TMJ PAIN + CHRONIC HEADACHES: HOW BOTOX CAN HELP

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For over 10 years I have suffered with chronic headaches and TMJ pain, but it hasn’t stopped me! It has made me who I am – stronger and tougher! It has been my own physical pain that has driven me to find the answers on how to stop it and to help others with similar ailments to find relief. One option that has proven successful to me personally, and for my patients, is Botox.

BOTOX TO RELIEVE CHRONIC PAIN

What is TMJ? Temporomandibular joint disorders, more commonly known as TMJ, are usually the result of inflamed and painful chewing muscles around your jaw. The masseter muscles are the main source of discomfort. 85% of all chronic head pain is related to masseter muscle contraction, making Botox the more effective form of treatment than other modalities.

I started getting Botox for my chronic migraines several years ago at the Jefferson Headache Center. But, it wasn’t until I started having Botox injected into my masseter muscles that I began to feel significant relief.  

The masseter muscles are the muscles involved with clenching, grinding, and chewing. These muscles can radiate pain to the temples and neck. When Botox is injected into the masseter muscles, the Botox acts as a muscle relaxant to ease these strong, tense, tender muscles and reduce pain. Do not worry – you will still be able to talk and chew and Personally, I have daily pain in my masseter and temporalis muscles, so I receive Botox in these muscles every 3-4 months for pain relief.clench, but with less force, and, therefore, less pain. 

The masseter muscles involved in clenching, grinding and chewing, and are responsible for most TMJ pain.
The masseter muscles involved in clenching, grinding and chewing, and are responsible for most TMJ pain.

HOW THE TREATMENT WORKS

It’s normal to be nervous, but I promise this process isn’t scary. It’s actually very satisfying. (I’ll explain soon.) First, I palpate the muscles so I can prepare the amount of Botox based on the strength of the muscles and your pain level. The needle used to deliver the Botox acts as a dry needling to break up the tense muscle fibers. Botox is then injected into the muscle to deliver 24 hour, long lasting relief. The satisfying part is when the needle is injected into the trigger point in the muscles – a location that causes the most pain – patients feel immediate relief. 

Typically, if a patient has pain in their jaw, I start by injecting the masseters. This is because once the jaw is relaxed, other areas the pain may refer to will relax as well, such as the temples and neck. If pain/headaches are located between the eyes and forehead, we can treat these at the same time. One of the aspects I love about my practice is my center shares space within my Father’s Periodontics and Implantology practice. We decided this strategically allows for us to collaborate, if necessary, on complex cases of TMJ. How? By utilizing his experience and comprehensive surgical scanning machinery in order to rule out bone deterioration in the joint. This could be the answer to pain that is not responding to the Botox treatment.

Emily and her father Dr. G. William Keller, DDS, reviewing a case together.
Emily and her father Dr. G. William Keller, DDS, reviewing a case together.

BOTOX + INSURANCE + THE MISSING “PUZZLE PIECE”

Have you seen the commercials advertising Botox for chronic migraine? This is a FDA approved Botox treatment, usually covered by insurance and performed by a neurologist. In order to be qualified for this treatment, patients must have at least 15 headache days a month and have tried multiple medications for pain reduction. This medical procedure includes a total of 31 sites in 7 key areas of the head and neck. However, the 31 sites do not include the treatment of the masseter muscles, which I believe is the missing puzzle piece! Botox for chronic migraine includes 31 sites because migraines and pain are complex. By injecting Botox into the pain fibers involved with headaches, it blocks the release of chemicals involved in pain transmission. So, if we aren’t completely sure which area of the face and neck are triggering a migraine, we have probably covered it in the 31 injection sites. 

Unfortunately, since the masseter muscle treatment is an off label use of Botox, it is not covered by standard insurance policies.

HOW LONG IT TAKES TO NOTICE IMPROVEMENT 

Once Botox is delivered, it takes approximately 2-4 weeks to notice improvement. Pain relief is not immediate, but as mentioned above, the act of the needle itself can provide relief initially. At a month, I assess my patients, their pain level, and determine if they need additional Botox. The masseter muscles (as seen in the diagram above) are large, strong muscles and can require a lot of Botox. At the one month visit, we may need to deliver additional Botox.

I set expectations with patients and let them know that Botox isn’t always the only answer for TMJ pain and headaches but an amazing adjunct to other types of treatment modalities!

Patient with decreased pain, as well as a slimmer, more defined jawline 4 weeks after her Botox treatment.
Patient with decreased pain, as well as a slimmer, more defined jawline 4 weeks after her Botox treatment.

If you have headaches or TMJ pain you would agree that it’s not just the act of clenching and grinding your teeth that is causing your pain. It’s the daily stress, high achieving type A personalities, lack of sleep, dehydration, and overall LIFE that leads to this muscle tension! 

Botox can relax these tense muscles and reduce your pain, but I believe it is just as important to find and treat the other sources. If you have TMJ pain, make sure to avoid opening your mouth wide, hard foods and chewing gum – anything that requires the jaw to overact. Additional treatments to help soothe sore facial muscles include craniosacral therapy, energy healing, acupuncture, rolfing, diet, exercise, yoga, etc. I have tried it all and am here to help you too!

On a side note, although not the initial intention, my patients were pleased to have pain relief and a slimmer defined jawline, as an added benefit, after their Botox treatments.

REAL PATIENTS, REAL RESULTS

How I have helped one of my patients suffering with chronic TMJ pain.

“I am a patient for life is what I told Emily after receiving Botox for my TMJ.  I have suffered from TMJ for over 30 years. I have tried many things (night guard, anti inflammatories, massages, cranial work, etc.) with little success. My pain was constant/chronic and was getting progressively worse in my neck, shoulders, ear, temple, and jaw.

I had read reviews about Botox for TMJ and how it relieved the pain.  I was extremely nervous about trying it. Emily calmed my fears by thoroughly explaining how the procedure would work, listened patiently to all my concerns and answered all my questions.

I would like to say how happy I am that I am a client of Emily Keller Rockwell. For years I have suffered from masseter hypertrophy. This has caused me to be self-conscious and embarrassed of my appearance. After years of doctors trying to figure out a cure for this, I was left feeling hopeless and frustrated. I met Emily and she suggested that I get treated with Botox. Wow, what a difference! I can finally take a picture without hiding half of my face. This has been life changing for me. Because of Emily I feel pretty again, I can smile again without feeling out of place. Emily is gentle, sweet, kind, and caring, and is a true professional. Thank you, Emily, for truly caring. - A.M.
I would like to say how happy I am that I am a client of Emily Keller Rockwell. For years I have suffered from masseter hypertrophy. This has caused me to be self-conscious and embarrassed of my appearance. After years of doctors trying to figure out a cure for this, I was left feeling hopeless and frustrated. I met Emily and she suggested that I get treated with Botox. Wow, what a difference! I can finally take a picture without hiding half of my face. This has been life changing for me. Because of Emily I feel pretty again, I can smile again without feeling out of place. Emily is gentle, sweet, kind, and caring, and is a true professional. Thank you, Emily, for truly caring. – A.M.

I feel like a whole new person. I am still amazed at the difference and wish I had done it sooner,” – Anonymous Patient.

Have questions or want to share your experience with Botox and chronic pain? Share in the comments below. 

tags: Botox, TMJ, Muscle Pain 

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