How is Trigeminal Neuralgia Associated with TMJ Pain?
If you experience consistent face pain, you might be worried about trigeminal neuralgia or if it’s TMJ related.
When patients have pain complaints that surface the above question, a discerning orofacial practitioner needs sufficient information to appropriately guide treatment. The Minnesota Head & Neck Pain Clinic is familiar with the multiple questions people ask about the trigeminal nerve’s association with TMJ. We’ll answer many of them here, and once we see you in person, we can establish your personal TMJ pain management plan.
Table of Contents
- How is Trigeminal Neuralgia Associated with TMJ Pain?
- What is Trigeminal Neuralgia?
- How do TMD and TN Differ?
- TMJ vs. Trigeminal Neuralgia: Knowing the Difference
- What are Typical Treatment Options for Trigeminal Neuralgia?
- CONCLUSION: Gain Evidence-based Strategies to Overcome TN’s Challenges
To best understand Trigeminal Neuralgia’s association with TMJ Pain, we’ll offer a basic definition and answer a few questions.
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is a facial pain disorder symptomized by excruciating, sudden and recurrent facial nerve pain. It is often triggered by routine, daily activities and is localized to one side of the face. Fortunately, it is a rare face pain condition. Individuals with TN require specialized care to manage symptoms and improve their quality of life.
How Common or Rare is Trigeminal Neuralgia?
Studies reporting on the prevalence of TN vary over the years; it is currently estimated to be 4.3 per 100,000 person-years, with an increased incidence with age and a higher rate of incidence in females (5.9/100,000 person-years) than males (3.4/100,000 person-years). The rate of incidence is higher in older individuals, but more specifically it showed a much sharper increase in incidence for those between the ages of 37 to 67 years.
Being as rare as it is, the pain may actually be a hidden TMJ issue.
What causes Trigeminal Neuralgia?
Neuralgias in the face can result from dysfunction in neuronal firing of the peripheral sensory nerves.
In addition to the TMJ and the masticatory muscles that may impact TN, psychological factors may contribute to orofacial pain. It may also result from or be exacerbated by migraine, cluster headaches, or tension types. A thorough patient history helps to identify the possible source(s) of the orofacial pain and provide a screen for other causative or contributing factors.
About half of the time, the superior cerebellar artery is the cause of neurovascular compression. This occurs when a blood vessel presses on a nerve, which leads to pain. Other possible causes include thickened tissue around the nerve, aneurysms, tumors, and injury to the nerve. Demyelination or dysmyelination, which are when the nerve functions in unusual ways, can also generate pain.
Are there Different Types of Trigeminal Neuralgia?
Medical practitioners organized and diagnosed TN into three different classes or categories. These vary based on the cause and according to which branch is affected.
Three Classes of Trigeminal Neuralgia:
- Type 1 TN
- Type 2 TN
- Secondary TN
Type 1 TN (also known as classic trigeminal neuralgia) is the most common type of trigeminal neuralgia. It is characterized by sudden, severe, electric shock-like pain in the face. The pain is usually triggered by touching the face, chewing, or talking.
Type 2 TN, also called atypical trigeminal neuralgia, is less common than Type 1 TN. It is characterized by constant, burning, aching pain in the face. The pain is triggered less often by touch or other activities.
Secondary TN is caused by an underlying medical condition, such as a tumor, multiple sclerosis, or an aneurysm. The pain is similar to Type 1 TN, but it is often more severe and persistent.
Facial nerve neuralgia is also rare and can cause painful paroxysmal spasms of the facial muscles on one side. This disorder is often challenging to distinguish from trigeminal neuralgia because of frequent voluntary facial muscle contractions. These muscle contractions happen in response to a painful attack of that condition.
How do I know if I have TMJ or trigeminal neuralgia?
One way to diagnose between the two conditions is that trigeminal neuralgia typically consists of pain only. It commonly lacks the other symptoms TMJ sufferers may experience. TMJ and TMD problems impact the jaw joint by causing irregular motion, popping, or grinding.
What can be mistaken for trigeminal neuralgia?
Medical conditions that can present similar to trigeminal neuralgia include cluster headaches or migraines, Myofascial Pain Dysfunction Syndrome (MDPS), post-herpetic neuralgia (pain experienced following an outbreak of shingles), and TMJ disorder.
Fortunately, not all pain experienced on our faces leads to trigeminal neuralgia. For example, MDPS involves the muscle used for chewing. This form of facial pain commonly occurs due to overworked muscles used for mastication or chewing. Muscle fatigue can flare up in the mandibular or jawbone area when a person has a teeth-grinding issue. It’s also important to rule out sinusitis and ear infections.
How do TMD and TN Differ?
Both conditions are clinical diagnoses, and, initially, commonly misdiagnosed one as the other. A foundational understanding establishes that both conditions cause facial pain that is often intermittent (but sometimes continuous), usually unilateral (infrequently bilateral), and can be triggered or exacerbated by touch, talking, or eating (and at times by nothing at all). With that in mind, let’s look at common differences.
TMD = temporomandibular disorder; TN = trigeminal neuralgia
|Point of Difference||TMD||TN|
|Underlying Pathologies||The etiology of TMD remains partially understood; however, it is believed to be multifactorial. TMD refers to disorders characterized by inflammation or misalignment of TMJs. “TMDs” refers to the disorders, and “TMJ” refers only to the temporomandibular joint itself.||Classic trigeminal neuralgia is associated with neurovascular compression in the trigeminal root entry zone. TN is when the trigeminal nerve, which is divided into 3 main branches, is irritated or compressed.|
|Symptoms||TMJ not only causes pain, it can also result in numerous other symptoms. TMD pain tends to be described as dull and aching and may radiate to the ears and temporal, periorbital, mandibular, and posterior neck regions.||In contrast, TN is reported as lancinating, electric, and shooting pain in the distribution of the trigeminal nerve. Trigeminal neuralgia tends to only cause pain. You won’t experience the duller, sharp aches that come with excessive pressure on your teeth, muscle tension, or jaw dysfunction.|
|Where it Occurs||TMD includes a common group of musculoskeletal and neuromuscular conditions that present as pain or dysfunction related to the temporomandibular joint(s), the muscles of mastication, and/or the associated tissues.||TN is limited to the fifth cranial (trigeminal) nerve, and though other pain conditions may also occur concurrently, it is not as common as in TMD. It typically causes pain on one side of the head.|
|Commonaltiy & Pain Condition||A high proportion of patients with TMD and headaches suffer simultaneously from multiple other pain conditions, and the term “chronic overlapping pain conditions” has been introduced to suggest possible shared etiology and disease mechanisms.||TN is a less common neuropathic pain condition.|
|What Triggers It||TMD symptoms can be either triggered or made worse by clenching, chewing, swallowing, or grinding teeth over time.||TN pain is often triggered by facial movement, change of temperature and by touching the face at a specific point (the trigger point). It may be caused by damage or irritation to a nerve. Or, it can even be triggered by wind – even a slight breeze or being in front of an air conditioning.|
|Prognosis||The prognosis of TMD pain is fairly good, with only 5% to 10% of those with symptoms requiring treatment and a spontaneous resolution rate of up to 40%.||TN can be unpredictable, with periods of remission and recurrence lasting weeks to years over the course of a lifetime. It is often a progressive condition that begins with infrequent mild pain, but attacks become more frequent and severe over time.|
TMJ vs. Trigeminal Neuralgia: Knowing the Difference
What actions should a person take if they have TN-TMJ related symptoms?
Steps to take if you think you may have Trigeminal Neuralgia-TMJ issues:
- Schedule an appointment to get a diagnosis and treatment.
- Avoid things that seem to trigger your pain or make it worse.
- Keep a log of when your pain occurs and any over-the-counter medications you take before your diagnostic appointment.
- Ask about physical therapy.
- Make sure you get sufficient sleep.
- Learn relaxation techniques by partnering with a pain health coach.
With the right help, you can manage your pain and enjoy a healthier life.
Abscessed teeth, periodontal infection, nasal pathology, sinusitis, bruxism, myofascial pain, and other disorders in the region of pain should each be treated adequately before establishing a pain management plan. For an example, you can check out our Bruxism Parafunction Risk Assessment for Pain Patients.
It’s okay if you still have more questions. While it is best to ask a pain specialist in person, we’ll cover a few more here.
What is paroxysmal neuralgia?
Paroxysmal neuralgia is an intermittent pain that suddenly comes and may just as suddenly go. It commonly affects a person’s face, head, and neck. It is often confused with myofascial pain.
There are different types of paroxysmal neuralgia, each with its own symptoms. For example, trigeminal neuralgia causes pain in the face, usually on one side. Occipital neuralgia causes pain in the back of the head. Glossopharyngeal neuralgia causes pain in the throat and ear. An accurate diagnosis before starting treatment is critical for long-term success.
A thorough evaluation of the patient’s habits, lifestyle, work, medical history, and home environment may reveal the presence of single or multiple factors that contribute to the pain. Only after eliminating these factors, and subsequently the pain, will the diagnosis be firm.
How are Paroxysmal Trigeminal Neuralgia and Atypical Facial Pain Different?
Paroxysmal trigeminal neuralgia and atypical facial pain are both fairly common conditions that cause facial pain – but each has different characteristics. Patients describe atypical facial pain as dull, unrelenting, and find it hard to define its site of origin.
Atypical TN is identified due to a unilateral, prominent constant and severe aching, boring or burning pain superimposed in addition otherwise typical TN symptoms. Cases of typical TN are more likely to follow a minor aching or burning pain within the affected distribution of the trigeminal nerve.
Within the maxillofacial region, neuralgias can present in different severities and can affect patients of any race, gender and age. Over “85% of cases of Trigeminal Neuralgia are of the classic type known as Classical Trigeminal Neuralgia (CTN), while the remaining cases can be separated to secondary Trigeminal Neuralgia (STN)”, according to Trigeminal Neuralgia by Kandasamy Ganesan
The February 15, 2021, article defines neuralgia as paroxysmal, intense intermittent pain that is often limited to specific nerve branches to the head and neck. The trigeminal nerve is responsible for sensory innervation of the scalp, face and mouth; a late diagnosis can result in damage or disease to this nerve. That may manifest in sensory loss, pain or both.
When a person’s TMJ is out of alignment or damaged, that often adds pressure on the trigeminal nerve, causing pain in the face, jaw, and teeth. This is when we call it trigeminal neuralgia. Conversely, if your trigeminal nerve is damaged or malfunctioning, it can cause pain to your TMJ and surrounding areas.
The National Institute of Health (NIH) explains how the trigeminal nerve is closely associated with a person’s jaw joints.
“The nerve’s mandibular branch supplies sensory innervation to the TMJ itself, as well as to the muscles that move the jaw. This means that any problems with the TMJ can potentially affect the trigeminal nerve, and vice versa.” – NIH: Anatomy, Head and Neck, Temporomandibular Joint by Bruno Bordoni
What are Typical Treatment Options for Trigeminal Neuralgia?
There are different conservative treatments including medication, trigger point injections, and physical therapy. The best treatment for you will depend on your medical history, the type of neuralgia you have, and how severe your symptoms are.
Trigeminal neuralgia and a TMJ disorder can sometimes occur together. When this happens, the pain from trigeminal neuralgia may worsen by jaw movements, which can irritate the trigeminal nerve. Treatment can vary depending on the underlying cause of your face and/or jaw pain.
Doctors and pain specialists can best diagnose and treat it based on your symptoms and a physical exam. They may recommend a MRI or CT scan to rule out other conditions. An MRI can spot damage to the trigeminal nerve.
Carbamazepine is considered first-line therapy for TN and is the only medication approved by the FDA for the treatment of trigeminal neuralgia. According to Biomarkers in temporomandibular disorder and trigeminal neuralgia: A conceptual framework for understanding chronic pain by Johns Hopkins University, TN pain case studies are rare.
Those that are available create a slightly varying understanding of TN pain compared to TMD. In TMD important inflammatory mediators are found to be elevated and associated with increased pain, rodent models of TN have found that of 5-HT1A and 5-HT2C defensive receptors lower pain behaviors.
The Minnesota Head & Neck Pain Clinic uses a systematic evaluation and treatment of diagnosed disorders. With proper treatment of these disorders, continuous activity in the trigeminal nerve will be minimized.
5-Star Google Review – Correct Head and Face Pain Diagnosis
“My neurologist referred me to Mn Head & Neck Pain Clinic to help diagnose my head and face pain. From the first visit, I knew I had landed in the right place. Dr. Thakur quickly identified the source of my pain and got me on the right track to address it. The entire team of Dr’s, Nurses and therapists have been great! Dr Thakur, Dr. Clavel and all of the other staff members listen to the patients and quickly respond to messages. Even when I found out that my insurance wouldn’t cover my visits there, I have continued to go see Dr. Thakur” – Andrea Golis
CONCLUSION: Gain Evidence-based Strategies to Overcome TN’s Challenges
As this article identifies, overlap may exist between the symptoms of trigeminal neuralgia and TMJ. Both may cause orofacial pain or jaw spasm – which is why you need an accurate diagnosis. By working closely with your pain provider and by accurately monitoring your symptoms, you can improve the quality of your daily life.
Through patient education, accurate diagnosis, comprehensive and sustained pain management, a multidisciplinary approach helps those suffering from either TN or TMJ.