Temporalis Trigger Points and Referred Pain Patterns

Before you read about temporalis muscle pain from trigger points, you may want to find out more about the temporalis muscle.

The temporalis muscle is a very-hardworking muscle of the jaw. Even though it is located on the side of the head, its primary function is to assist in closing and retracting the jaw as a chewing muscle. If you place your fingers just above your ear while clenching and unclenching your jaw you will be able to feel the temporalis at work. In fact, this is a good idea because if you clench your jaw very tightly you will feel a very powerful contraction in the temporalis, showing just how hard this muscle can work. Muscles of the face and head are easily overlooked yet they are some of the busiest muscles in the body. Especially overworked are the muscles of mastication, like the temporalis, which not only work while we chew but may sometimes be continuously called on during periods of stress when we habitually clench or grind out teeth. This is referred to as bruxism. The temporalis, in fact, is likely to be involved in jaw pain of myofascial origin and also with headaches. Trigger points are common in this muscle.

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Temporalis Trigger Points Causes and Symptoms

Trigger points may be activated in the temporalis by trigger points of the sternocleidomastoid or masseter. Fixing the trigger points in these muscles may resolve the problem in the temporalis.

The temporalis is commonly associated with TMJ problems both of myofascial pain origin and other. As mentioned above, bruxism and teeth clenching can activate trigger points in the muscle or trigger points in the muscle can bring about bruxism. Whatever the case, the muscle becomes overworked and strained. An impact of any kind against the side of the head in the temporalis area can also cause trigger points to occur. Note that trigger points can be, and usually are, self-sustaining. They can persist long after the offending incident or injury has resolved. This, in fact, is one of the most important things to remember about trigger points: unless they are treated they are self-perpetuating.

TP’s can occur because of dental work or jaw work that requires long periods of jaw immobilization or during cervical traction for neck pain. Often, the trigger points caused by these procedures add to the pain symptoms iherent to the original problem leading to further unnecessary work. So for instance, extensive dental work leads to trigger points in the temporalis muscle. These trigger points add to the face pain and toothache leading to the mistaken assumption that further dental work is needed which of course only worsens the problem. For these problems any muscle of mastication including the temporalis and masseter and any neck muscles of postural control such as the sternocleidomastoid, can be related. Neck pain cause from TrP’s in the upper trapezius, for instance, may lead to faulty treatments for the cervical spine, these treatments leading to even more trigger points in the masticatory muscles, etc. Forward head posture, like with many other muscles, can also lead the TrP’s in the temporalis.

Other causes are excessive gum chewing, a cold draft of air on the side of the head (as when driving with an open car window in winter), and anything that causes the teeth not to meet properly or displaces the jaw, such as dental work or related jaw problems. Abscesses in teeth or jaw inflammation may lead to TrP’s in the temporalis. Chronic mouth breathing may be a culprit as well. Also, as stated, trigger points in the sternocleidomastoid, masseter can set up satellite TrP’s here. Trapezius trigger points may also spread problems to the temporalis.

Temporalis TrP’s are associated with head-pain and are a clinical feature of tension-type headace of myofascial origin (myogenic headache). They refer pain to the ipsilateral head, sometimes to the front of the head over the eyebrow, and to the face and upper teeth. See the image below for these referred pain patterns. Headache sufferers often report that the pain from temporalis TrP’s occurs inside the head. Other muscles that refer pain to the head and are a clinical feature of tension headache are the upper trapezius, sternocleidomastoid, suboccipital, splenius capitis and cervicis, and others.

Sometimes pain can be felt in the side of the face in general, which can be felt as a diffuse jaw pain. It is possible for the pain to extend anywhere from the side of the chin all the way to the postero-lateral neck region, with much of the pain being concentrated in the side of the head or the temple region, above and/or slightly posterior to the trigger point. Temporalis TrP’s can also cause pain and heat and cold sensitivity in the upper teeth and gums. Temporalis TrP’s are a feature of TMJ problems (TMD) as mentioned above and prolonged TrP’s in the temporalis and masseter muscles can permanently damage the jaw. Increased tear production in the adjacent eye has also been reported.

Self Massage for Temporalis Trigger Points

Locate the tender point and massage with even strokes with supported fingers. It may be helpful to open the mouth slightly. Alternatively, apply pressure to the trigger point while opening the mouth wide. Repeat several times and move on to the next trigger point. Be sure to find and treat other associated trigger points as covered in this article. Heat application may be helpful for temporalis TrP’s as well. If needed or desired a trigger point massage ball can be used to treat the temporalis. Do not use very firm balls such as lacrosse balls, which are frequently used for deep tissue massage. 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.,²Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print,³De Las Penas, Cesar F., Lars Arendt-Nielsen, and Robert Gerwin. “Chapter 6: Muscle Trigger Points in Tension-Type Headache.” Tension-type and Cervicogenic Headache: Pathophysiology, Diagnosis, and Management. Sudbury, MA: Jones and Bartlett, 2010. 70-71. Print.,⁴Weiner, Richard S. Pain Management: a Practical Guide for Clinicians. Boca Raton [etc.: CRC, 2002. Print.,⁵DeLaune, Valerie. Trigger Point Therapy for Headaches & Migraines: Your Self-treatment Workbook for Pain Relief. Oakland, CA: New Harbinger Publications, 2008. Print.

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