About the same as you, for the first 7-10 days I had very little pain, then the spasms started again & the pain in my jaw joint returned. I have slept better since the treatment though. I have to fill in a form to return to the pain clinic next week. The fact that im being treated at a general pain clinic probably means im a bit of a experiment for the doctor who is doing the injections ( botox dosage/site location). Hopefully the next time i can have some input as to where he puts the injections.

Dyan you have heard my story so what are some other options you can of for me? I had no side effects from the botox is what i was trying to say. I know all to well there are side effects from medications as i have had to be on several over the past eight years to help cope with the severe pain and I have been to an excellent TMJ specialist who continues to follow me. I am not a candidate for surgery not that i would have it done. My mri shows my tmj's to be fine. I do to a chiro, have massage and go to a head, neck and jaw clinic regularly. i am also a nurse so I do have some background education on medications etc. i am open to hearing any other options out there.

AJM I saw a chronic pain specialist for my injections and he has a lot of experience doing these injections for tmj. i had the injections in the temple and jaw area bilaterally. how about you? It may take a few injections before we feel the effects. do not get the injections sooner than two months from your previous ones. Where do you live? how old are you?

I live near Northampton , England. I am male & 39 years old.

how many injections did you have and where. My injections also included Decadron for inflammation and marcaine an anesthetic agent.

3 , in tmj , into the muscle on the front of cheekbone & aonther one somewhere near the last one.

Can you tell me other options?

I've had a real struggle finding anything that works to be honest. I've been down the usual route of painkillers, antidepressants, etc. Tried alternative stuff such as acupunture, osteopaths, massages etc. I've had sinus washes & tmj wash-out & mouth guards. I've had x-rays, mri scans & nothing has shown up as being abnormal.

Thanks for responding. I am hoping to hear from Dyan as well if she has other options I can try.

My story is long. Started the headaches in 2000. Tried the medical route first and neurologist. No go. Tried massage and chiro then orthodontist. Didn't like him and switched to one who had tmj and neuromuscular dentistry under her belt. We did braces and appliances etc. i worked for a year and a half in so much pain that my body started shutting down. I was off work for one and half years. In 2004 i felt better and have only had smaller relapses. In the time until 2004 i was in horrible pain. The only med that worked was Methadone so you know how bad it was. had to deal with some bad depression as you can imagine after dealing with such terrible pain on a daily basis for so long. Right now I am on my worst relapse it's been a year with daily headaches and mostly bad every day. I take tramadol for pain but not too too much help. although if I didn't take it i would probably have severe headaches every day. I don't want to go on morphine like meds at this point. i still want to function. right now i have been doing chiro and massage weekly and also biweekly to a head neck and jaw clinic. I had the botox in july and had relief the first week. I see my pain dr. next tues. I can't have botox for two months from the last injections. so i take it one day at a time. I am open to any info or other method of treatmennt to help with these headaches or cure for this tmj problem.

you get passed from pillar to post. Im sure I had Tramadol at some time, you tend to lose track , & nothing really seem to touch the pain. I have had problems sinc e the extraction of my wisdom teeth in 1996, & similar to you it does come & go, but it is there all the time now. It doesnt seem to bother me that much if im up & moving about my main problem is that it really hurts when im trying to sleep, & that obviously brings its own problems. There seems to be a real lack of understanding of this condition in the UK both with medical people & even friends & family. Its cost me my last few jobs, I'm not doing much work at the moment as im hardly functioning due to awful sleep patterns. GPs here are reluctant to give people sleeping pills.

I am so sorry to hear that you have lost jobs to the terrible pain. what are you doing now? I am a nurse at a children's hospital and work part time.

ive been busy so hadnt time to reply-----try massage--chiro, physical therapy.

do a google search on botox side effects--you come up with tons of them. yes you may not have it now but it may take awhile.

I have tried all forms of therapy and continue with massage and chiro weekly and head, neck and jaw clinic biweekly. In regards to the botox, I figure if it will help this daily severe pain I have had for the last year then it is worth it. One must try anything to try to survive until my treatments and therapies have helped my tmj disorder.

I've had a really hard time of convincing anybody that the problem is real. It's the hidden nature of tmj pain ( in the absence of any obvious damage or physical disability) that has been a barrier for me to get any treatment.How did your problem get triigered off ???

ive been dealing with excruciating tmd pain for all my life and i did it with out drugs and botox. if i can do it any one can.

you arent alone with trying to convince people that it is real. its one of those things that if you dont have it you dont understand it.

I'd go to extreme measures if I thought that would do any good.

Everyone deals with pain in a different way. Age will make a difference as well. I am fifty and after being in severe pain on a daily basis for years my body shut down and I had to go on sick leave. One must listen to their body. It is not that easy. I continue to try any form of treatment and continue to be followed by my neuromuscular dentist who also specializes in TMJ. I hope that I will be able to be in a better place some day in regards to this pain and get this TMJ disorder under control. But it is extremely difficult to go to work daily (and I have to have my wits about me as I am a nurse)and function at home when you're pain is 15/10 pretty much all the time. You do what you have to do to survive and try to be happy. I take one day at a time.

AJM is noticed my headaches starting when I was chewing licorice. How about you?

I started getting pain in my scalp about 2 weeks after have 2 wisdom teeth out. After a few months the pain got worse day by day & spread to other areas ( neck, jaw etc).

Has you botox settled down at all ?? I'm not to bad at the moment, the pain does seem to have reduced although i have noticed a reduction in my ability to chew food.

For botox info, look at Dr. Rivkin's ABC news segment on youtube and note websites below. I have been incorrectly diagnosed with migraines since triptan antiinflammatories help a little. Don't rashly assume your migraines are TMD, because it is very rare that apparent Migraines aren't migraines. Disclaimer: this is all theory since Botox is not approved and no clinical trials have been done. The official TMJ site says, for example, that temporary TMJ should be treated with anti-inflammatories, rest, heat etc., and severe with those plus pain relief. Wikipedia's bruxism entry is pretty good. But, bruxism's insidious silent sibling 'jaw clenching' just isn't covered anywhere, so here goes:

if you have teeth grinding or jaw clencing, get them cured or a mouthguard is useless and only delays tooth damage, not damage to the jaw joint or potential painful chronic neuromuscular joint disorder (TMD), which can even trigger migraines or rarely produce disabling pain attacks that aren't migraines. Most dentists and doctors do what they know to do as opposed to figure out with the patient what really needs done in the right order. So if fixing your bite does not stop the clenching or grinding, you need to check out the first link below to the UC San Diego Dr. Davidson. Make sure you read not just his sample consult but also the notes at the end. SKIP THE NEXT 4 PARAGRAPHS unless you want to learn how much time and $$ can be wasted diagnosing and finding the correct treatment for jaw clenching or bruxism (my saga).

I broke my neck and thought so during an injury in the early 90's. An HMO trying to save $$ told me that my swollen useless hands and arms HAD to be carpal tunnel because I worked in computers, and for 3 1/2 years said it's better to avoid surgery and do hand therapy, while I kept asking for a neck x-ray. When they fired my doc and gave me one, they rushed me in for titanium lamination of C5-C7. It stopped the progression of nerve damage, and I learned to hold my head up and got a little use of my hands back. Dug 6 months in the garden with a screwdriver, then a spoon, and in 2 years a mini shovel. Got a little of the use of my hands and arms back. Why am I telling TMD people this?

Because my headaches and neck/shoulder pain etc. got worse and worse!! Asked alot of docs - what's this ear pain -- "oh we can give you surgery to open your swimmer's ear "-- what a waste of time and $$. Asked the dentist about the jaw pain and muscle spasms. Dentist said mouthguard -- didn't help at ll. Another said bite correction - $$$ and useless. An ENT really lost me time (more than a year) saying I need an arthoscopic TMJ jaw flush with saline. He said his surgery was a complete success, with much arthritis removed, so I should get better and that's the most that anyone can do. The HMO had told me to suck it up on pain for 2 years, to let the nerves calm down (after 3 1/2 years of my cord kinked and folded over on itself ) -- another waste of painful time, (but not for them since that's the statute of limitations).

Suicidal by 2003 with constant migraine like headaches coupled with spastic colon and major muscle spasms down to my toes (like severe hemiplegic migraine). Not enough time between attacks to recuperate - either exhausted, concussed and sore from spams or having the next attck. A brain scan showed lots of tiny points of white (dead) matter in my brain from venous occlusions. Told me time to test for MS, but was negative. By 2004 virtually bedridden while pain center says not clear enough diagnosis because lamination solid, and not enough radiculopathy to explain pain. So, I kept going to any surgeon or doc who would see me (not many), and in 2004 an emergency room doc said to try Imitrex and the newer Relpax which helped shorten attacks a bit. There's lots of well meaning docs and dentists out there, but almost none knew to look for the neuromuscular disorder Temporal Mandibular Disorder, which includes my jaw clenching, which can silently and unconsciously occur day and/or nite. TMD is what causes bruxism, too.

All the above docs suggested that I am attention-seeking, need psychiatric help, and some rejected me. Neurologist put me through all migraine prevention drugs for 18 months, and nothing worked unless it knocked me out. Got a little relief from 2007 baclofen and zanaflex, but just enough to get out of bed a few hours a day. Writhing with pain despite opana, and the latest headache specialist said it MUST be migraine because I admitted to getting hangovers if I drank alot (last time was 30 years earlier in college). Despite no family history! Despite beginning in my forties after breaking my neck! He wanted me to spend a year plus cycling thru the same old migraine preventatives again! This time with no muscle relaxants or painkillers! I was either in agony after an attack or in agony of the next attack, with no time to heal the pulled muscles I'd get from head to knee between attacks. Went back to the internet, as I did each year, and this year found new stuff on bruxism (or its insidious silent sibling jaw clenching).

Self diagnosed jaw clenching as my main trigger of pain attacks, and convinced my pain doc to botox my masseters - he'd just looked up a 2-shot protocol (which spots to stick) in a doc-only database. Within a week I got some relief and proof that I am now on the right track.

Have convinced an experienced TMD botoxer to consult with my pain doc for the next botox, since the protocols aren't set yet (I think it's supposed to be 4 or 5 along each masseter, not the 2 that I got). Time'll tell. Worst case is you eat liquid or mush diet 3 months if more Botox than your particular case needs, but I don't mind that, since I'm already thinking of just pulling all my teeth! (Many people have told me this cured their headaches). Actually, I'm thinking of taping my nose shut at night to see if mouth breathing prevents clenching. (8/23/08 update - works to delay attacks though not pain. I forgot for a 90 minute nap day 4 and needed triptans and breakthrough painkillers!) I wish I'd known about clenching in 2003 when a bad attacks had gotton to the point where muscle spasms pull my lower jaw so hard that the teeth don't meet and my whole head gets inflammed! Not to mention the inability to sleep for years now, effect on my I.Q., memory, strength, ability to perform daily duties - I'm like a 95 year old. Some or all because I clench and jut unconsciously. The spastic colon, impactions, no sense of time, complete disability. The constant inflammation made my sinuses & allergies a mess.

What you need to get checked for is teeth grinding (Bruxism) or its insidiously silent sibling "jaw clenching". Only 5% of Bruxers go on to develop chronic local pain, but it can even trigger migraines occasionally. Even more rarely, you can get so much pain that you develop central sensitivity and so much inflammation that it includes migraine-like headaches as just one of the pain attack symptoms, which can be like hemiplegic migraine and completely disabling. After botoxing for my jaw clenching, I have far fewer "pain attacks", and am now working on trying to stop the neuromuscular disorder of jaw clenching (TMD is what causes Bruxism or jaw clenching although some dentists think that a bad bite alone, called malocclusion, can cause it). If you don't work on this, any relief is temporary.

The sooner it is diagnosed, the easier to correct. Since its causes are partly hereditary and mostly individual to that patient's stress responses and jaw anatomy, there is no single cure. Fixing your bite, mouthguards to prevent tooth destruction, and dental restoration are things that dentists know should be done, but preventing the cause (stress response? bad bite?) should instead be done first. A few sleep studies check for it (the original at Stanford).

Jaw clenching/bruxism of TMD can be as much as 40 minutes of massive force per hour while sleeping . Sum of all eating clenches in a day is little more than 20 minutes, so you can see how nighttime could wear through mouthguards, teeth, jaw, joint, and your quality of life. Read the first link below, especially the notes after the doc/patient consult transcript. TMD can, although very rarely, be disabling. I sometimes wonder if maybe 1% of migraine and cluster headache sufferers should cure their grinding/clenching instead -- or at least rule it out.

To diagnose and cure your TMD or TMJ caused by teeth grinding (Bruxism) or jaw clenching, study Bruxism in Wikipedia, and at least the web page below by Dr. Davidson at UC San Diego. Don't skip his notes at bottom titled "Additional Thoughts".

To summarize the web pages below, the patient suffering from the chronic pain of teeth grinding or jaw clenching may have anything from local pain to severe cases of inflammation with spasms so severe that they set off migraine-like headaches requiring cerebral vasoconstrictors (triptans), and/or neck and shoulder pain that can even shoot down the arm. The variety of symptoms and their severity can make diagnosis difficult. The patient can also have eventual or causitive damage to the jaw joint(s), teeth, and maybe bone loss. Severe cases may not be treatable until a short course of Botox breaks the cycle. Kids usually go through and spontaneously outgrow a phase of TMD with adible Bruxism, or silent clenching which can cause pain and headaches.

After diagnosis, the actual cause of the grinding or clenching must be determined and eliminated. This can require stress reduction and/or dental restoration to fix a bad bite (malocculsion). Botox alone, done repeatedly, without fixing the cause, will eventually damage the jaw muscle permanently. Use the relief period Botox gives you to learn how to stop the activity. Usually stopping E.G. jaw clenching requires an investment of time (stress identification and reduction). Usually insurance does not pay for Botox and some of the other TMJ/TMD treatments since there is no one-size-fits-all treatment that insurers can cost justify.

Something to try for daytime unconscious jaw clenching is to let your tongue rest comfortably in your mouth, whether the front or back of it rests comfortably just touching the upper jaw. Then let your lower jaw rest up against your tongue, without actually biting the teeth together. This is an attempt to find a "stable" position for your lower jaw that does not stress your jaw joint. Try to make it habitual and unconscious, so it becomes your default position. This is crucial and you can use breathing or any other adjunct that helps you develop this habit.

http://health.ucsd.edu/specia lties/surgery/davidson/consults/tmj.htm is the UCSD professor Dr. Davidson, who, at the bottom of a "typical" TMJ patient/doctor script, writes his "Additional Thoughts" paragraph, in which he says that Botox is not a cure for TMJ. At best it should be used temporarily only with those whose grinding, clenching, or spasms are resistant to all therapies. Without curing the original cause, which is usually how the patient handles stress, Botox will eventually weaken and damage the jaw permanently. He thinks pain killers are wrong, leading to nothing but addiction. Since many painful years average before correct diagnosis, I think that temporarily they may be needed. Lastly, he says that since TMJ is a chronic pain problem, patients should be prescribed amitriptyline (where not contraindicated) in doses of 5, 10, or at most 25 mg. before bed. Although most doctors start at higher levels, he says that anything higher will create unnecessary side effects like sleepiness, without working better for TMD. Remember, this treatment is an adjunct to finding the cause and stopping the TMD activity.

http://www.westsidemedicalspa.co m/tmd-treatments-los-angeles.html is the page for Dr. Rivkin, who does non-surgical cosmetic procedures plus a lot of Botoxing of TMD, which he says is sometimes enough in itself to cure grinding or clenching. Search youtube or his website for his 2 min. ABC news segment.

www.designersmilz.com/html /tmj.html and www.designersmilz.com/html /reconstruction.html are a couple of web pages of Dr. Correa, who practices 'neuromuscular dentistry', which is appropriate since this is a neuromuscular disorder currently being treated by doctors, neurologists, and dentists, and may require therapy in cases where causitive stress response is difficult to identify and/or reduce. Dr. Correa concentrates on the need for accurate diagnosis of exactly what physical problems have developed, and the need for anything from fairly inexpensive to extensive and pricey restoration. But the main thing is to diagnos the CAUSE and fix it before spending alot of dental dollars.

Be aware that Botox is not approved (paid for) by most insurers for TMD or TMJ, so find a doctor who will charge you his price plus processing for the vial itself. Ask Walgreen's what their current price is. Then you will still have to pay for the treatment(s). Since causes range from bad bite to stress response, there is no single treatment. Also, it's pretty rare that Bruxism or jaw clenching progresses to this level of pain and damage. Even if 20% of the population is doing it, only 5% get pain, and maybe less than 1% of refractory migrainers or cluster headaches are cured by identifying and stopping TMD. 50 years of sufferers have been falling through the large crack between doctors who are untrained and dentistswho want to do the restoration work (that should be more like follow-up work after sucessful treatment to stop TMD). TMD is still difficult to diagnose and to cure, and at this point of limited TMD expertise, the patient has to become an expert who actively works on diagnosis and treatment.

As more people get relief from Botoxing, even if it is temporary, better stats will come out on what % of people have TMD (and are not whiners or migrainers or cluster headachers or hemiplegic migrainers), and more doctors will think to check for and treat it. It's not impossible to diagnose if your doctor or dentist includes checking for sore masseter (jaw) muscles, sore related muscles, joint soreness and movement problems, pattern of teeth wear, headache diaries including sleep patterns/studies. But getting a neurolgist and a dentist with experience to collaborate can be challenging. So, right now, the patient has to be the one to make sure these problems are ruled out or diagnosed, and the patient has to be the one to make sure that the cause is identified and treated (TMD stopped). Hopefully my suggestions above on nose taping, finding the stable daytime position, and botox-as-diagnostic-tool will help you.

you could tape your nose shut with odorless paper bandage tape - I use about 2 inches of 3/4 inch wide to cover 90% of my nostrils. It is horrible, but much less horrible than kicking off migraines and worse, and even would be useful diagnostically. I thought it up myself, thinking that you probably can't clench or grind if your mouth has to be constantly open to breathe. Of course, mouth breathers catch more colds not using the ciliae of their noses. And, although it's no where near as bad as TMD is for your teeth, it isn't healthy to get dry mouth.

But, as severe TMD'ers know, it's for some people enough to let them function again. Am awaiting TMDDyan's advice - why can't you just post it?