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Women & Pain

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: December 2, 2022

Facial Pain Problems: Why So Many Women?


In my practice, we see 4 distinct categories of facial pain problems.

  • Muscle and joint pain problems
  • Nerve pain problems
  • Tension Headache and Migraines
  • Chronic widespread pain (formerly called fibromyalgia)

It would seem that these problems could affect anyone, but in fact, the vast majority of patients that walk through the door of our practice are women. Believe it or not, somewhere between 78% and 82% of all the patients we see are female.


In the past, this dominance of women was attributed to social and cultural factors that prompted women to seek care more frequently than their male counterparts. Though women do seek care more frequently than men for a number of medical problems, research in pain biology has provided evidence that there are unique factors that are likely driving this huge statistical difference, particularly in the face and jaw.


The Estrogen Connection


One big biologic difference between men and women relates to the hormone estrogen. Studies have shown that variable levels of estrogen not only have the ability to impact the effectiveness of the body’s endorphins (our natural pain fighters) but can also increase inflammation associated with the Temporomandibular Joints (TMJ). During times of persistent stress, compromised sleep, and monthly menstrual cycles, estrogen levels fluctuate sufficiently to prompt pain to emerge in unexpected ways not commonly seen in men.


As estrogen is known to compromise the strength and adaptive capacity of ligaments throughout the body, the TM joints are a common location for problems to surface. As a result, the supportive jaw ligaments in women are likely to become more readily compromised when subject to the forces of normal function and certainly to excessive functions like gum chewing, nail and cuticle biting, and clenching or grinding of the teeth. As a result, symptoms of jaw clicking, popping, and locking are more likely to occur, persist and escalate in women when compared to men.


Also, when considering the biologic differences between men and women, it is worth mentioning that the jaw muscles of men have greater endurance than similar muscles in women. This likely occurs as the jaw muscles of women receive less blood flow (and therefore less oxygen and nutrients) than the same muscles in men, making them more susceptible to tiring more easily during both normal and excessive jaw use.


As a result, as oxygen levels in muscle tissue drops, the chemical makeup of the muscle changes with lactic acid and other irritating substances accumulating over time. These chemical changes lead to muscle soreness initially and then muscle weakness and susceptibility to spasms as time passes. These factors, therefore, may be responsible for the predisposition women have to developing facial and jaw pain and problems associated with jaw motion.


In attempting to understand why women have much more profound pain experienced in the Temporomandibular joints, the impact estrogen potentially has in increasing the intensity and persistence of inflammation cannot be overlooked. Specific estrogen receptors in the TM joints of women must, therefore, not be overlooked when trying to understand the predisposition of women to these often debilitating problems.


Migraines, Continuous Nerve Pain & Chronic Widespread Pain


Within this category of diverse sufferers, we again see a female dominance. Though the reasons for the onset of these very different pain problems in all individuals are not fully understood, there is evidence that each of these pain problems, to some degree, is connected to lowered nerve firing thresholds. Research has, in fact, suggested that these lowered nerve-firing thresholds that lead to pain are the result of an individual’s genetic makeup (an individual’s phenotype) and or due to changes in an individual’s genetic makeup due to environmental influences. These are called epigenetic changes. One or both of these factors are often responsible for changes in the way the brain interprets sensory signals received from all parts of the body.

When normal sensory signals received from bodily tissues are interpreted as noxious, an individual becomes predisposed to pain problems. As over 60% of all sensory information reaching the brain comes from the oral and facial region, women who more commonly have these genetic or epigenetic profiles will suffer to a greater extent whether the initiating factors were traumatic events of all degrees, environmental challenges, sleep compromises and/or life stressors of all types.


As the medical community begins to understand this biologic predisposition to facial pain and jaw-related problems, women who come to my office are not categorized as complainers who can’t handle life’s tensions and challenges. Rather, we understand the complexity of these problems and don’t blame the person. We focus on putting the best treatment strategies together that will confront not only the pain-prompting biology but also the person who is in trouble.


With the success that we have achieved over the years, you should be optimistic that there are answers to your problems.

DISCLAIMER: The advice offered in response to your questions is intended to be informational only and generic in nature. Namely, we in no way offer a definitive diagnosis or specific treatment recommendation for your particular situation. Our intent is solely educational and our responses to your actual questions serve as a springboard to discussion of a variety of dental topics that come up in a day-to-day dental practice. Any advice offered is no substitute for proper evaluation and care by a qualified professional.

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