One of a busy day someone came to me with compliant’s of severe migraines associated with vomiting and nausea early in the morning and frequent episodes of migraine all day long for the last 10 years, symptoms made worse when chewing gum and tinnitus (ringing in the ear) associated with pain.
My impression in this case was ‘Text Neck’ causing cervicogenic headache (neck-headaches) as I guided my client through my treatment plan that would entail a referral to a neurologist if symptoms persist. From this case I reciprocated that temporomandibular joint pain (jaw pain) is usual consequence of neck pain that then on the other hand causes severe headaches/migraines. According to my clinical reasoning provocation of symptoms during chewing meant that the temporomandibular joint (TMJ) is responsible for migraines just as well as the neck.
How does it happen?
There is a strong correlation between postural dysfunction of the cervical spine (neck) and TMJ by virtue of muscle coupling force mechanism around the neck and jaw area.
A dysfunctional cervical spine resulting from sustained poor posture (text neck for example) can cause jaw joint pain. How?! This dysfunction in the neck tensions front belly of a muscle (digastric) that connects from the mandible (jaw bone) to a horseshoe-shaped bone (hyoid bone) situated in the front midline of the neck.
This attachment means that when the head is excessively bend forward the digastrics will exert a backward force on the mandible. With prolonged forward-bend neck as it occurs with sustained poor postures, the jaw bone joint attachment (mandible condyle) will be pushed back resulting to jaw pain, jaw jerking on closing mouth, swelling, increased muscle tension around the jaw muscles and other places in the skull.
Here’s how it happens: Your jaw muscles tighten (as a result of tension in your neck) when you grind or clench your teeth- or do things such as chewing gum for example provokes pain from your jaw then travels to other places in the skull, causing headaches or, in severe cases, migraines.
What you feel when you have Migraines caused by your neck and jaw.
- Migraines (Neck-Headaches) early in the morning and mild to severe episodes during the day.
- Nausea and vomiting in severe cases.
- Restrictions/Limited range of motion in neck movements.
- Migraines are made worse with chewing.
- Jaw jerking when closing mouth with ‘clicking’ noise in the jaw.
- Jaw and facial pain.
- Tight neck, facial or jaw muscles.
Assessment
As with all areas of physiotherapy a thorough history is taken. Assessment will include:
- Assessment for swelling, tenderness, muscle tension or hypermobility of the jaw joint.
- Assessment for posture, range and quality of movement of the jaw and neck.
- Deviation or deflection of jaw and signs of grinding and clenching teeth during sleep.
- Rule out other clinical causes of headaches, neck pain and jaw pain.
Physical Therapy
Treatment of migraines associated with this condition will be based on findings on assessment by an experienced and trained physical therapist who would include the following based on the findings:
- Intra-oral myofascial (muscle and it’s covering) release.
- Facial muscle release.
- Neck, shoulder and back myofascial release.
- Therapeutic exercise rehabilitation programme.
- Adjustment of temporomandibular joint.
- Atlanto-occipital joint thrust manipulation and upper cervical spine mobilization.
Remember to consult your doctor, physical therapist or dentist to find out the real cause of your migraines.
Written by:
Moses Katasi
Physical Therapist
