Can Bruxism Cause Headaches and Neck Pain?

By Dr. James Fricton

TMJ-related bruxism is commonly found to cause headaches and neck pain issues.

Bruxism, or teeth grinding and clenching, often leads to tension in a person’s jaw, neck, and head muscles. This tension commonly causes headaches.

Aside from the sheer pain of having a jaw that fails to function correctly, having it escalate to a severe headache, too, diminishes a person’s pain threshold. Some even call it a “clenching jaw headache“ or “muscle contraction headache”. Grinding your teeth, whether you are aware of it or not, can lead to migraines and neck pain.

Table of Contents

• What Triggers a Clenching Jaw Headache?
• What Bruxism Behaviors Cause Headaches?
• Can Stress-Triggered Bruxism Cause Headaches?
• Is TMJ Bruxism Related to Chronic Headaches?
• How do I Know if my Headache is TMJ Related?
• Do Self-care Strategies Help Prevent Headaches and Neck Pain?
• What is the Best Muscle Relaxant for Bruxism Headaches?
• Answers to Additional Questions About Bruxism Headaches
  • Can Bruxism from SSRI Medications Go Away?
  • How Is Bruxism different from a TMJ disorder?
  • What does a bruxism headache feel like?
  • What Types of Headaches are Associated with Bruxism?
• Summary: Gain Treatment for Bruxism-Associated Headaches

What Triggers a Clenching Jaw Headache?

The most common cause is jaw tension. A person’s TMJ muscles span their jaw, cheeks, and the side of their head. Bruxism can overwork these muscles to the point of throbbing headache pain, and in some instances, migraines and neck pain. TMJ can trigger confusing referred pain in the form of headaches, neck pain, shoulder aches, and even toothaches.

The pain often worsens when moving the jaw, but at times, it is felt even the jaw is resting.

Headaches are one of the many common symptoms of bruxism. Temple or behind-the-eye headaches are one of the many common symptoms of bruxism since it strains the temple muscles. People who unknowingly grind their teeth are three times more likely to develop TMJ-related bruxism. Statistics show that headaches have been found in 65% of patients who clench and grind their teeth.

In some TMJ cases, bruxism can be frequent and severe enough to lead to jaw disorders that are accompanied by headaches, and other problems. Every headache has a cause, and TMJ headaches are no exception. Your TMJ pain specialist is the best-trained clinician to treat not only your headache and pain – but to additionally decipher root causes. Healthcare providers can use our Bruxism Risk Assessment for diagnosis.

Other common oral parafunctional habits include chewing gum, biting or chewing oral tissues such as cheek mucosa and lips. Other poor habits are biting/chewing on non-food objects such as pens, pencils, erasers, and fingernails. Additionally, repetitive behaviors that are goal-oriented but continuous can also strain your teeth, jaw, and neck musculature. Examples are playing musical instruments with the mouth, scuba diving, and phone cradling.

What Bruxism Behaviors Cause Headaches?

There are specific bruxism behaviors and oral habits that cause headaches.

Jaw pain, headaches, and neck pain are the best indicators of daytime or night-time bruxism behavior, there are also other signs that indicate bruxism is present. Knowing your headache triggers assists you in avoiding situations that cause your bruxism headaches.

Bruxism behaviors and oral habits that may cause headaches include:

1. Tooth wear and fracture.
2. Jaw muscle tenderness and TMJ tenderness.
3. Enlargement of jaw muscles.
4. Cheek or lip biting.
5. Tongue or buccal ridging.

1. Tooth wear and fracture. When nighttime bruxism is present, it involves tooth grinding and the teeth will show atypical wear facets, fracture, or crazing of the enamel. Studies show that simple tooth contact can increase the activity of the temporalis and masseter muscles compared to a relaxed baseline. However, because the presence of abnormal wear patterns is a historical record, the presence of such patterns cannot be used as a reliable indicator of current, ongoing grinding.

Pain from a tooth’s nerve pulp can travel along your trigeminal nerve to other parts of the head, causing what feels like a classic tension headache. At times, nerve pain from tooth damage can trigger an even more severe form of headache known as migraine.

2. Jaw muscle tenderness and TMJ tenderness. If you suffer from morning headaches or jaw pain, there likely is a connection. As we stated above, teeth grinding and clenching can indeed cause headaches!

This may also be more strongly related to daytime clenching, gum chewing, fingernail biting, and other day activities than nocturnal habits. Morning muscle soreness may indicate nocturnal habits. However, the presence of pain may not be a good indicator of nocturnal clenching.

3. Enlargement of jaw muscles. Mild clenching may not be readily observable but high-intensity clenching may be observed as bulging of the body of the masseter or temporalis muscles. Muscular factors are also a possible etiology of tension headaches, according to the National Institute of Health (NIH). [1] ^[1]

4. Cheek or lip biting. Sores of the cheek mucosa or inner lips will indicate whether patients chew on their oral tissues. Evidence of such parafunctions will often present as a thin line of lacerated tissue or a patch of shredded tissue about where the teeth meet.

5. Tongue or buccal ridging. Bracing the tongue against the teeth will contribute to a scalloping ridge on the lateral border of the tongue. It may occur from a negative intraoral pressure from “sucking in”. Likewise, clenching or oral suction will compress the buccal mucosa against the teeth and contribute to scalloping ridge at the teeth line on the buccal mucosa. “Scalloped tongue is most commonly associated with TMD cases in women and those involving frequent headaches”, according to Medical News Today. ^[2]

Can Stress-Triggered Bruxism Cause Headaches?

Stress can amplify TMJ bruxism and headache pain. Your jaw muscles are connected to the cheeks and under your chin. When a person with bruxism clenches or grinds their teeth, the tension created spreads out and up into the head and neck. This tension can become a headache, as well as create sore muscles throughout the face, head, neck, and even into the shoulders.

Stress makes it more difficult to tolerate any type of pain. Stress may affect your motivation or ability to follow through with muscle rehabilitation, relaxation, and other recommendations for healthier living. You may engage in poor habits more often when you are under stress. Discuss this with members of your pain management team.

Learning general relaxation exercises and using alternative ways to deal with life’s challenges is typically helpful. Most importantly, all the possible contributors to your physical problem should be addressed. This way, you gain the best treatment result for bruxism-related headaches. Improvements may be gained in the near future (3-6 months) as well as good long-term maintenance for relaxed and healthy muscles.

Is TMJ Bruxism Related to Chronic Headaches?

It can be. Your TMJ muscles impact your jaw, cheeks, as well as the side of your head. Thus, TMJ bruxism overworks these muscles. It can occur to the point of generating throbbing headache pain, and in some instances, migraines.

Chronic headache pain may last for a long period of time with minimal or no relief. When you have had pain for a long period of time you are likely to find yourself increasingly more frustrated and irritable, or even depressed.

This is a fairly predictable response to consistent pain. If this is the case, consider discussing these frustrations with your chronic pain provider. Often there are different approaches that can be applied to changing lifestyles and attitudes. This is helpful when experiencing frustration and depression as well as physical pain.

How do I Know if my Headache is TMJ Related?

If you note any of the following symptoms occurring alongside your headaches, then it’s likely that it’s bruxism TMJ related.

• Clicking or locking in your jaw joint.
• Struggling to open your mouth wide.
• Difficulty and pain when chewing.
• Frequent head, neck, jaw, and/or shoulder pain.

If the above describes your symptoms, seek professional care as early as possible.

What Additional Factors Cause Bruxism Headaches?

Many other physical factors may contribute (directly or indirectly) to your headache, jaw or neck pain. Your sleeping habits, dietary habits, use of caffeine, alcohol, medications, exercise habits, and stress levels – all can add up.

They may create a vulnerability to developing bruxism headaches. Take good care of your body. It appreciates regularity (e.g., eating and sleeping at about the same time each day). When you take overall good care of yourself, your body’s ability to resist stresses and challenges of everyday living are better.

An early and correct diagnosis by an orofacial pain specialist can mitigate the risks of potentially requiring TMJ surgery at a later time to replace the joint in your jaw.

Do Self-care Strategies Help Prevent Headaches and Neck Pain?

Self-care can be helpful for reducing bruxism and rebound headaches and neck muscle issues.

First, let’s explain what a rebound headache is. Rebound headaches are also known as “medication overuse headaches”. They commonly are caused by long-term use of medicines to treat headaches such as migraines. “Pain relievers offer relief for occasional headaches. But if you take them more than a couple of days a week, they may trigger headaches”, according to Mayo Clinic. ^[3]

For every minute you relax the jaw in the TONGUE UP, TEETH APART, JAW DROPPED, AND RELAXED position, you are not engaging incorrect oral habits. We’ll cover this relaxed state in full during your Bruxism Risk Assessment. This practice is a muscle relaxation exercise specific to the jaw, head, and neck. This will also increase your awareness of incorrect oral habits. Over time, you will find yourself automatically “correcting” and relaxing when you notice muscle tightening.

Self-care strategies that lessen rebound headaches and neck pain:

• Avoid caffeine. Caffeine is a “muscle tensing” drug and can make your muscles tighter and contribute to rebound headaches. Caffeine or caffeine-like drugs are in coffee, tea, soda, chocolate and some aspirins. Decaffeinated coffee typically has less caffeine than regular. Heavy daily caffeine use can trigger rebound headache issues; but a cup a day should be no problem.
• Apply low heat. Heat applications can relieve tense neck, jaw, and shoulder muscles that trigger headaches. Use a heating pad, hot water bottle, hot towel, a hot shower or bath, or a warm compress to relax tense muscles.
• Massage. Gently massage your head and neck muscles to see if you can gain relief. If your headaches are due to stress or anxiety, massaging contracted muscles can help them relax. Properly functional muscles let you enjoy daily life.
• Follow your provider’s advice. If your pain provider prescribes medicines to prevent headaches or relieve jaw strain/stress, follow instructions exactly on how to take them. As well, be consistent with your home exercise plan.
• Try a nocturnal alarm. They are useful to treat nocturnal bruxism. Typically, these devices monitor masticatory EMG activity or sounds. When the activity exceeds a threshold for a given period of time, an alarm sounds and wakes the bruxer – which terminates their teeth and jaw grinding/clenching behaviors.

Note: Nocturnal alarms can temporarily reduce bruxing behaviors. Because sleep is disrupted, patients who use nocturnal alarms may report sleepiness and difficulty concentrating while the alarm is being used. Discontinuation of the alarm may lead to a “rebound” in the level of grinding.

What is the Best Muscle Relaxant for Bruxism Headaches?

Injecting trigger points in the jaw, head and neck musculature can relieve chronic headaches and TMJ bruxism.

They can be used to stop the cause of bruxism by relaxing the over-active jaw muscles. They are relatively comfortable and are easily performed in-office by a trained clinician. A trigger point injection (TPI) is helpful to soothe muscle pain. Minnesota Head & Neck Clinic pain specialists find that treatment for tension headaches and myofascial pain, among other conditions, often benefits from TPIs.

Trigger point injections work similar to Botox® injections by:

• Taking some pressure off the jaw.
• Helping to break your jaw muscle tensing habit.
• Stop or at least minimize discomfort.
• Block pain receptors within the nerves surrounding the muscle, and, in turn, reduce the pain signals sent to the brain that cause headaches. ^[4]
• Help to reduce further damage to your neck and jaw alignment.

Injecting into masseter muscle is generally sufficient for treating TMJ bruxism. Injecting into other masticatory muscles such as your temporalis, medial and lateral pterygoid, digastric, geniohyoid muscles is possible but seldom considered unnecessary. For certain patients they provide immediate relief for severe pain when experiencing individual headache or migraine attacks. They help treat an overall worsening of head and neck pain in patients with chronic headache disorders who are having increased symptoms.

Answers to Additional Questions About Bruxism Headaches

Can Bruxism from SSRI Medications Go Away?

Yes. According to NIH, antidepressant-associated bruxism/jaw pain often begins within 3–4 weeks of medication initiation or dose titration. It can resolve within 3–4 weeks of SSRI drug discontinuation. ^[5]

The exact medical science of how bruxism and SSRI medications relate is unknown. However, it appears that SSRIs trigger jaw clenching due to their effect on the level of neurotransmitters like serotonin in the brain. These neurotransmitters impact a person’s mood and contribute to movement regulation.

Recognition, evaluation, and effective management of pain patients has the potential to increase headache treatment efficacy and potentially reduce the need for antidepressants. When you suffer from jaw pain or headache discomfort, you should talk to your pain specialist to find a solution that works for you.

How Is Bruxism different from a TMJ disorder?

Bruxism is caused by clenching and grinding your teeth. TMJ is caused by an imbalance in your jaw joints. A TMJ disorder occurs because one or both of your temporomandibular joints (your TMJs) fail to function correctly.

Habitual and prolonged teeth grinding (bruxism) can wear down your teeth so much that you may develop an imbalanced jaw (TMJ). TMJ and bruxism have many of the same symptoms; however, the two conditions have unique causes and characteristics. Having one does not mean that you have the other.

Similarities between bruxism and a TMJ Disorder:

1. Both can cause you discomfort and pain when moving your jaw.
2. Both may be accompanied by headaches.
3. Both have a negative effect on the proper functioning of the mouth.

Youth who experience simutaneous concussion and headaches should be tested for an TMD disorder.

What does a bruxism headache feel like?

Bruxism headache patients have described them as dull aching, or the feeling of pressure on both sides of the head. Others have articulated a feeling of wearing a too-small hat that generates pain in a ring circling their head. Patients familiar with migraine headaches describe it as much the same.

What Types of Headaches are Associated with Bruxism?

Four types of headaches are found in association with bruxism:

1. Tension headaches.
2. Migraine headaches.
3. Morning headaches.
4. Cluster headaches.

We’ve learned a lot from our years of treating patients with these four headache types. We now share our finding in more detail.

1. When bruxism triggers tension headaches

Bruxism tension headaches may be prevented if contact between opposing canine and posterior teeth is reduced. This helps avoid intense clenching of the wearer’s temporalis muscles. A tension headache can feel like a tight band clamped on the head causing dull, aching pain. It may be accompanied by tenderness of the person’s scalp, neck, and shoulder region. However, this headache type is classified as mild or moderate (not severe).

Bruxism often tires your eating muscles. Ensuing jaw soreness from their overactivation can set off a tension-type headache. It can trigger a domino effect of new problems by making it harder to get a good night’s sleep. This is why insufficient sleep is prevalent among people suffering from tension-type headaches and is linked to heightened symptoms. Your face may even become sensitive to touch.

2. Bruxism associated morning headaches

“Morning headaches are also known as “wake-up headaches”. Sleep bruxism (SB), as the name implies, occurs when sleeping. It is a masticatory muscle activity during sleep characterized by teeth clenching or grinding and/or bracing or thrusting of the mandible. A lack of quality sleep may contribute to increased sensitivity to pain.

This in turn increases the frequency of headache attacks. “Around 15–74% of individuals with obstructive sleep apnea (OSA) suffer from morning headache, and morning headaches are often unspecific”, according to Helena Martynowicz and other researchers’ report as quoted by NIH.

The May 14, 2019 Evaluation of Relationship Between Sleep Bruxism and Headache Impact Test-6 (HIT-6) Scores article by Frontiers Media also reports that migraine and frequency of headaches are associated with painful TMD in adolescents. The conclusion is that “there may be a central working mechanism overlapping TMD and headache”.

Sleep bruxism and morning headaches are reported more frequently in patients suffering from sleep apnea. Morning bruxism headache often includes fatigue and muscle soreness due to ongoing jaw muscle contraction while a person sleeps. Morning headaches that are associated with bruxism commonly dissipate when the person wakes and more normal jaw functions resume.

3. Bruxism-triggered migraine headaches

Migraine headaches are often accompanied by nausea and vomiting, as well as the person experiences sharp, throbbing or pulsing pain. That is typically due to “nociceptive pain”, which is a type of pain caused by damage to body tissue. A temporary, overnight oral appliance can inhibit clenching, let damaged tissue rest and heal, and is useful to treat sleep apnea.

Recent research discloses a closer relationship between migraines, nociceptive pain, and TMDs than previously thought. “TMD can trigger headaches, as well as exacerbate existing primary headaches, and also contributes to the chronicity of migraines”, reports Oana Almăşan in his January 2023, NIH Oral splints in the management of nociceptive pain and migraines: A scoping review, article.

The January 2023 report concludes that “Due to the complexity of nociceptive pain and migraines associated with TMJ dysfunction, the diagnosis and treatment should be comprehensive. A specialist in TMDs, along with a neurologist, a psychiatrist, a psychologist, a physiotherapist and a dentist, should be involved in the treatment of nociceptive pain and migraines.”

If a person’s trigeminal nerve generates pain signals from the TMJ to the brain, a chemical release may result in the onset of a migraine. Increased patient awareness of when jaw muscle movement can trigger a headache helps to avoid those stressors. Orofacial pain specialists have the training to merge treatment for orofacial pain that is accompanied by migraines.

4. Bruxism-associated cluster headaches

Cluster headaches can also be more intense than a migraine attack but fortunately do not last as long as a migraine headache. Fortunately, they are seen less often in bruxism patients.

Summary: Gain Treatment for Bruxism-Associated Headaches

Correcting your temporomandibular joint and helping your jaw move into its optimal position may alleviate most headache problems related to TMJ, muscle, nerve, and joint disorders.

We can help! Call and Schedule a Clinic Visit

 

• Plymouth: (763) 577-2484
• St. Paul: (651) 332-7474
• Burnsville: (952) 892-6222
• St. Cloud: 763-233-7252

Author: James Fricton DDS MS, co-founder of this pain clinic network. He is globally known for teaching fellow bruxism specialists and for helping patients with simple to complex head, neck, orofacial pain, and TMJ conditions.

 

References:

[1] Nihir Shah and Sajid Hameed, Muscle Contraction Tension Headache, https://www.ncbi.nlm.nih.gov/books/NBK562274/, Oct 24, 2022

[2] By Jennifer Huizen, https://www.medicalnewstoday.com/articles/scalloped-tongue, December 25, 2017

[3] Sandhya Pruthi, et al., Medication overuse headaches, https://www.mayoclinic.org/diseases-conditions/medication-overuse-headache/symptoms-causes/syc-20377083

[4] Deena Kuruvilla and Matthew S. Robbins, The Basics of Trigger Point Injections for Headache and Migraine, https://americanmigrainefoundation.org/resource-library/trigger-point-injections/, June 2016

[5] Andrew R. Garrett and Jason S. Hawley, SSRI-associated bruxism, https://mhnpc.com/2023/03/31/ssris-and-teeth-grinding-can-trigger-bruxism/, April, 2018