Temporal Tendinitis: Migraine Mimic
by Edwin A. Ernest, III, DMD
This article describes a very common headache disorder called temporal tendinitis1-7
which is often initiated by auto accident trauma and is complicated diagnostically by the
intrinsic and extrinsic components of the temporomandibular joint (TMJ) and dental
occlusion.
 Figure 1. Temporal muscle and its tendon inserting at the
mandibular coronoid process. Courtesy Ernest Publications
In pain management, diagnosis is key. Goethe’s maxim says “What ones knows,
one sees.” Conversely, what one does not know, one does not see. When diagnosing,
physicians look through a mental filter when viewing the patient. Appropriate and
effective diagnosis and treatment of neck and head injuries requires both dental and
medical knowledge in the areas of teeth, soft tissue, and TM joint function. If the
patient has jaw joint pain and soft tissue pain, the clinician must determine which is
primary and which is secondary in the diagnostic stream. In particular, it is crucial to
first assess the condition of the jaw joint and its muscles and tendons before proceeding
to equilibrate the teeth.
Intense, chronic head pain of questionable origin has been a dilemma for patients and
doctors alike. The patient may often complain of pain and an aching sensation over the
eye, behind the eye, radiating into the lateral temple over the ear, and into the occiput,
or the rear of the head. The pain may radiate from the rear of the head into the neck,
shoulder, back, as well as the arm and hand. The cheek and cheek-bone areas may be
reported to be swollen along with aching and throbbing. The eye may feel sore and feel as
if the eye ball is trying to pop out of the socket. With many patients suffering from
temporal tendonitis,8-12 the ear, jaw joint, insertion of the stylomandibular
ligament, and the upper and lower molar teeth may ache and throb. The range of vertical
opening of the mouth may also be restricted due to the contracture of the injured temporal
tendon. Another feature of temporal tendinitis is seen in some patients who do not seem to
be able to close the back teeth together.1 This problem is apparently related
to the inability of the injured tendon (splinting effect) to properly contract due to pain
and inflammation.
Please refer to the May/Jun 2006 issue for the complete text. In the event you need to order a back issue, please click here.
— May/Jun 2006
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