Migraines and fibromyalgia: the TMJ connection

Wednesday, January 02, 2013 by: Mike Bundrant
Tags: migraines, TMJ, fibromyalgia

(NaturalNews) What follows is heavy reading. If you suffer from headaches, migraines or fibromyalgia, it will be well worth it to discover the relationship of these issues to the position of your lower jaw. The content of this article could change your life. We have my colleague Leonard J. Feld, D.D.S. to thank for it.

Many people suffer for years from debilitating symptoms such as migraine-like headaches, blurred vision, dizziness, ringing in the ears, soreness around or pain behind the eyes, facial pain, or clicking jaw joints. Their first course of action is to visit their primary care physician, who may treat symptoms with no clear diagnosis for the cause.

Migraines have been declared one of the top 10 disabling medical conditions, with sufferers experiencing more pain and restriction in their daily activities than people diagnosed with osteoarthritis, diabetes, and depression. In addition, those suffering with headaches deal with extensive sequela from the primary diagnosis and the subsequent disorders that can create a significant personal, social and societal burden.

Those dealing with migraines are more likely to be diagnosed with mood, sleep, movement, and pain disorders, such as depression, anxiety, insomnia, and fibromyalgia. The combination of trigeminal nerve insult, along with the sympathetic nervous system and brain function, make up what has been suggested to be the trigeminovascular reflex, responsible for migraine headaches. Neurologists will tell you that the trigeminal nerve is responsible for these migraine vascular headaches.

There is a classification of medical disorders, called "neurogenic inflammatory disorders." These include but are not limited to: dizziness, imbalance, migraines, headaches, asthma, fatigue, depression, anxiety, insomnia, seizures, and fibromyalgia. Clinical experience has shown that a high percentage of these disorders, including fibromyalgia, respond to orthopedic jaw-alignment therapy. Fibromyalgia is a disputed diagnosis, though many members of the medical community consider it a disease because of a lack of abnormalities on physical examination and the absence of other objective diagnosis tests.

Fibromyalgia symptoms are not limited to pain, however, leading to the alternative term fibromyalgia syndrome (FMS). Other major symptoms include: debilitating chronic fatigue and weakness, sleep disturbances, sleep-disordered breathing, joint stiffness, difficulty with swallowing, irritable bowel and bladder abnormalities, numbness and tingling, dizziness, fainting, imbalance and ringing in the ears. Fibromyalgia also frequently exists simultaneously with psychiatric conditions such as depression and anxiety disorders. Not all people diagnosed with fibromyalgia experience all associated symptoms. Fibromyalgia is still considered a controversial diagnosis lacking scientific consensus about its cause.

There is still debate over what should be considered essential diagnosis criteria and whether objective diagnosis is possible for fibromyalgia. In general, most physicians diagnose patients with a process called "differential diagnosis," or what they find based on the patients symptoms. A physician will usually consider the presence of widespread pain lasting for more than three to four months, affecting all four quadrants of the body (i.e., both sides above and below the waist, including the temporomandibular or "jaw" joint). The medical cause is not known and although neither degenerative nor fatal, FMS is pervasive and persistent. Physiological distress decreases coping ability and has a significant and independent association with symptom severity and function.

Let's take a closer look at TMJD and CMS and their similarities to fibromyalgia. TMJD frequently occurs when the mandible (or lower jaw bone) is not aligned properly with the maxilla (or upper jaw/cheekbone). This often results in a dislocation of the protective disc that sits between those two bones as the lower jaw works, pushing the lower jawbone farther back in its working socket (fossa), which in turn compresses the nerves and blood vessels there.

CMD is a condition in which the teeth are not positioned in relation to the maxillary and mandibular bones in a way that's conducive to the muscles suspending the jaw. This misalignment requires the jaw muscles to accommodate the tooth position, thus causing the muscles and trigeminal nerve to become hypertonic/hyperactive. Diagnosis of these two conditions often includes examination, medical history, CT X-ray exam, computer-based 3D jaw analysis, surface electromyography and TMJ vibration study, which is a computer movement analysis verifying soft tissue discrepancies of the TMJ.

Temporomandibular joint dysfunction is usually difficult to diagnose because it begins as a soft tissue injury. The longer the condition goes untreated, more symptoms occur and more parts of the body are affected. In fact, a patient may present the doctor with numerous symptoms that appear to have no relationship to the jaw itself.

Consequently, many chronic suffers of TMJ are referred from doctor to doctor, in search of relief from recurrent and in some cases unbearable and debilitating pain. The intensity and duration of this pain can lead to emotional problems for patients trying to cope.

According to Dr. Brendan Stack, director of the Nation Capital Center for Craniofacial Pain in Falls Church, Virginia, many persons with TMJ syndrome who go through a litany of tests with negative results end up on a psychiatrist's couch after being told by doctors that their pain is "all in their head."

According to Dr. Harold Gelb, director of the Temporomandibular Clinic at the New York Eye Infirmary, and a well-known authority on TMJ, the problem is actually an orthopedic one. "If one foot is shorter than the other, the entire body is unbalanced. The jaws work the same way. When the teeth don't meet properly, the jaws become tense and strained, and stress is put on the joints. Because the head, jaw, neck, and shoulder muscles are all interrelated, when there's an imbalance, they are all affected."

Dr. Gelb speculated that about 90% of all headaches are due to muscle spasms or contractions, and that muscle contractions in the jaw are a potential cause for headaches in as many as 40 million of the chronic pain suffers.

Taking the mystery out of diagnosis

Beyond the need for a physician or dentist who has knowledge of this condition, the greatest help in detecting TMJ is a specialized x-ray machine called a cephalometric tomography. This X-ray creates 3-D imaging in layers, allowing doctors to examine various levels of the joint for evidence of jaw displacement or other pathological changes. This equipment is imperative to diagnosis and determination of the degree of injury, considering that normal x-ray equipment usually cannot capture this jaw dysfunction.

Dr. Nikolaas Tinbergen was able to demonstrate that changes or problems in body structure can affect the health of the entire body. For this discovery, he won the Nobel Prize for Medicine in 1973, a fact neither well-known nor publicized by physicians.

Later, Dr. Aelred Fonder, a dentist associated with Dental Research Foundation in Illinois, demonstrated a list of systemic health symptoms (symptoms relating to particular organs or with the whole body) that abated when the temporomandibular joint was corrected. In observing women with such conditions as migraine headaches (99%); chronic sinusitis (86%); symptomatology of the eye (84%); and chronic skin rash (93%) co-existing with dental stress conditions, Dr. Fonder found that "once the malocclusion or imbalance was corrected and the dental stress of temporomandibular joint malfunction treatment and neuro-muscular imbalance was eliminated, patients' symptoms diminished."

When diagnostics have confirmed that CMS or TMJ is present, treatment is initiated with an orthosis, a plastic appliance to reposition the mandible or jaw bone. This is typically a removable dental appliance that supports the mandible in a relaxed neuromuscular position. This creates a calming of the trigeminal system and in time typically resolves many associated pathologies.

When a person's TMJ dysfunction has been corrected and that person is free of pain, not only does one feel better physically, but an overall sense of well-being can return.

Dr. Leonard Feld is a TMJ-TMJD Dentist with offices in Los Angeles, San Jose and Palm Desert. He is the co-founder of the TMJ & Sleep Medicine Network and his philosophy is always conservative, non-invasive and non-surgical treatment. DocFeld.com.

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