A migraine is a neurological disorder characterized by moderate to severe head pain, often described as throbbing or pounding, that commonly occurs on one side of the head. It is frequently accompanied by debilitating symptoms, including nausea, vomiting, and a heightened sensitivity to light and sound. The pain is not always confined to the skull, as patients often report associated symptoms that radiate into the face, neck, and shoulders. This explains why the jaw might ache during a migraine attack.
Referred Pain and Migraines
Migraines can cause jaw pain, which is typically a manifestation of “referred pain.” Referred pain occurs when discomfort originating from one location is mistakenly perceived by the brain as coming from a different site. During a migraine, pain signals from the core neurological event are misinterpreted as soreness or discomfort in the jaw or face muscles.
This jaw pain is a symptom of the neurological disorder itself, not a separate issue with the jaw joint or muscles. This co-occurrence happens because the same complex nerve pathways relay sensations from both the head and the jaw area. Once the migraine resolves, the associated jaw and facial discomfort generally subsides.
The Trigeminal Nerve Pathway
The physiological mechanism explaining referred jaw pain involves the Trigeminal Nerve, the fifth and largest cranial nerve. This nerve is the primary sensory highway for the entire face, including the jaw, teeth, and muscles of mastication. Triggering a migraine involves the sensitization and activation of this extensive nerve system.
The Trigeminal Nerve has three main branches; the mandibular branch handles sensory input from the lower jaw region. During a migraine, neurological changes activate the trigeminal system, often starting in the meninges (the pain-sensitive coverings of the brain). This activation signal travels to the Trigeminal Nucleus Caudalis in the brainstem.
This nucleus is where sensory input from the head, face, and jaw converges. Signals originating from the core migraine process mix with pathways from the jaw muscles. The brain receives a flood of pain signals through these converging pathways and can misinterpret the source, leading to the perception of pain in the jaw, even if the joint is healthy. This central sensitization explains how a migraine creates a throbbing, aching sensation in the facial and jaw area.
Differentiating Jaw Pain from TMJ Disorder
It is important to distinguish migraine-induced jaw pain from pain caused by Temporomandibular Joint Disorder (TMJ/TMD), a condition affecting the jaw joint and surrounding muscles. Symptoms of both can overlap significantly because both involve the trigeminal nerve system. However, key differences in presentation help determine the source of the pain.
Migraine-Induced Jaw Pain
Jaw pain symptomatic of a migraine is typically throbbing and accompanied by common migraine characteristics, such as light sensitivity or nausea. This pain usually appears and disappears as the migraine attack progresses and ends, and it is often worsened by physical activity. The jaw joint function itself is usually normal, without mechanical issues.
Primary TMJ/TMD Pain
In contrast, primary TMJ/TMD pain is characterized by chronic muscle tenderness, a dull ache in the jawline or near the ear, and mechanical symptoms independent of a headache attack. Indicators of a structural TMJ issue include an audible clicking, popping, or grinding sound when the jaw moves, or limited jaw movement. Pain that noticeably worsens when chewing or yawning points toward a primary TMJ disorder.
Treatment for Combined Symptoms
When jaw pain is associated with a migraine, the most effective strategy is treating the underlying migraine attack itself. Acute abortive medications, such as triptans, interrupt the neurological cascade involving the trigeminal system, resolving both the head pain and the secondary jaw pain. Calming the overactive nerve pathway alleviates the referred pain in the face and jaw.
Preventative therapies aimed at reducing migraine frequency, such as CGRP inhibitors or certain antidepressants, indirectly reduce associated jaw pain by stabilizing the trigeminal nerve’s sensitivity. Non-pharmacological treatments can also provide relief for accompanying muscle tension.
Non-Pharmacological Relief
- Applying heat or cold compresses to the jaw and neck muscles to soothe discomfort.
- Eating softer foods to reduce strain.
- Practicing relaxation techniques to reduce strain on jaw muscles, which may be hyper-sensitized during the migraine process.