Teeth Grinding May Lead to Headaches and Jaw Pain–How to Find Relief

COVID-19 and other stressors have contributed to increased teeth grinding, experts say.

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If you have ever heard the sound of your partner’s teeth grinding while he or she sleeps, you are not alone.

About one in four people globally struggle with bruxism, with higher prevalence among women.

While occasional teeth grinding and clenching—especially during stress—is common, frequent grinding can strain the teeth and jaw joints, leading to tooth damage, jaw pain, and headaches.

What Is Bruxism?

Bruxism is a medical term for habitual, involuntary teeth grinding or clenching that goes beyond normal chewing. It can occur unintentionally during the day (awake bruxism) or at night (sleep bruxism).

The excessive strain placed on the temporomandibular joint (TMJ)—which connects the skull to the jaw—and on the muscles that control chewing, swallowing, and speech can cause temporomandibular disorder (TMD). TMD may stem from bruxism, jaw injury, osteoarthritis, or displacement of the articular disk within the joint.

Bruxism has also been linked to TMD and headache symptoms.

Signs and symptoms of bruxism include:

• Jaw pain or stiffness
• Tooth wear
• Fractured, chipped, or loose teeth
• Multiple cracked or broken fillings
• Aching teeth and stiffness in the face and temples, particularly in the morning after waking up
• Indentations along the side of the tongue
• Restless sleep, difficulty falling asleep, or your partner noticing tooth grinding sounds while you sleep

Risk factors for bruxism include smoking, caffeine, illicit drugs, alcohol, certain medications, and poor sleep.

Common Headache Presentations

Having a headache upon waking is a common symptom associated with bruxism, and studies have shown a clear link between morning headaches and sleep bruxism.

Factors such as snoring, restless sleep, night drooling, sleeping position, and lack of sleep may trigger the onset of sleep bruxism.

Another common headache related to bruxism is a “tension headache” or “primary headache.”

Tension headaches can be felt as a dull ache or tightening sensation, usually across the entire head. They can feel like a pressing or tightening on both sides of the head.

According to a study published in the Journal of Oral & Facial Pain and Headache, people who struggle with awake bruxism are five to 17 times more likely to experience tension-type headaches than those without bruxism.

Migraines, also a type of primary headache, are characterized as moderate to severe, are usually felt as throbbing pain on one side of the head and can last from hours to days.

Migraine headaches associated with a painful jaw joint and teeth grinding are more common among adolescents, while sleep bruxism has been associated with migraine in the pediatric population.

Why Bruxism Has Spiked in Recent Years

While bruxism is a common presentation worldwide, the post-pandemic period has caused it to spike.

“Stress is the main cause of clenching and grinding,” Dr. Damian Teo, a lead dentist at the Melbourne TMJ and Facial Pain Centre in Australia, told The Epoch Times.

Stress, anxiety, and other emotional disturbances have been shown to exacerbate TMJ disorders, especially in patients who experience chronic pain.

Awake bruxism appears to be strongly related to emotional stress, while sleep-related microarousals correlate with sleep bruxism.

The sleep-related microarousals found in sleep bruxism refer to obstructive sleep apnea (OSA)—characterized by short periods of interrupted breathing caused by the partial or complete blocking of the airways. A brief wake-up period or arousal follows that restarts breathing.

High levels of psychological stress, including anxiety and depressive symptoms, and excessive daytime sleepiness, have been observed in people who experience OSA.

Some studies have shown the stress hormone cortisol to be elevated in people with obstructive sleep apnea; however, that link is inconclusive.

“Snoring and sleep apnea can cause clenching and grinding—that’s another big stressor,” Teo said.

Meanwhile, stresses both during and post-pandemic have been well documented, with work-from-home arrangements exacerbating known psychosocial problems, such as isolation, the blurring of work-family boundaries, and unhealthy behaviors such as poor diet, excessive sleep, and addiction.

A 2024 study found that almost two in three Australian adults reported higher levels of sitting, alongside increased levels of stress and anxiety, from working at home.

The authors noted that remote work amplified concerns about sedentary behavior, with employees spending more time at their desks and being less physically active because of reduced commuting and increased virtual meetings.

Similarly, in the United States, many workers during this period have battled physical, mental, and financial risks to their health and well-being, and many suffered from COVID-19 symptoms long after original infections, along with high levels of stress and burnout.

Moreover, stress can arise from a wide range of sources beyond work, including psychological strain, family issues, academic pressure, illness, injury, surgery, or hormonal changes, according to Teo.

Some patients have told him their pain began during the COVID-19 pandemic because of increased clenching, often triggered by events such as car accidents or driving in traffic, he said.

Darron Goralsky, a physiotherapist and clinical director of Melbourne TMJ and Facial Pain Centre, told The Epoch Times that COVID-19 and the post-pandemic period created a “perfect storm” for increased bruxism, headaches, and related conditions.

Goralsky added that areas beyond the jaw—such as the head, neck, shoulders, sleep behavior, posture, and breathing patterns—should be considered, given the range of factors that can contribute to bruxism and headaches.

Treatments for Bruxism

Treatments for bruxism are focused on preventing additional tooth damage and on relieving associated symptoms.

Preventing Additional Tooth Damage

Many patients with teeth grinding issues are prescribed occlusal splints, or mouthguards, which can provide temporary relief by protecting the teeth and relaxing the jaw muscles.

“Not all splints are born equal. In the right hands, the splints can do a lot more than just protect the teeth, and if they’re addressing enough of the areas, they can make a very big impact,” Goralsky said.

However, occlusal splints may not address underlying problems, such as neck, shoulder, or airway issues, Teo stated.

In some cases, they might worsen symptoms, especially if the patient has sleep apnea or snoring issues, as the splint can obstruct the airway, Teo said.

Goralsky added that in such cases, a different type of device—a mandibular advancement splint—may be more appropriate, as it helps open the airway.

Therefore, a more comprehensive approach, involving sleep doctors, specialized dentists, physiotherapists, or psychologists, may be necessary to address the root causes of the problem.

Counseling and Managing Stress Levels

For stress management, cognitive behavioral therapy and relaxation techniques, such as mindfulness and meditation, are recommended for awake bruxism.

For sleep-related bruxism, sleep hygiene counseling is considered good practice. Avoiding alcohol, caffeine, and tobacco before going to bed is necessary for maintaining good sleep.

Additionally, people experiencing obstructive sleep apnea should consider getting their airways checked by a sleep physician or surgeon, Teo said.

Botox

Botulinum toxin A (Botox) injections have been shown to benefit patients with severe bruxism and are usually administered to the masseter and temporalis muscles, the main muscles used for chewing.

A randomized controlled trial found that both occlusal splints and Botox injections significantly improved patient satisfaction and sleep quality in managing sleep bruxism.

However, Botox injections only decrease the strength of jaw muscle contractions and do not decrease the incidence of sleep bruxism events.

Teo said that because Botox wears off after about three months, some patients undergo repeated injections several times a year for years, only to find it eventually becomes less effective. He stated that such patients may achieve better results by addressing the muscles and joints of the head, neck, and shoulder region.

Goralsky agreed, noting that while Botox can be effective, it often fails to address the underlying issues and instead serves as more of a “Band-Aid” approach.

Musculoskeletal Work

Certain muscles, such as the masseter and sternocleidomastoid, can cause headaches and jaw pain, which are sometimes misdiagnosed as TMD, Teo said.

The masseter muscle, responsible for chewing, can refer pain to the jaw, temples, and ears, while the sternocleidomastoid muscle, involved in neck movement, can cause pain behind the eye, Goralsky said.

Both Goralsky and Teo suggest that patients with TMD symptoms, such as headaches, may actually need treatment for neck or shoulder issues instead of dental work.

Additionally, being physically active, such as through cardiovascular exercise, can assist with the management of any type of headache, be it tension, migraines, cervicogenic (emerging from issues with the cervical spine), or TMJ-related headaches, according to Trudy Rebbeck, a specialist musculoskeletal physiotherapist and professor.

Additional Treatments

Other treatments for bruxism include repairing damaged teeth, physiotherapy to relieve pain and fatigue in jaw muscles, eating soft foods, stretching exercises, and postural exercises. In extreme cases in which joint mechanics are being compromised by a damaged, displaced disk or by severe arthritis, TMJ surgery may be indicated.

Because it is common to implement more than one approach, it is recommended that you speak to your dentist, doctor, or physiotherapist about your options.

Goralsky said that if a dentist overlooks important factors such as airways, posture, or stress when addressing headaches, jaw pain, or teeth grinding, it may be worth seeking a second opinion or exploring a more comprehensive approach to treatment.