If you’re one of the millions of people who suffer from persistent jaw pain and unexplained headaches, there’s a good chance your dentist has diagnosed your condition as TMD (temporomandibular joint disorder). But when the treatments that work for most people, such as oral appliances, exercises, and relaxation techniques, don’t work for you, your symptoms may stem from an entirely different condition.
I’m Dr. John E. Dinan, one of the board-certified Orofacial Pain specialists at New York TMJ & Orofacial Pain. Orofacial pain specialists like me focus on the needs of patients who have jaw disorders, persistent toothaches, nerve pain disorders, and headaches – what most people call TMJ.
For years, patients have come to our practice having been diagnosed with TMJ pain and disorders only to discover they were facing something entirely different – migraine. Let me tell you about two such patients whom I’ll call “Nora” and “Veronica.”
Nora, 36, had been living with pain for over two decades. Every month during her menstrual cycle, she experienced excruciating and throbbing pain in her right temple and jaw. These episodes brought with them heightened sensitivity to light and sound. She told us that the pain was so awful that it actually made her nauseous.
Nora’s agony lasted for 48 to 72 hours before it finally subsided, only to return the next month. She also heard a clicking sound in her right temporomandibular joint (TMJ) when she opened her mouth wide. Nora had been diagnosed with TMJ many years before coming to our office. Numerous types of oral appliances gave her no relief. The only thing that helped was Ibuprofen, but it only reduced her pain by about half.
When we reviewed her dental records and x-rays, we discovered that her jaw and temporomandibular joint were normal.
Veronica, 24, arrived at our office, also having been diagnosed with TMJ. For five years, she had experienced severe throbbing pain two to three times every month in front of her right ear and under her right eye. Like Nora, Veronica’s dental records and x-rays showed no definite jaw issues. Unlike Laura, her pain was not accompanied by jaw clicking.
Veronica’s pain episodes typically lasted between 24 and 48 hours and were accompanied by heightened sensitivity to light and sound and periods of nausea.
How We Arrived At Our Diagnosis
At our practice, the method of diagnosis is focused first on listening carefully to our patients’ stories. Next is a comprehensive medical and dental history assessment and an examination and imaging.
In the end, it was apparent that both patients did not have TMJ; they had migraine. The misdiagnosis had led to ineffective treatments and endless suffering.
Symptoms Of Migraine
Migraine affects about 12% of the population and is characterized by a combination of the following:
- Moderate-to-severe pain intensity
- Pain that pulses
- Gets worse from physical activity
- Includes nausea and/or vomiting
- Sensitivity to light and sound
- Pain periods from four to 72 hours
About a third of migraine sufferers also experience visual, auditory, and sensory changes right before a migraine.
When we compared Nora’s and Veronica’s symptoms to the list above, it confirmed our suspicions: the issue was migraine, not TMJ.
Both patients were ecstatic when we explained to them that they experienced migraine, and it is treatable. After years of their lives disrupted by pain, they finally could see a light at the end of the tunnel. We prescribed sumatriptan, a medication known to alleviate migraine-related symptoms such as nausea, vomiting, and light and sound sensitivity. Some patients discover their migraines vanish entirely, and others find their symptoms less intense with sumatriptan.
Nora and Veronica both got relief from their pain attacks with sumatriptan (which further confirmed the diagnosis of migraine). They now see their primary care physician for their long-term management and prescriptions.
From a doctor’s point of view, it is a great joy to see patients emerge from the disabling impact of chronic pain. Nora’s and Veronica’s stories highlight the importance of an accurate diagnosis. While we couldn’t change the past, we opened the door for them to have a brighter future.
If you can relate to Nora’s and Veronica’s stories and live in the NYC metropolitan area, feel free to reach out to us. We’re here to listen to you and help you on your journey to getting relief. Click here for our office contact information.
If you’re outside the NYC region, you can locate an Orofacial Pain specialist in your area by going to the American Board of Orofacial Pain directory. Click here.