Masseter Trigger Points and Referred Pain Patterns

Before you read about masseter trigger points and the pain they cause, you may want to find out more about the masseter muscle.

Masseter Trigger Points and Referred Pain

The masseter muscle can easily become chronically tense with trigger points and it is the most likely muscle to cause severe problems with opening the jaw. As the main muscle of chewing or mastication, the muscle is highly active and is among the first to tense when we are in emotional distress or when we are concentrating deeply or angry. This tension can go on for extended periods of time so that the masseter is likely to be a problem at some point for almost everyone. Clenching or grinding the teeth in this fashion is called bruxism and it happens to all of us once in a while. For some, this can become a chronic and debilitating problem, especially when it occurs during sleep as part of a sleep disorder. The masseter and other muscles of mastication can suffer tremendous strain and develop trigger points. On the other hand, it is possible for the presence of trigger points in these muscles to bring on bruxism.

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Trigger points in the superficial layer can refer pain to the eyebrow, upper jaw (maxilla) and the rear part of the mandible. They can also refer pain to the upper and lower molars which can become sensitive to pressure or temperature change so when the molars suddenly become sensitive check the masseter for trigger points before you buy special toothpaste for sensitive teeth or visit the dentist, although it is always best to seek professional medical advice when experiencing any kind of unusual pain or discomfort. Trigger points in the deep layer refer pain to the ear region (see images below).

In general, masseter trigger points cause pain in the eye, face, jaw, and teeth area. An unexplained earache can be a result of masseter trigger points and it is reported in Travell and Simons that TrPs of the masseter can even cause that annoying itch deep in the ear that you can never quite scratch. Trigger points in the deep layer may also be a cause of tinnitus (perception of ringing noise in the ear with no cause). They are a possible contributor to myogenic tension-type headaches especially if TrPs of the neck muscles are contributing to the headache pain.

Note: Tinnitus is usually a ringing noise but all sorts of other noise perceptions may occur such as high pitched whining, buzzing, or hissing. Sounds like insects or electrical currents. Whistling, ticking, or a pure steady tone such as is generated when you take a hearing test, are all possible.

Forward head posture can cause problems leading to trigger points in the masseter. This posture indirectly causes tension in the supra and infrahyoid muscles which in turn pull down on the masseter lightly. In order for trigger point therapy of the masseter to be successful, posture must be corrected. Since associated problems may involve many muscles it may be best to see a professional therapist, but in general, correction of posture should help alleviate myofascial pain of masseter origin.

If the masseter develops trigger points its synergists are likely to follow suit, so expect TrPs in the temporalis and medial pterygoid muscles. It is associated, with TrP’s of the neck and jaw muscles, with TMJ pain and bruxism. Headaches and TMJ pain may likely be caused by complex overlapping referred pain patterns by several muscles of the jaw and neck, such as the sternocleidomastoid, which is associated with forward head posture, or the trapezius. ¹Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. “Chp. 8: Masseter Muscle.” Travell & Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 329. Print.

Masseter TrPs may often be satellite trigger points to primary trigger points in the larger neck muscles, such as the trapezius. The masseter and temporalis are posture muscles controlling the position of the jaw (the temporalis does most of the job during relaxation) and they control the position of the jaw during chewing. Since the head always moves during chewing as well the neck muscles and the mastication muscles are linked in postural control. Therefore it can be difficult to alleviate trigger points in the masseter (and temporalis and pterygoid) if there are trigger points present in the neck muscle. The reverse is also true. ²Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, 2005. Print.

Note: Satellite trigger points used to be referred to as “secondary” trigger points but the term satellite is not preferred because it is more clear. Satellite trigger points are simply trigger points that are activated by other trigger primary or “key” trigger points and will tend to be located in areas within the pain referral zone of the primary trigger point or in muscles that are functionally associated with the muscle harboring the primary trigger points, such as synergists.³Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, 2005. Print.

Masseter Trigger Point Self Massage

As you can see from the images below, trigger points can develop anywhere on the masseter muscle including near the cheekbones, and the bottom edge the jaw. They can be massaged from the outside with the fingers being supported by the opposite hand but the best way is to put your thumb inside your mouth and knead the muscle between your thumb and fingers. Using the hand opposite from the side you are workng on, insert your thumb back in front of the molars the molars and feel for the bony ridge-like area called the coronoid process. This is the area to work on and you should be able to feel the thick and rubbery masseter muscle. Press the muscle between the thumb and the index and middle fingers.

Explore the muscle from the top to the bottom and all the way back to the ear. Find the most tender areas. The images below will give you an idea of where to expect the tender points. Pressing on and massaging these points may feel very painful. Massage them as strongly as you can stand for about one minute. Continue daily until the pain and problems subside and squeezing the muscle no longer hurts and then continue for several days after that. ⁴Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.,⁵DeLaune, Valerie. Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief. Oakland: New Harbinger Publications, 2008. Print.,⁶“masseter (anatomy) – General Practice Notebook.” http://www.gpnotebook.co.uk/simplepage.cfm?ID=-100270003.

Masseter Trigger Point Images

Unless otherwise noted, all images on this page used under license. Images by LifeART (and/or) MediClip image copyright 2010. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved. Images not for reuse.