If you’ve been suffering from chronic jaw, face, or head pain, you may have a condition called temporomandibular joint disorder (TMD). The temporomandibular joint (TMJ) connects your lower jaw to your skull, allowing you to open and close your mouth. When this joint is damaged or dysfunctional, it can lead to tremendous pain and discomfort. The good news is that trigger point injections offer a safe, effective way to alleviate TMJ pain and regain mobility. In this comprehensive guide, we’ll explore everything you need to know about using trigger point injections to treat your TMJ disorder.

Before diving into trigger point injections, it’s important to understand the difference between TMJ and TMD. The TMJ is simply the anatomical joint that connects your jawbone to your skull. TMD refers to medical problems affecting this joint and the surrounding muscles.

TMD can arise from injury, arthritis, muscle strain, joint dislocation, and clenching or grinding of the teeth. It affects over 10 million Americans and is more prevalent in women. The pain is typically felt in the jaw, face, temples, neck, and shoulders. Other symptoms include:

  • Clicking, popping, or grating sounds in the jaw
  • Locked jaw or difficulty opening the mouth wide
  • Headaches or migraines
  • Earaches, dizziness, and ringing in the ears
  • Toothaches with no apparent dental cause

So in summary, TMJ refers specifically to the jaw joint itself, while TMD describes the range of disorders affecting this joint and the surrounding musculoskeletal structures.

Trigger point injections are an effective treatment for TMJ pain, especially when it’s caused by muscle dysfunction. Trigger points are hyperirritable knots or tight bands within a muscle that develop due to injury, overuse, or strain. These knotted areas can radiate pain in localized areas or refer it outward to other parts of the body.

For example, trigger points in the masseter muscle, which controls jaw clenching, can refer pain to the cheek, teeth, or directly to the TMJ. Trigger points can also restrict motion and cause muscle weakness.

During a trigger point injection, a thin needle is inserted directly into the trigger point. The injection contains a local anesthetic like lidocaine, sometimes mixed with a steroid. The local anesthetic provides immediate pain relief by numbing the irritated tissues. The steroid brings down inflammation, enabling the knot to relax.

The act of needling the trigger point also produces a therapeutic benefit. It helps break up knotted muscle fibers and interrupt the pain cycle. Patients experience increased mobility in the jaw and less headache, facial pain, and neck stiffness. The effects of a single injection can last for several weeks, providing progressive relief as the muscles start to heal.

TMJ trigger point injections should only be administered by trained healthcare professionals. The most qualified practitioners are dentists or oral surgeons who specialize in TMJ disorders. They have an in-depth understanding of the TMJ anatomy and advanced skills in needle placement.

Other providers like physical therapists, pain management physicians, or primary care doctors might also offer trigger point injections after undergoing proper training. However, their level of expertise and success rates may vary. Maxillofacial radiologists can also guide injection placement using imaging technology like ultrasound or fluoroscopy for real-time visualization of the needle.

It’s crucial to seek out seasoned providers who will take the time to properly examine your condition, identify the problem areas, use imaging if needed to pinpoint the injection site, and employ proper sterilization techniques. This will ensure you get the right treatment with the lowest risk of complications.

The substances injected into the trigger points depend on your specific condition, the provider’s preference, and the desired outcome. Here are some of the common medications used:

  • Local anesthetics like lidocaine or bupivacaine provide immediate, temporary numbness so you don’t feel the needle or experience pain during the procedure. This numbness wears off within a few hours.
  • Corticosteroids like triamcinolone or methylprednisolone reduce inflammation and can provide pain relief for several weeks or even months. However, there are limits on how many steroid injections you can get per year.
  • Botulinum toxin (Botox) can paralyze overactive muscles that contribute to TMJ pain. The effects may last up to 6 months.
  • Saline solution is sometimes injected as a “dry needling” technique without anesthetics to produce a therapeutic effect by disrupting the trigger point.
  • Other agents like hyaluronic acid may lubricate the joint while dextrose can promote healing.

The duration of pain relief depends on several factors like the medication injected, the severity of your condition, your overall health, and adherence to post-procedure care recommendations.

On average, you can expect the following timeframes:

  • Anesthetics alone like lidocaine provide a few hours to a couple days of relief. The numbness wears off rather quickly but can break the pain cycle.
  • Steroid injections relieve pain for several weeks to a few months by reducing inflammation. However, there are limits to how many you can get.
  • Botulinum toxin starts working in 2-3 days and offers 3-6 months of muscle relaxation and pain relief before the effects wear off.
  • Saline injections offer shorter-term relief, from a few days to a couple of weeks, by disrupting the trigger point.
  • Hyaluronic acid may act as a joint lubricant for several weeks to months.
  • Dextrose can promote long-term healing lasting a couple of months.

Your practitioner will determine the right substances and injection schedule based on your needs. Be patient, as it may take a few treatments to experience the full benefits.

When performed correctly using sterile technique, trigger point injections are very safe with minimal risks. However, as with any invasive procedure, some potential adverse effects include:

  • Mild pain, bruising or bleeding at the injection site
  • Brief increase in muscle soreness lasting a few days
  • Infection – rare if the skin is sterilized beforehand
  • Allergic reaction to the medication – unlikely unless you have known allergies
  • Nerve injury or paralysis – very rare with an experienced provider

Using the smallest needle necessary, proper placement, and injecting only approved amounts of medication can minimize these risks. Make sure to disclose your full medical history to avoid complications. Contact your doctor immediately if you experience any worrying symptoms after the injection.

With appropriate precautions, you can feel confident in the safety and effectiveness of TMJ trigger point injections. The benefits typically far outweigh the small risks.

While trigger point injections can provide tremendous relief for TMJ pain caused by muscle trigger points, they work best when combined with other therapies to address the root causes. Some complementary treatments include:

  • Physical therapy to strengthen the jaw muscles, improve range of motion, and promote correct posture/alignment
  • Oral splints or mouthguards to protect teeth from grinding and stabilize the jaw joint
  • Heat/cold therapy to relax muscles and manage inflammation
  • Medications like muscle relaxants and anti-inflammatories to relieve symptoms
  • Stress management techniques like meditation, yoga, or counseling to reduce clenching/grinding
  • Dietary changes to eat softer foods that don’t overtax the jaw muscles
  • Good oral hygiene to prevent dental issues from exacerbating TMJ problems

A customized treatment plan including trigger point injections and other modalities can provide lasting relief from TMJ disorder.

There is no set schedule for getting trigger point injections. The frequency depends on the severity of your condition, the duration of relief from each session, and considerations relating to the injected medication.

If only a local anesthetic is used, you may be able to get injections every few weeks as needed for pain flares. However, frequent exposure to anesthetics isn’t recommended.

For steroid injections, spacing them out by months is safer to avoid complications like tissue atrophy. Botulinum toxin sessions are typically scheduled every 3-6 months based on the long duration of effect.

Make sure to follow up with your provider after each session to evaluate your progress and determine optimal timing for repeat injections. Keep a pain journal tracking your symptoms so you can work together to customize your treatment plan.

Let’s compare the pros and cons of trigger point injections to other leading TMJ treatments:

1. Trigger point injections


  • Targeted relief of acute muscle pain
  • Immediate effects from anesthetics
  • Less invasive with lower risks


  • Temporary relief requiring repeat injections
  • Doesn’t address joint issues or dental malocclusion

2. Oral splint therapy


  • Stabilizes jaw joint by optimizing the bite
  • Provides long-term relief by preventing clenching/grinding
  • Can be worn preventatively or as-needed


  • Doesn’t address existing inflammation or muscle knots
  • Can take weeks to adjust to wearing the splint

3. Botulinum toxin (Botox) injections


  • Provides longer-lasting muscle relaxation (3-6 months)
  • Smooths lines/wrinkles caused by facial muscle strain
  • Covered by some insurance plans


  • Repeat injections required as effects wear off
  • Doesn’t treat joint disorders or malocclusion issues
  • Potential side effects like bruising, headache, facial asymmetry

As you can see, each treatment has a role in a comprehensive plan. Trigger point injections excel at delivering fast relief from acute muscle pain but don’t fix underlying joint problems. Combining therapies is key for the best outcomes.

If you decide to pursue trigger point injections, here’s what to expect during a typical session:

  • You’ll have a consultation to discuss your medical history, symptoms, and goals. Your provider will conduct an oral exam to identify problem areas.
  • The injection site is marked and thoroughly cleaned to prevent infection. Some practitioners may apply a topical numbing cream.
  • You’ll be seated comfortably and may be given a mouthguard to bite down on. Try to relax as much as possible during the procedure.
  • Using a very thin needle, your provider will inject the anesthetic and/or steroid directly into the trigger points. You may feel some pressure or a pinching sensation.
  • After injecting all the planned sites, your provider will massage the area to work the medication into the tissues before removing the needle completely.
  • The entire appointment takes about 15-30 minutes. You’ll be monitored for potential adverse reactions before leaving.
  • You may experience some mild soreness, swelling, or numbness for several days after the injection. This is normal.

Be sure to follow all pre and post-procedure instructions carefully. Ask your provider how many sessions they recommend and what results you can expect to achieve.

To maximize pain relief and avoid complications, follow these tips after your treatment session:

  • Rest your jaw as much as possible – eat soft foods, don’t talk excessively, and avoid chewing gum or tough meats.
  • Apply cold compresses to reduce swelling and use OTC pain relievers if needed.
  • Be very gentle when brushing teeth, shaving, applying makeup, or washing your face.
  • Abstain from intense exercise for at least 48 hours to avoid increased blood flow to the area.
  • Monitor the injection site for signs of infection like worsening pain, swelling, warmth, redness, or pus.
  • Keep up with your other TMJ treatments like oral splints, physical therapy, and medications.
  • Maintain proper posture and hydration. Use moist heat pads once swelling goes down.
  • Schedule follow up appointments as recommended by your provider to assess progress.

Alert your dentist or doctor immediately if you have any concerns after the procedure so they can provide guidance for continued recovery.

Since trigger points manifest in muscles, it helps to understand the key muscle groups involved in TMJ pain:

  • Masseter – This strong jaw muscle can develop trigger points causing pain in the cheeks, TMJ area, and upper/lower molars when clenching.
  • Temporalis – Trigger points in the temporalis muscle, which allows you to close your mouth, can radiate pain to the temples, TMJ, and upper teeth.
  • Medial/lateral pterygoids – These internal muscles that enable side to side and forward jaw motion can have trigger points that cause deep pain in the mouth and around the ears when activated.
  • Digastrics – This muscle connects the jawbone to the hyoid bone and its trigger points can refer pain to the jawbone, chin, and neck area.
  • Sternocleidomastoid (SCM) – Trigger points in the SCM, which tilts and rotates the head, can cause TMJ pain that radiates up to the temples, forehead, eyes, and ears.

Identifying which muscles contain trigger points causing your pain allows for precise injection placement for relief.

The cost of TMJ trigger point injections depends on your geographic location, the provider’s qualifications, the number of injections needed, and whether you have insurance coverage.

  • Without insurance – Expect to pay $100 to $400 per injection, with specialists charging higher fees. The medications used, facility fees, and number of trigger points treated impact the per-session costs.
  • With insurance – If trigger point injections are covered, you’ll pay any required deductible plus copays of around $20 to $60 per session. But confirm specifics with your insurance provider.

Some plans may cover a limited number of injections annually or require preauthorization. Many practitioners offer flexible payment options if trigger point injections could benefit you. Discuss the expected costs during your initial consultation.

As discussed earlier, trigger points can develop in various muscles involved in jaw function, causing referral pain. Here are the main muscles treated with TMJ trigger point injections:

  • Masseter – This strong superficial muscle that controls chewing is frequently injected to address trigger points causing TMJ area and cheek pain.
  • Temporalis – Trigger points in this fan-shaped muscle along the side of your head are common targets, reducing pain radiating to the temples.
  • Medial/lateral pterygoids – Injections into these interior muscles that enable the mandible to move sideways and forward can alleviate deep facial and ear pain.
  • Digastrics – Treating trigger points in these paired muscles connecting the hyoid bone to the jawbone helps relieve chin, neck, and jaw pain.
  • Sternocleidomastoid (SCM) – The SCM muscles running down from behind the ears to the collarbone have trigger points that refer TMJ pain up to the face, head, and eyes when injected.

Your provider will determine which muscles to target during trigger point injections based on a thorough exam and your symptom patterns.

While most patients experience significant relief from TMJ trigger point injections, some may feel temporarily worse before improving. Here are a few reasons why:

  • The needle penetration and injection can cause inflammation and soreness around the injection site as the body starts healing.
  • If the muscle knot was extremely tight, the agitation from the needle may initially provoke muscle spasms and increased tightness before the benefits kick in.
  • Since trigger points radiate pain outward, numbness at the injected area may unmask secondary pain from other unresolved trigger points.
  • Rarely, some patients may be susceptible to pressure-induced flare ups or experience irritation from the injectate.

Increased post-injection soreness is usually transient, resolving within a few days as the treatment takes effect. If the worsening pain concerns you, contact your provider. Additional injections to address secondary trigger points often help in these cases.

In summary, if you are battling chronic TMJ pain and conservative efforts haven’t helped, consider exploring trigger point injections. When performed correctly by a qualified specialist, injections can safely deactivate muscular trigger points, restoring mobility and dramatically reducing face, jaw, and headache pain.

However, remember that trigger point injections work best as part of a comprehensive treatment plan. Combining them with other therapies that address joint disorders, psychological factors, and dental problems can provide lasting relief by targeting TMJ disorder from all angles.

Useful Links:

TMD (Temporomandibular Disorders)

37 year old male with one month history of left-sided jaw pain and headache.

Assessing the effectiveness of botulinum toxin injections into masticatory muscles in the treatment of temporomandibular disorders