I am a back sleeper (I have spent $$$ on pillows as thought was position of my head—I would feel like I got beat up by Mike Tyson in the morning!) but the connection to the occipitals and sub occipitals I am interested in. These headaches have been the Bain of my existence but I feel like I may have found the root of the issue. I definitely clench during day as well. Thank you so much for this site and in advance for the answers.
Hi Enrico,
Just about anything could be flaring up your migraine condition. Your dentist could tell you if you have worn out the splint. Another helpful article if you are waking with migraine or headache can be found here. I hope this provides a few clues.
On another note, we need more doctors like you treating patients with migraine. Very few really understand what it is like and there is a huge demand for a doctor who genuinely cares about their patients. If you haven’t already, consider a career in neurology or even specialize as a GP in headache. There are so many good treatments and options available and you can literally give patients their life back.
Hello doctor thank you for this article right after I woke up I immediately Googled my symptoms and this came up. About 5 years ago when I was going through a divorce I noticed that I would have horrible neck spasms and they would never go away with massage therapy twice a week.. my physical therapist recommended getting a hard mouthguard and I was basically a miracle I had no spasms no more pain. Fast forward to a week ago, I stopped drinking caffeine. I used to have a 32 oz Diet Coke everyday at lunch . The next morning I had a horrible headache around my eye sockets I assumed it was the caffeine withdrawals, it was pretty much the same the next couple days.. Id also be tired in the mornings and feel like taking an afternoon nap.. Anyways, over 10 days later since I stopped caffeine cold turkey, I woke up today with horrible neck pain below the skull and both sides of the head, especially the muscles you can feel when you bite down… I thought to myself this couldn’t be a caffeine withdrawal anymore this is something else and I still wear my mouthguard every night so I read this article and then read the article you wrote about the causes and thought it may be a cluster headache or the other headache that says some caffeine before bedtime will help. Either way my first goal is to make an appointment with my dentist to see if my mouthguard is ineffective, and an occular splint … im also going to have some dark chocolate before bed to see if a little caffeine helps.. not quite a 32 ouncer but some.. it’s just really strange because before I stopped the caffeine I was sleeping fine. Maybe im one of the few that needs alittle caffeine? thanks for your article. Pat
I’m glad this helped Pat. Remember migraine brains are also sensitive to change. Any changes you want to make, the more that they can be gradual the better. The question worth asking is how were you sleeping before?
This is the most helpful site I have found. I’m 68 years old and I have been clicking and clenching my back teeth for about 9 years. I find myself clicking my teeth to songs, clicking along with tapping my foot or just clenching. I often get headaches from doing it. I try to be aware and stop but it doesn’t seem to help. Sometimes I am preoccupied with a project or busy traveling or doing something and I’ll notice I’m not doing it (yay). Most times, however, it’s happening all day long. I wear a retainer at night so I think that helps then. My face and mouth are so tired from this and I just can’t stand it any longer. I’ve mentioned it to my dentist and my doctor. Dentist suggested a night guard (but i wear my retainer) and possibly an ENT doc. My GP doctor hasn’t been a help, said the only thing I can try is botox. What would you suggest at this point? If you suggest biofeedback or other process, how do I start finding someone?
Hi Sandy, I’ve really struggled with this as well to be honest and I do a lot of the good things like getting a good amount sleep, reasonable diet, regular exercise, and meditation. But I still clench at night, every night. So I’m actually considering a hypnotist. The challenge here is where to find someone who is accredited and reputable. They have mixed reviews so I’m proceeding with caution. I haven’t booked anyone yet.
Excellent article, with some great information and advice. I thought I would share my experience because it could help someone. I was experiencing tension headache almost daily. Had a few doctor visits, increase exercise, magnesium and water intake but still had persistent headaches. Also got a stand up desk at work because I stare at screens quite a bit. That somewhat helped but the headaches still in greed throughout the day. I already had a a bottom mouth guard but decided to dig out my old top mouth guard. Within days my headaches were gone. Since the pandemic I have grinned my top mouth guard down so my headache have come back. So as a piece of advice I would suggest to people who have exhausted some of these options to maybe try a different sleep guard. Switch from top to bottom or vice versa. As we all know, anything is worth a try when dealing with debilitating headaches. Fingers crossed my new mouth guard relieves my problems. At the moment I am taking a muscle relaxant before bed, doesn’t really do the trick. I’ve considered using a sport mouth guard for the time being until my detention appointment.
Thank you for sharing Tyler. Good suggestion about changing night guards and one that I plan to try! I was warned by my dentist not to use a sport mouth guard… they are not designed for purpose and can apparently warp your bite or teeth alignment when used extensively and if not careful.
I take antidepressants as I am prone to periods of depression. I was warned that they could cause jaw clenching. Having worked through a CBT programme combined with the antidepressants my mood is much better and consistent with very few outbursts of anger and really low mood.
The jaw clenching does however give me headaches. I found this out last week when I consulted my Doctor who proscribed muscle relaxants but has restricted the dose because of the risk of dependancy. This has worked in the short term but what do I need to do for long term relief?
I am aware that I am clenching my jaw in the day time and when this happens, I make a conscious effort not to do it but of course, this does not last. What should I do?
Peter I struggle with this personally as well still today. I notice that I am better when I am meditating or taking time to unwind each day. I use a splint at night which really helps. Without that, I’d be in trouble. Frankly, I’m considering a good hypnotist if I can find a credible one. I’ve just about everything else. My posture is poor and I do need to do more about that. But it is a tricky habit to kick!
A very useful article- my dentist has suggested removing all my molars to prevent bruxism as my bite is so bad these are the only teeth that meet and take all the pressure. I have about 2 migraines a month lasting 3 days if I don’t take sumitriptan. Every morning I wake up with a painful face. Would the cephaly device help me? I use a night guard and have done for years but it is not helping
If it is not working, then it’s time to try something else. Improving your migraine condition can help. Cefaly could help. It’s worth a try. I’m considering some extreme measures, but it is worth going through everything on the list carefully. I still am struggling with my bruxism too – but my night guard does help. I’d also consider changing your night guard, which sometimes can help.
Great page. I’m a psychologist and I’m trying to find a behavioral treatment protocol for someone who is clenching their jaw during the day. Typically there is a manual associated with any clinical trial that clinicians can use with their patients. Do you have links or references for that?
Hi Max, which clinical trial are you referring to?
I do not know if anyone has said this yet or not, but as a day clencher I have been trying to research this myself and stumbled across an article stating that if you put the tip of your tongue between your teeth it helps to relax the muscles. As soon as I read it I tried it and it seems to have helped. It also makes it harder for you to clench while your tongue is there. My slight headache has also dissipated. Hope this helps others!!!
Thank you for sharing Cindy!
Hello Carl: Found this article and I’m looking for the right medical specialist. Maybe you can advise?! I’ve had bruxism since at least age 20 (now 50) when someone told me I ground my teeth at night. Jump ahead 30 years and I’ve worn a night guard (now front-only type) for almost 10 years. I wake with daily headaches, but I have a collection of issues like cervical disc narrowing (C6 caused numbness in hand), tear in rotator cuff. At this point, I’ve tried PT, message, mouth guard, muscle relaxers, gabapentin, naproxen, etc. However, I don’t know what specialist to start with — a dentist, neurologist who specializes in headaches, ENT, pain management specialist, etc. My collection of migraine types is increasing. Just this year, had migraine that made me think I had a stroke.
Now, when I get my back teeth worked on, my jaw disclocated (just happened with root canal yesterday). Very scary experience.
Anyhow, might you (or others) have a suggestion on which specialist might be best to help me sort out the headaches to get a fresh view on things? The doctor in the article was neurologist. Thanks!
Susan (USA)
Hi Susan, a headache specialist with a sub-specialty certification in headache medicine is what I would seek out. You can see a directory of them at American Migraine Foundation or there is another directory for a slightly different certification at the National Headache Foundation. With all these issues it might require tackling each as best you can to get some synergistic results. It’s unlikely you’ll find one magic solution that addresses them all. Good luck!
Thanks so much Carl! ENT has been ruled out and Neuro is next. This article will be printed out as a resource for the consult. Best, Susan
Hi Carl,
I came across this a few days ago because like all the others who have commented, I have suffered from jaw clenching, headache, face pain for 20 plus years. In some small ways it’s comforting to know that I am not the only person who deals with this. I have 2 questions; first- Which Doctor do you believe is the best to see? I have seen all of the typical ones and have yet to get any real relief. Second, have you heard of anyone having adverse effects from Botox injections (like jaw being frozen)?
Oh I guess I have one more question, why do you think when a patient is trying to convey the pain of this condition that a doctor automatically thinks that one is drug seeking?
Thanks,
Aimee
Hi Aimee,
To answer your questions 1) The best doctor is someone who genuinely listens to you and is interested in helping you. Sometimes a GP who does additional research and makes inquiries on your behalf is better than a tired specialist that doesn’t really care. 2) I haven’t. When Botox is used for the jaw it should have the opposite effect. It should relax clenching/grinding with the hope of acting as a circuit breaker. 3) Doctors need to be increasingly careful of this because there are serious implications. So if you’ve done your homework and you come across in a credible way speaking to an empathetic doctor then hopefully you shouldn’t have any issues. Relationships with doctors are like any others, they require trust which often takes some time.
Hi there: I am a retired physician who during my years as a practicing generalist; noted a significant correlation between true ( migraineurs-* diagnosis confirmed by patient’s personal neurologist and coexisting presence of bruxism as established by concomitant clinical presence of TMJ tenderness upon physical examination during an acute episode-or post episode migraine of several days post episode.). I am convinced that the connection isn’t serandipidous in occurrence but an indicator of the possible etiological cause of the migraine. I would also find such tenderness in migraineurs when not experiencing headache at time of an Exam. I am knowledgeable of the trigeminal pathway which provides neurosensory efferent pain impulses into the trigeminal ganglion and from there into the pain conducting trigeminal brain pain circuit ( which now is a leading subject for the peptide treatment blockers). I am in the process of trying to get a study and get firm statistical data to establish a strong link with migraine- bruxism connection as previously mentioned. If the results are significant, then this relationship may provide a fresh approach to the understanding of the brain/body regulatory circuitry for self regulation of one’s own neurological homeostasis of our cerebral fulcrum point of normalcy. Would appreciate any response. The condition of restless leg has also been associated with migraine but not my area of interest.
Sounds like a worthwhile study Dr Rumsey! Migraine and bruxism needs more research and treatment options!
Hi! I started clenching a few years ago, I am 29. I guess it was a stressful time but I have not been able to stop since. I do it day and night and it gives me headaches every day. I got a mouth guard almost right away but one year later I developed some sort of allergy to it that doctors first didn’t believe and then could not explain. In Sweden where I live, it seems like they only do mouth guards in one material and I clench to hard to get the silicone one. Needs to be hard. I saw a wonderful jaw specialist and for now she is doing research and told me to stop pressing my jaws and also my tongue at day. It is so hard to stop! I am seeing a neurologist in a few weeks, hoping to get Botox and for it to help me get a new start.
I have tried as many things as possible for this problem, massage, psychical therapy, acupuncture, muscle relaxers, acupressure, vitamins, meditations for inflammation etc.
I am a yoga teacher and I think that active relaxation helps and is good overall and might help the body and mind “let go”. I am also trying out “sleep tape” because I tend to mouth breathe during the night. Thinking about seeing a psychologist about stress and mental health.
I hope this gets in a better light in the medical world because it took forever for me to get taken seriously and get treatment. It is also very expensive even though it might be worth it.
Feels good to not be alone in this. Please share and maybe we can tell our story and get tips and tricks from each other.
/ Fanny
Thank you for sharing Fanny. I’m the same. Tried everything I could even with daily meditation, exercise and good quality sleep the clenching remains. Incredibly stubborn habit.
I have had clenching and grinding problems for many years now. I am 50 now. I have tried night guards but to no avail. At times, to ease the headaches – I take up to 10 Advils in a day. I haven’t tried accupunture but its all temporary relief. I saw an add for laser for migraine – is that something you would recommend?
I haven’t seen any evidence supporting laser therapy for migraine. I’d ask them for it before you go further. Take care with the medication use. Having 15 days or more with pain killers like Advil could lead to medication overuse headache or rebound headaches.
Found your article while researching ‘clenching the jaw’. I did want to pass on (as I never read any comments about) how wonderful Craniosacral Therapy is. I would highly recommend this to you and ALL of your readers. I have been seeing a CST for many years for many different types of issues and my therapist never disappoints. A good experienced therapist can release blockages and assist the flow of cranial rhythm. Most recently, she concentrated in my mouth and released some fascia scar tissue from a old root canal. I have more dental work scheduled and can not even imagine not following it up without CST. Wishing you and your readers healthy days ahead.
Interesting article. I found a few biofeedback devices and new coming to the market. If this is a habit, it will be essential to see how the biofeedback devices work. For more information check sleepguard headband, cerezen (now defunct), bth4, bruxrelief, and others.