Temporomandibular Joint (TMJ) Dysfunction – Jaw Pain, Headaches and Dizziness
By Dr. Yoon Jeon, MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
Two female patients presented to our clinic with temporomandibular joint (TMJ) dysfunction associated with jaw muscle tension and upper cervical spine dysfunction.
Although their presenting symptoms differed, both cases demonstrated the importance of assessing the relationship between the temporomandibular joints, surrounding muscles and cervical spine.
Case 1 – Persistent Jaw Pain Following Dental Treatment
A woman in her mid-60s presented with a 12-week history of persistent left-sided jaw pain and difficulty opening her mouth fully.
Her symptoms had developed following a dental appointment, with constant aching around the left temporomandibular joint.
She had subsequently consulted both her dentist and GP, but the symptoms persisted despite their advice. Her GP recommended continuing dental follow-up, while the dentist considered the problem likely to be muscular rather than related to displacement of the TMJ disc.
The pain was particularly aggravated by eating and prolonged talking. She had been taking paracetamol for symptom relief.
The patient also reported associated neck discomfort.
Case 2 – TMJ Dysfunction Associated with Dizziness and Headaches
A second female patient presented with recurrent dizziness, headaches and ongoing jaw muscle tension.
She reported considerable stress and frequent jaw clenching, particularly during periods of increased tension.
The dizziness occurred mainly when standing up, although she occasionally experienced symptoms while sitting.
She had undergone a brain scan and blood tests, with no significant abnormalities reported.
Her GP recommended continued monitoring, and she was regularly monitoring her blood pressure at home.
She also attended routine dental check-ups every two months.
The presence of jaw clenching, TMJ dysfunction and upper cervical muscular tension raised the possibility of a musculoskeletal contribution to her symptoms, although the origin of her dizziness remained uncertain.
Clinical Examination
Case 1
On physical examination:
Restricted mouth opening, with deviation towards the left
Tenderness over the left temporomandibular joint
Increased muscular tenderness involving the masseter and pterygoid muscles
Bilateral upper cervical joint restriction
Tenderness and muscular tension in the upper cervical and suboccipital regions
Case 2
Clinical findings included:
Mildly restricted mobility of both temporomandibular joints
Tenderness over the masseter and pterygoid muscles
Restricted right upper cervical joint mobility
Tenderness and muscular tension involving the suboccipital muscles
History of frequent stress-related jaw clenching
These findings suggested a combination of temporomandibular and cervical musculoskeletal dysfunction.
Clinical Impression
The overall findings were consistent with:
Case 1
Left temporomandibular joint dysfunction
Associated masticatory muscle dysfunction
Upper cervical facet joint and muscular dysfunction
Referred facial and temporal pain
Case 2
Bilateral temporomandibular joint dysfunction
Upper cervical joint and muscular dysfunction
Stress-related jaw clenching
Headaches and dizziness of uncertain origin
Possible cervical musculoskeletal contribution to dizziness
The dizziness in the second case was not considered sufficient on its own to establish a diagnosis of cervicogenic dizziness.
Other potential causes, including vestibular, cardiovascular and neurological conditions, remained relevant to the differential diagnosis.
Treatment
Both patients received individualised conservative treatment programmes, adjusted according to their clinical presentation and response.
Chiropractic TMJ Mobilisation and Adjustment
Gentle manual and instrument-assisted techniques were applied to the temporomandibular joints where appropriate.
Treatment aimed to address restricted jaw movement and associated musculoskeletal dysfunction.
Cervical Spinal Manipulation and Mobilisation
Gentle chiropractic adjustments, traction and mobilisation were applied to the restricted cervical spinal segments.
Particular attention was given to the upper cervical region, where joint restriction and associated muscular tenderness were identified.
Soft Tissue and Myofascial Therapy
Soft tissue techniques were applied to the affected muscles, including:
Treatment included manual soft tissue therapy, muscular stretching and trigger point techniques.
Acupuncture and Electroacupuncture – Case 1
Acupuncture formed an additional component of the first patient's treatment programme.
Local facial and jaw acupuncture points, including Xiaguan (ST7), Quanliao (SI18), Yifeng (TE17), and muscular trigger points, were selected according to the patient's clinical presentation.
Electroacupuncture was introduced during the treatment course, using 2/100 Hz and 100 Hz stimulation protocols.
TDP heat therapy and auricular acupressure were also incorporated during selected appointments.
Home Exercises and Self-Care
Both patients were instructed in self-administered soft tissue massage and cervical stretching exercises.
Additional advice included:
Gentle jaw muscle massage
Avoiding excessive jaw loading or clenching
Maintaining comfortable jaw movement
Temporarily choosing softer foods when painful
Applying cold or warmth according to symptom response
Continuing prescribed cervical mobility exercises
For the second patient, ongoing GP monitoring of dizziness, headaches and blood pressure was also recommended.
Clinical Rationale
Temporomandibular disorders are commonly associated with pain, restricted jaw movement and muscular tenderness.
The temporomandibular joint is functionally related to the surrounding masticatory musculature, while cervical musculoskeletal dysfunction frequently coexists with TMD.
The trigeminal and upper cervical sensory systems have anatomical and neurological connections, providing a possible explanation for overlapping facial, temporal and cervical pain patterns.
In some patients, temporomandibular disorders may also coexist with headaches, dizziness or other otological symptoms.
Although a relationship between TMD and dizziness has been reported in clinical studies, a direct causal relationship has not been conclusively established.
Cervicogenic dizziness remains a diagnosis requiring careful assessment and exclusion of other possible causes.
The treatment programmes therefore focused primarily on the identifiable musculoskeletal dysfunction, while monitoring associated symptoms and maintaining appropriate medical follow-up.
Outcome
Case 1 – Progressive Recovery from Persistent Jaw Pain
The patient initially experienced gradual improvement in jaw mobility and pain.
During the early treatment phase, intermittent flare-ups continued, including occasional stabbing pain around the left cheek and temporal region.
Symptoms were particularly noticeable after eating, prolonged talking and towards the end of the day.
As treatment progressed:
Jaw mobility improved
Facial and temporal pain gradually reduced
Muscular tenderness diminished
Episodes of severe jaw pain became less frequent
By the later stages of treatment, only mild residual aching remained around the posterior aspect of the left TMJ.
At the eleventh treatment visit, approximately seven weeks after commencing care, the patient reported feeling very well and had been completely pain-free for several days.
A further review was arranged, and she was advised to continue her home exercises.
Case 2 – Recovery Following Six Treatment Sessions
The second patient completed a course of six conservative treatment sessions addressing her temporomandibular and upper cervical dysfunction.
The patient was reported to have made a full symptomatic recovery following treatment.
At a follow-up appointment four weeks after completing the treatment course, she remained symptom-free.
As no further symptoms were reported, she was discharged from active treatment.
This represented a favourable outcome, although the available clinical information does not establish which component of treatment contributed most to recovery or whether the dizziness was directly caused by the TMJ or cervical dysfunction.
Discussion
Temporomandibular disorders can produce a range of symptoms beyond localised jaw pain, including facial discomfort, headaches, impaired jaw mobility and associated cervical muscular tension.
The close functional relationship between the jaw and cervical spine is particularly relevant when patients present with overlapping symptoms.
Both cases demonstrated identifiable TMJ and upper cervical musculoskeletal dysfunction, supporting a treatment approach that addressed these regions together.
In the first case, the patient had experienced persistent jaw pain for approximately three months before attending the clinic.
Despite previous dental and medical consultations, her symptoms remained troublesome.
A combination of manual therapy, acupuncture and rehabilitation was followed by progressive improvement, with the patient ultimately reporting several pain-free days at her final recorded treatment.
The second case was clinically interesting because of the coexistence of dizziness, headaches, jaw clenching and cervical dysfunction.
Published research has suggested an association between temporomandibular disorders and dizziness, potentially involving altered sensorimotor function and interactions between cervical and trigeminal sensory pathways.
However, current evidence does not establish that TMJ dysfunction directly causes dizziness.
Furthermore, dizziness associated with standing requires consideration of alternative causes, including orthostatic blood pressure changes and vestibular disorders.
Consequently, although a musculoskeletal contribution was considered possible in the second case, the precise cause of the dizziness could not be established from the available clinical findings.
The patient's symptom resolution following conservative treatment was encouraging, but it does not independently confirm the proposed mechanism.
These cases highlight the potential value of individualised conservative management while recognising the importance of appropriate medical and dental assessment.
Conclusion
These two cases demonstrate favourable outcomes following conservative chiropractic management of temporomandibular joint dysfunction and associated cervical musculoskeletal problems.
The first patient presented with persistent jaw pain and restricted mouth opening that had not adequately improved following previous medical and dental consultations.
After a programme combining chiropractic care, acupuncture, soft tissue therapy and home exercises, she reported complete relief of jaw pain at her final recorded treatment visit.
The second patient presented with TMJ and upper cervical dysfunction associated with headaches, stress-related jaw clenching and dizziness.
Following six treatment sessions, she reported full symptomatic recovery and remained symptom-free at a four-week follow-up, allowing discharge from active care.
These cases illustrate the potential benefits of an individualised conservative approach addressing both TMJ and cervical musculoskeletal dysfunction.
They also emphasise the importance of careful clinical assessment, particularly where dizziness or other symptoms may have causes unrelated to the temporomandibular joint.
References
Busse, J.W. et al. (2023). Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ, 383, e076227.
Busse, J.W. et al. (2023). Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ, 383, e076226.
Reiley, A.S. et al. (2017). How to diagnose cervicogenic dizziness. Archives of Physiotherapy, 7, 12.
Seemungal, B.M. et al. (2022). The Bárány Society position on cervical dizziness. Journal of Vestibular Research, 32, 487–499.
Disclaimer: These case studies describe individual patient experiences. Clinical outcomes vary, and improvement following treatment does not establish that every symptom was caused by the musculoskeletal findings or that similar results can be guaranteed.
