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Quix Trigeminal Neuralgia or TMJ?
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Quix Trigeminal Neuralgia or TMJ?

How do you know the difference? The right side of my face hurts, from the temple, eyebrow, down the jaw, and my teeth. I have trouble talking, eating, or shifting my jaw from side to side. I thought maybe TMJ because of my stress, but the went to the TN site that Kathy gave me, and did the on-line diagnostic questions, and it came up with TN-type2.  I called my dentist this am, and can't get in until the 30th of April. Since I already take Tramadol, neurontin, and baclophen, does it make any difference which one it is?   I'm just falling apart a piece at a time! LOL

Maggie
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721523_tn?1331585402
I have had both.  When it is my tmj, there us usually but not always popping of the jaw.   It is not loud, but you can feel it pop open and shut.  when I am having an MS relaps, I have the other.  It us usually not associated with the popping.  It is actually more painful, and difficult to target the source.  

Not sure if this will help!  Sorry, I know that it is miserable.  My TMJ is acting up today.  No popping, though.  It is just sore right at the joint.  I know that it is TMJ because I slept on that side of my face all night.  I find it interresting that they both happen on the same side of my face only.

Ann
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645390_tn?1338558977
I have both. With the TMJ, my jaw gets a click on occasion, but no real pain, per say. With the Trigeminal Neuralgia is is lots of pain for me. It feels like my skin in on fire and shooting pain in on the side of my cheek, up towards the temple and near my jaw. Is this an MS related symptom? I have had this for years, and have always associated it with cold sores in my mouth. I have had the pain, and not the cold sore, but always thought somehow it was part of that virus. I would be very interested to here about this,
Thanks,
Michelle
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405614_tn?1329147714
I'm not sure how TMJ is treated; muscle relaxants?  physical therapy?

I know that my TN was helped by increasing my dose of Lyrica, which is similar to neurontin.  Can you increase the dose of neurontin (better call your doctor first) and see if it helps?  That might point to whether it's nerve pain.

One thing my physical therapist told me when she thought I had TMJ was to go on a soft diet and see if that made things better.  She told me to eat stuff like pureed soup, ripe bananas, pudding, milkshakes (like my body needs that,no thanks! lol), and so on.  I didn't enjoy that, and it didn't seem to help me much.

I think that the nerve pain and holding my mouth funny because of it caused the muscles in my TM joint to spasm, which made for a lot of popping and pain there, too.

I wonder if there is a connection; any of you wise ones out there know?

Ann is so right; the pain from TN is much worse,  and it's difficult to point to where the pain is coming from.  My dentist tested all the teeth on my upper left jaw, and they all reacted to cold, some more strongly to others, but not enough to say that the pain was from a tooth.  She said she had to think more globally, as in TN.

Maggie, I hope you get some relief soon.  Does your dentist have a cancellation list, so you can get in sooner?

Take care,

Kathy



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Thanks all of you. I do sometimes get the clicking, but not this time. I can't open it far enough to see if it will "click" Been putting hot packs on it when I can, but can't run around with a Bed Buddy Sinus Pack while I'm working, LOL no where to heat it up! It's not that my dentist is booked, it's that he's MIA. He's on vacation. They told me to call on the 30th if it was still hurting, and they would work me in....bless them. I will try increasing the neurontin, I have lots of that. And yes, muscle relaxants are listed as one of the treatments for both conditions. Still hurting...Maggie
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645390_tn?1338558977
Just wondered how you are feeling today. Did increasing the neurontin help?
Thinking of you,
Michelle
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It seemed a little better today, altho I only got 4 1/2 hrs sleep last night because it was hurting. I just forgot and yawned, and that reminded me in a hurry, LOL. Thanks for asking.

Maggie
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147426_tn?1317269232
Sorry to have left this so long, but I have been thinking about how one would tell the difference.  The two problems could resemble one another. but, this is how I would approach it.  The area of pain would definitely overlap.

TMJ is a problem in the joint.  It is basically a musculo-skeletal problem.  So there would be greater pain with use and movement.  The jaw muscles would often be in spasm so the ability to open the mouth wide could be reduced.  There might be pain to deep pressure along the chewing muscles and very often at the joint itself.  It should be better with rest and worse after eating. Just touching around the area should not make it better.

The problem with "resting" the TMJ is that often we have the TMJ problems because we clench or grind at night.  So that sleeping makes the problem worse.  Are there family members (like a spouse or partner) who could tell you if you grind your teeth or clamp them together repeated.  Do you often notice just as you are drifting off or on awakening that you are clenched?  The dentist should be able to pinpoint areas of abnormal wear from clenching or grinding.

The TMJ can affect the entire side of the face with pain.  If you all try clenching your teeth repeatedly, and feeling the muscles on the side, you will see that the main muscles in the cheek become hard, but so does the large sheet of muscle fanning out in the temple area beside and above the eye, the temporalis muscle.  If you palpate those muscles while you clench and they hurt - it points more toward this being a TMJ problem.

Yes, it can be treated with warmth and NSAIDS.  The main treatment is directed at stopping the initial insult - overuse and misuse from clenching and grinding.

I was born with only half the normal number of permanent teeth, so my jaw is far too small.  My jaw began clicking and popping by the time I was 10.  By age 30, the head of the jaw bone was so worn down that it didn't click or grate any more.  So, popping only happens to the jaw that is still pretty healthy.  Mine is permanently subluxed now and I can only open my mouth about 25mm.  

Now, Trigeminal Neuralgia is a nerve pain that generally does not cause deep muscle pain, or not specifically muscle pain.  It typically has a trigger in the classic form such as touching somewhere on the lip or cheek or chewing or hot or cold.  There is not a place where you can push on that makes it exquisitely worse.  The type of TN that would be confused with TMJ is the Type 2 or the "Symptomatic TN of MS."  When I had TN the trigger tooth would hurt, but so would the whole jaw and the pain went all the up to the TMJ - which makes sense, because that is where the Trigeminal nerve emerges to give sensation to the face.

Now, there are three branches of the Trigeminal nerve (Cranial nerve V)  These are V1, V2, and V3.  V1 deals with the sensation of the upper face down to and including around the eye.  V2 is the maxillary branch and deals with the middle part of the face, the nose and the upper lip.  It includes sensation of the upper gums.  It also has a motor portion that ennervates the muscles of chewing.  V3's (the mandibular branch) runs mostly along the jaw and serves the jaw area above the jawline, the lower lip and the lower gums.

The most common source of TN is V2, so that the pain is felt in the middle of the side of the face.  The person may feel convinced that the pain is coming from the upper teeth and it is not uncommon to have people insist that these teeth be taken out.  Or, TN may be missed by uneducated or unscrupulous dentists and dental procedures done or recommended.  More and more dentists are quite aware of TN and recognize it from the description of pain, once a dental cause has been ruled out.

The next most common is V3.  The same description applies to TN from the maxillary branch.

It is rare for TN to come from V1.  So pain that truly involves the temporal area is less likely to be from TN and more from TMJ - or possibly from migraine.

It is unusual, but quite possible for TN to bew from both V2 and V3.  However, involvement of all three branches in TN is rare.

Since TMJ is regular pain - that is pain that has an actual painful cause, it is best treated with conventional pain meds, like NSAIDS or opiates.

TN is neuropathic pain and responds poorly to conventional pain meds.  The drug of choice is carbamazepine.  I'm always surprised when a doc tries Neurontin or Lyrica first.  When carbamazepine doesn't work, then they would move to Neurontin (gabapentin) or Lyrica.  Sometimes people need to rotate between various meds.

Kathy is correct.  Bracing the mouth or holding the face in an unnatural pose to prevent the pain can cause a secondary pain in the TMJ or the muscles of the face.  this would be felt as an additional, but different pain.

In my experience holding the face or pressing on it did not affect the pain.  I did it anyway, for lack of something else to do, but the pain of true TN is not affected by local pressure or massage.

That's about it in a nutshell.....

Quix
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645390_tn?1338558977
Can TN be a symptom of MS? I am so curious about this. I have had TN for probably 5 years at least, off and on. I have it right now for about 1-2 weeks. Although, I am still in the middle of some type of flare too, although I think I am getting a little bit beter. I always associated this face pain with a cold sore in my mouth, although at times can never find the cold sore to find the source of the pain. I have been to my primary care doc on a few occasions due to the pain in my ear from this, thinking I had an ear infection. I never did, and at one point he thought I had shingles. Never developed into shingles at that point, thank goodness. But the pain can get so excruciating...just shocks of pain. sometimes I have to try not to touch anything near my face or move my head too quick.

Should I tell the neuro tomorrow about the TN? I never mentioned to her before, just felt like "it was one of things" that is an intermittent problem with me.
Thanks,
Michelle
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Thank you all so much for your replies, experiences, and expertise. Quix, when I did the sx assesment on the TN website Kathy gave me, it diagnosed(we all know what on-line dx are worth) the problem as TN-Type2, so you are right on the money. Still hurting a lot, so just have to tough it out until the 30th, when my dentist returns.This weather isn't helping, lots of aches and pains from the rain, and snowed last night. Will Spring ever come!  Thanks & hugs to all.

Maggie
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147426_tn?1317269232
Michelle - Yes!!!!  TN can be a symptom of MS.  Trigeminal Neuralgia is seen 50-300 times more often in MS than in the non-MS population.  (The numbers vary because the incidence of Non-MS TN varies with different things I read.)

Michelle - you definitely should report this pain to your neurologist.  If possible include either a note from your doc and dentist or their medical notes showing that you have repeatedly complained of this.  The fact that it has come and gone means that it has Relapsed and Remitted.

Do NOT, however, tell him you think you have Trigeminal Neuralgia.  Just describe the pain and what triggers it and tell him that it comes and stays for a while, then goes away.

Maggie - no problem.  Glad we could help!

To all - the best site for learning about TN is

pfa-support.org

We really need an HP on all of this.

Quix
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