INTRODUCTION
According to the National Institutes of Health (NIH), headache is the most common form of pain. Moreover, The International Classification of Headache Disorders, published by the International Headache Society, classified over 150 types of headache disorders.
Besides primary headaches, secondary headaches, occurring as symptoms of other diseases, are included in this classification. One such headache is temporalis muscle pain. So, let’s first say something about the temporalis muscle.
The temporalis muscle, located at the temples, helps to close the jaw. It works in tandem with the masseter muscle, another major chewing muscle.
Overactivity or strain in these muscles can result in headaches, facial pain, and muscle spasms, which are common symptoms of TMJ and TMD. In some cases, the temporalis muscle may become hypertrophic or enlarged, exacerbating these symptoms.
ANATOMY
Temporalis muscle, also known as temporal muscle, is a thin, fan-shaped muscle. The muscle originates from the temporal fossa and temporal fascia. Temporalis muscle covers the entire side (temporal area) of the head. It extends from above the ear to behind the eye. At the same time, the other end tapers down and reaches under the cheekbone to attach to a special anatomical projection of the mandible (lower jaw).
Furthermore, it is one of the muscles of mastication -meaning its primary function is – chewing food. This muscle is also responsible for closing the jaw, clenching the teeth, and retracting the jaw. The temporalis muscle also assists in the side-to-side movement of the mandible.
The temporalis muscle is innervated by the anterior and posterior deep temporal nerves from the mandibular division of the V cranial nerve – trigeminal nerve. As the temporalis muscle is an essential muscle of the temporomandibular joint (TMJ) – jaw – it may also be involved in its dysfunction.
Temporal tendonitis is an inflammatory condition involving the tendon that connects the large temporalis muscle to the lower jaw. This inflammation can produce intense headaches, often mistaken for migraines. Symptoms of temporal tendonitis may include pain around and behind the eye, temple pain, pain in the lower and upper jaw, and pressure or pain within the ear.
SYMPTOMS
It may become painful when the temporalis muscle becomes inflamed, overused, fatigued, traumatized, or otherwise irritated. Pain originates from the trigger points within the muscle. These trigger points are hypersensitive and hyperirritable spots in the muscle, which cause the muscle fibers to have reduced blood flow, become spastic and even get build-ups of toxins and other waste products.
Trigger points in the temporalis muscle are a pretty common cause of, mainly tension headache. They can cause pain locally, in the temporal region and jaw, but also referred pain to cheek, upper incisor, and maxillary teeth, and around the eye and eyebrow. The pain may radiate to other areas and even mimic migraine pain.
The temporalis muscle pain generally occurs unilaterally, i.e., on one side of the head. Trigger points may form almost anywhere in the temporalis muscle, and the pain spot is identified by palpation. Besides the pain itself, which can be very severe, temporalis muscle pain can also lead to restricted jaw movements, light sensitivity, ear pain and pressure, and swelling of the cheek.
Moreover, medical researchers discovered that the temporalis muscle might be the primary pain spot of tension headaches and potentially the primary center of migraine pain.
Different temporal muscle pain patterns exist, depending on the trigger points. The pain might lead to headaches at the back of the head or spread obliquely backward, vertically upwards, behind the eye, across the cheek, and to the jaw and teeth.
Causes of Temporalis Muscle Pain
When it comes to the causes of temporalis muscle pain, they are numerous.
The causes include trauma, gum chewing, prolonged immobilization, bruxism (tooth grinding), prolonged dental work, forward head posture, and other potential causes. For example, even emotional tension, stress, nail-biting, and thumb sucking may cause temporalis muscle pain.
Temporal tendonitis can result from various factors, such as trauma to the jaw, excessive opening of the mouth during dental procedures, or prolonged intubation for general anesthesia. Repetitive actions, such as chewing, talking, and laughing, can also contribute to inflammation in the tendon.
Diagnosing Temporal Tendonitis
To diagnose temporal tendonitis, a local anesthetic injection is administered at the point where the temporalis muscle inserts into the lower jaw.
If the pain subsides and the pressure within the ear seems to clear, it serves as a good diagnostic test for the condition. Additional tests may also be employed to confirm the diagnosis.
Differential Diagnosis
The differential diagnoses of temporalis muscle pain include temporal tendonitis, neoplasia, vascular malformation, polymyalgia rheumatica, migraine, temporal arteritis, giant cell arteritis, and reactive masticatory muscle hypertrophy (RMMH).
Temporalis muscle pain may also be concurrently present with other craniofacial disorders, including Ernest syndrome, anterior TMJ articular disk dislocation, myofascial pain, and even maxillary sinusitis.
Treatment of Temporalis Pain
As the pain can be pretty tough, the question arises: how to treat the temporalis muscle pain?
The management of a painful temporalis muscle begins – as with any other pain treatment – with the diagnostic evaluation of potential underlying causes, which can be challenging.
Treatment options for temporalis muscle pain vary depending on the cause and also severity of the pain. Generally, injection of a local anesthetic directly in the pain spot, followed by anti-inflammatory corticosteroid infiltration, should help, along with physical therapy.
Also, resting the jaw is a must, as jaw movements are the primary cause of stress and strain of the temporal muscle. Compressions – hot or cold – of the trigger points and applying pressure on these spots can also be helpful, as well as taking muscle relaxants and anti-inflammatory medications.
In some cases, oral splints/mouth guards are needed, and, although, in extremely rare instances, surgery can be required. Self-massage of the trigger spots is always welcome, especially if one is under stress.
However, if the pain is caused by other conditions, such as bruxism, the primary condition should be treated first.
Exercises for TMJ pain
Temporalis Muscle Stretch:
- Place the palm of your hand on the side of your head, aligning it with the corner of your eyebrow. There is a small indentation in the skull where your hand should rest.
- Gently press inwards and lift upwards, being mindful not to cause any pain. Clench your teeth to confirm you’re on the temporalis muscle.
- To deepen the stretch, slowly open your mouth. You should feel a gentle stretch in the temporalis and jaw area.
- If you prefer more pressure, use your knuckles instead of the palm of your hand. Press in slightly and lift up to stretch the muscle.
- Hold the stretch as long as it feels comfortable and repeat several times a day.
Temporalis Muscle Self-Massage:
- Identify the temporalis muscle by clenching your teeth and feeling it pop under your fingers. The muscle is roughly the size of your hand and can be found above the cheekbone.
- Using the tips of your fingers or knuckles, apply light to moderate pressure and make small circular movements across the muscle’s surface. Experiment with moving forwards or backwards to find the most comfortable direction.
- When you find a particularly tense area, spend some time massaging it to help release tension. Remember to be gentle with your tissues, as this is not a “no pain, no gain” situation.
- Cover the entire surface of the muscle to ensure you address all tense areas. Clench your teeth occasionally to confirm you’re still on the temporalis muscle.
Botox Treatment for TMJ/TMD Relief
Botox injections can help relax the temporalis muscle, thereby alleviating associated headaches and facial pain.
The Botox injection process involves administering approximately 20 units of Botox into the center of each temporalis muscle. This dosage may vary depending on the size of the muscle and the severity of the problem.
Patients usually receive an initial treatment and then return for a follow-up appointment in several weeks to assess their progress.
In addition to the temporalis muscle, we also address the masseter muscle, another significant contributor to TMJ/TMD symptoms. Both muscles, when overactive or hypertrophic, can place undue strain on the temporomandibular joint, leading to facial pain and even migraine syndromes.
Conclusion
Among over 600 named muscles in a human body, each with a specific function, all work synergistically, and they all contribute to global muscle function. Besides that, the temporalis muscle itself has several important functions. Therefore, temporalis muscle pain should always be well evaluated and appropriately treated.
Overactivity of the temporalis muscle, often in conjunction with the masseter muscle, can lead to facial pain, headaches, and muscle spasms.
By incorporating these gentle stretches and self-massage techniques into your daily routine, you can effectively alleviate tension and discomfort in the temporalis muscle. Remember to be patient with the process and gentle with your body. By taking the time to care for yourself, you can prevent further strain and promote overall wellbeing.
As with any medical procedure, it is essential to consult with a qualified professional to determine the most appropriate treatment plan for your specific needs.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.