The Need for Routine Migraine Screening in Women’s Health Care (4)

Published: March 26, 2026|Nicholas Gessner

Migraine and Temporomandibular Disorders

Medically reviewed by: Steven D. Bender, DDS

What are Temporomandibular Disorders?

Temporomandibular disorders (TMDs) are a set of complex and poorly understood conditions that affect the jaw joints (TMJs), muscles, and surrounding tissues. These hinge joints connect your lower jaw to your skull and work together with the muscles around your jaw and other structures in your head and neck.

There are three main classes of TMDs:¹

Disorders of the joints
Disorders of the chewing muscles
Headaches associated with TMD

Research shows that about 85% of individuals with TMJ disorders also experience other health conditions, both painful and non-painful, affecting different parts of the body.² These conditions can include allergies, chronic fatigue, headaches, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, neck and lower back pain, sleep disturbances, and vulvodynia.²

TMJ disorders can also be associated with connective tissue and autoimmune conditions, such as rheumatoid arthritis, juvenile rheumatoid arthritis, juvenile idiopathic condylar resorption, psoriatic arthritis, ankylosing spondylitis, Sjögren’s syndrome, systemic lupus erythematosus, scleroderma, and mixed connective tissue disease.² Because of this, TMDs often involve multiple body systems, highlighting the need for comprehensive care.²

Symptoms of Temporomandibular Disorders

Common symptoms can include:^3,4

Dull or constant jaw pain or muscle soreness
Trouble opening or moving the jaw
Locking of the jaw
“Popping,” “grating,” or “clicking” sounds when moving the jaw
Neck or shoulder pain
Headaches
Ear pain, fullness, or ringing in the ears
Vision or hearing changes

Causes and Diagnosis

Possible causes of TMDs include:³

Jaw injuries or trauma
Infections
Autoimmune or arthritic conditions
Dental procedures (even prolonged mouth opening)
Insertion of a breathing tube before surgery
Side effects from medications

Other factors—such as poor sleep, genetics, hormones, oral behaviors, symptoms related to a traumatic experience, and environmental influences—can also increase risk.³ In many cases, the exact cause isn’t clear.³

One commonly used screening tool is the 3Q/TMD, which includes three yes-or-no questions:⁵

Do you have pain in your temple, face, jaw, or jaw joint once a week or more?
Do you have pain once a week or more when you open your mouth or chew?
Does your jaw lock or become stuck once a week or more?

A positive response to any of the questions suggests that further evaluation by a healthcare provider may be helpful.

What Is the Relationship Between Temporomandibular Disorders and Migraine?

Temporomandibular disorders and migraine have a bidirectional relationship, meaning those with TMD have an increased risk of developing migraine and vice versa. One study found that people with migraine were about 6 times more likely to develop TMD, and those with TMD were about 2.5 times more likely to have migraine.⁶ This suggests that treating one condition effectively may help reduce the risk or severity of the other.

It is still unclear exactly why this relationship between TMD and migraine exists, but there are several factors that may link both diseases.

Shared pain pathway: Migraine attacks involve the trigeminal nerve, a major pain pathway that carries feeling from the face and jaw to the brain. When a migraine attack occurs, this nerve becomes activated, which is what produces the head and facial pain associated with migraine. Because the trigeminal nerve also carries feeling from the jaw, this pathway may contribute to both migraine pain and TMD-related jaw pain.
Increased levels of CGRP: During a migraine attack, the trigeminal nerve releases substances like CGRP (calcitonin gene-related peptide), which can increase pain, cause swelling, and widen blood vessels.⁷ People with temporomandibular joint pain have higher levels of CGRP, which may contribute to their jaw discomfort.⁷ Similarly, people with migraine show elevated CGRP levels during and between attacks, suggesting that a similar process may underlie pain in both conditions.⁸
Central Sensitization: Central sensitization occurs when the nervous system becomes more sensitive over time.⁹ This makes pain signals feel stronger than they normally would and can cause normally harmless sensations to feel painful, which can cause persistent migraine and jaw symptoms.⁹
Hormonal influences: TMD and migraine are more common in women, and changes in estrogen levels make the trigeminal nerve more sensitive.¹⁰
Genetics: Research on female twins suggests that some of the genetic factors linked to jaw pain (TMD) also increase migraine risk, though the overlap is small (~12%).¹¹
Psychological factors: Depression, anxiety, and stress are risk factors for both TMD and migraine.¹²

Commonalities Between Temporomandibular Disorders and Migraine

TMDs are twice as common in women as in men, and migraine affects women three times more often than men. Hormonal changes play an important role in both disorders.^13,14
Symptoms of both conditions can fluctuate over time.
There is no single test or scan that can definitively diagnose either condition. The diagnosis is based on symptoms and a clinical exam.
Both conditions can be affected by stress, anxiety, or depression.
Symptoms may begin or flare after a head or neck injury.
While neither condition is life-threatening, both can significantly affect daily life and overall well-being.
Fibromyalgia, irritable bowel syndrome, and insomnia are common comorbidities.¹³
Both conditions involve shared pain pathways, including the trigeminal nerve and its branches.¹⁵

Treatments for Temporomandibular Disorders

Most people with TMDs have mild or periodic symptoms that may improve on their own within weeks or months with simple home care practices. Experts recommend starting with the safest, reversible treatments for TMD.¹³Procedures that permanently change the jaw, teeth, or bite usually don’t improve symptoms, even in severe cases.¹³ Surgery for issues related to the temporomandibular joints is recommended only in approximately 5-10% of cases and should only be considered after all conservative measures have been tried and failed.¹⁶

It’s important to first rule out other conditions and/or medications that may mimic TMJ symptoms by consulting your medical doctor. For example, facial pain can be a symptom or a result of conditions, such as:

Sinus or ear infections
Decayed or abscessed teeth
Various types of headache
Facial neuralgia (nerve-related facial pain)
Tumors
Connective tissue disorders such as Ehlers-Danlos Syndrome
Eagles syndrome
Dystonia
Lyme Disease
Scleroderma

Education and self-care are usually the first steps in managing TMD.¹⁷ Providers can help patients understand that symptoms often improve over time, while also acknowledging the physical and emotional challenges these conditions can cause.¹⁷

Several self-care strategies may help with TMD:¹³

Good sleep habits: Keep regular sleep and wake times and reduce screen time before bed.
Diet adjustments: Soft foods can help reduce jaw strain.
Heat or cold therapy: Applying a warm or cool pack to the jaw may ease discomfort.
Avoid extreme jaw movements: Try to limit wide yawning, gum chewing, or other movements that strain the jaw.
Avoidance of non-functional teeth contact: Try to avoid letting your teeth touch when you’re not using them. Relaxing your jaw can help reduce strain and keep it in a more natural position.
Stress management: Stress can trigger migraine attacks and make TMD worse by causing jaw clenching or teeth grinding.

Other non-drug treatment options that may help people with TMD:¹⁸

Physical therapy
Cognitive behavioral therapy
Intraoral appliances (should be used only while sleeping and for short-term periods since sustained use can cause permanent changes in the bite)

Medications for TMD and Migraine

Some medications can help with both TMD and migraine, though there are differences in how they’re used.

Short-term use of NSAIDs (like ibuprofen or naproxen) can provide temporary relief for jaw or headache pain.

Muscle relaxants, such as cyclobenzaprine, are often used for TMD but aren’t typically prescribed for migraine.

Amitriptyline, a type of antidepressant, can be effective for both conditions. In one study, people with chronic TMD who took 25 mg of amitriptyline for two months saw a 63% reduction in spontaneous pain, compared with 16% in those taking a placebo; however, the evidence is not strong.¹⁹

OnabotulinumtoxinA is another option that can be used for both conditions. It is FDA-approved for chronic migraine and is currently used off-label for TMD-related pain. However, evidence for its effectiveness for TMD remains mixed.²⁰

Finally, propranolol is a promising drug under study for individuals with migraine who experience TMD pain. Interestingly, the benefits of propranolol in reducing TMD pain may be due to its effects on slowing heart rate rather than on reducing head pain.²¹

For more information about migraine treatments, click here.

What Type of Clinician Should I See for Temporomandibular Disorders and Migraine?

A primary care provider (PCP) is usually the best first contact for patients with suspected migraine and a general dentist is the best choice for a suspected TMD.

These providers can perform an initial evaluation, rule out red flags, and help coordinate care with other specialists.

Migraine is best managed by a clinician who specializes in headache medicine.

While the vast majority of TMD cases (>80%) can be successfully managed with conservative noninvasive, nonsurgical approaches, often provided by the general dentists and physical therapists with expertise in TMD, an orofacial pain specialist dentist is specifically trained to accurately diagnose and manage these disorders in the most evidence based manner and should be consulted prior to the initiation of any invasive non reversible therapies.²² Surgery is usually only considered for rare cases of temporomandibular joint-specific disorders that don’t improve after all conservative treatments have been attempted.

A Note to Patients and Providers

Healthcare providers should be aware of the connection between temporomandibular disorders and migraine.

Both conditions are complex, rely on symptom-based screening tools for diagnosis, and don’t have a single definitive test or marker.

If you have migraine, it’s important to tell your healthcare provider if you notice:

Jaw pain
Clicking or locking of the jaw
Teeth grinding or clenching
Facial soreness in the morning

Providing these details can help your clinician recognize when both conditions may be present.

Although sometimes prescribed, amitriptyline, onabotulinumtoxinA, and propranolol are not FDA-approved for treating TMDs.

Understanding the connection between TMD and migraine can help individuals with the conditions and providers work together to manage symptoms more effectively and improve daily life.

Allied Partner

The TMJ Association

Resources

Patient Resources

The TMJ Association: https://tmj.org/
Living with TMD: https://tmj.org/living-with-tmj/
List of Comorbid Conditions with TMD: https://tmj.org/living-with-tmj/diagnosis-and-related-conditions/related-conditions/
TMD Support groups: https://tmj.org/community/where-to-get-support/
NIDCR: https://www.nidcr.nih.gov/health-info/tmd

Clinician Resources

TMJ Association CME & Grant Opportunities: https://tmj.org/hope-in-research/for-clinicians-and-scientists/
2020 National Academies report on TMD: https://www.nationalacademies.org/projects/HMD-HSP-18-21

References

Author

Nicholas earned his B.S. in Biology with Honors Distinction in Neurobiology from Stanford University. After graduating, he spent a year conducting behavioral neuroscience research at the National Institutes of Health. He then returned to his roots in Rhode Island to pursue his M.D. at The Warren Alpert Medical School of Brown University. To date, Nicholas has received over $50,000 in funding for his basic science and clinical research at Stanford, Brown, Massachusetts General Hospital, and the NIH. He also mentors undergraduate and junior medical students, volunteers at a free clinic, and supports advocacy efforts at both the state and national levels.

In his free time, Nicholas enjoys traveling, spending quality time with loved ones, and exploring Rhode Island’s fantastic food scene. He is excited to bring his talents and experience to the Association of Migraine Disorders.

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.