Using Botox to treat facial pain, migraines, TMJ & bruxism.

  • TMJ

A migraine is a common type of headache that may have a variety of symptoms including nausea, vomiting, sensitivity to light and sound. In many people, a throbbing pain is isolated to one side of the head. Some patients suffering from migraines have warning symptoms, known as auras, before the actual headache begins.

The diagnosis for a Migraine usually includes the following criteria:

5 or more headaches within a 3 month span – each lasting between 4 and 72 hours

At least two of the following:

–          Pulsating sensations

–          Unilateral pain

–          Moderate to severe discomfort

–          Pain aggravated with exertion

And one of the following symptoms:

–          Light and sound sensitivity

–          Nausea and/or vomiting

Types of Migraines include:

Episodic – defined as less than 15 migraine headaches per month

Chronic – defined as 15 or more migraine headaches per month

Episodic migraine with aura

Chronic migraine with aura

Chronic migraine without an aura


Trigger Points are defined as hyper-irritable points in the skeletal muscle that are associated with palpable nodules in taut bands of muscle fiber. Trigger Points can be easily identified by holding palpation for 6-10 seconds at 4-8lbs of pressure. Myalgia will have no referral of pain, meaning the site and source of pain are the same. Myofascial pain will have a pain referral to another location, the site and source of pain are different. Trigger points occur at various sites in the head and neck.


TMJ, TMD, and Myofascial pain refer to different pathologies affecting the masticatory muscles, temporomandibular joint (TMJ) and related facial structures. The TMJ and its associated muscles control chewing and movement of the jaw. It is a hinge joint connecting the mandible to the temporal bone of the skull.   TMJ pain is often the result of issues with the joint and/or surrounding muscles including, but not limited to, grinding/clenching of teeth, stress in facial muscles, dislocation of the disc, arthritis or trauma to the jaw.

Symptoms of TMJ related facial pain include:

–          Pain and tenderness in the face, jaw, neck, temples and shoulders

–          Limited range of motion concerning the jaw

–          Feeling of jaw being stuck or locked in position

–          Clicking, popping sounds in the jaw when opening and closing

–          Tense muscles in the face and neck

–          Difficulty chewing or feeling teeth aren’t coming together properly


Bruxism is a dental condition in which a person grinds or clenches their teeth together. Often a person suffering from bruxism is unaware as they may unconsciously clench their teeth together during the day or grind them at night, which is called sleep bruxism.

Bruxism can range from minor to severe. In some cases, it can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other head and neck problems. Because many people have sleep bruxism and are unaware of it until complications develop, it’s important to know the signs and symptoms of bruxism and to pursue regular dental care.

Symptoms of Bruxism include:

–          Grinding or clenching

–          Teeth that are worn down, flat or chipped

–          Tooth sensitivity

–          Jaw and facial pain/tightness

–          Ear pain

–          Headaches

–          Facial pain

–          Damage to the tongue or tissue inside your cheeks


Treatment options for facial pain and headaches vary based on the type and cause of pain. It’s beneficial to utilize conservative options when treating facial pain. After receiving a proper diagnosis the treating clinician will determine what treatment plan is best.

Treatments options include transcutaneous electrical nerve stimulation (TENS), ultrasound, trigger-point injections, therapeutic Botox injections, ethyl chloride, low level laser therapy. TENS and laser light wave therapy send low levels of electrical or radio waves of energy to the affected area to stimulate blood flow to the joint and surrounding area.

Botox injections are being used more frequently in dental offices as “off label” treatments for more troublesome maladies such as TMD. Studies have shown patients who received these injections experienced significant improvement in pain, function, ability to open their mouth and levels of tenderness to palpation. Only your dentist can determine if you are a candidate for this treatment, the frequency of injections will depend on the severity of your condition.

To achieve a successful outcome, it is important for your dentist to use the correct injection technique, as well as follow the appropriate dosage guidelines.

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