Severe headache and eye pain despite little jaw pain

This de-identified 2024 case involved several months of severe bilateral headache and pain in or around both eyes, although the jaw itself was not very painful.

The patient said ophthalmic care had found nothing unusual and that orthopedic manual therapy had not resolved the discomfort. TMJ and masticatory-muscle function were therefore assessed as one additional part of a broader evaluation.

Care consisted of three visits including TMJ injection treatment and physical therapy. At the third visit, there was no jaw pain or opening difficulty and no report that headache or eye pain had returned, so the short course was ended.

The absence of headache and eye pain during the same period after care does not prove that the original symptoms were caused by the TMJ or predict the same result for another person.

Core course

The main concern was bilateral headache and severe eye or ocular pain lasting about three to four months. Jaw pain was not prominent, and the patient sought jaw-function assessment after ophthalmic and orthopedic care.

A history of masseter botulinum-toxin injections at a dermatology clinic in late March 2024 was recorded separately. Product, dose, exact injection sites, and prior reactions were not available in the public record.

About three weeks after the first treatment, headache and ocular pain had not occurred, but right-sided swelling, bruising, vague discomfort near the mouth, and earlier opening difficulty were also documented.

At the third visit, the patient reported no jaw pain, opened comfortably, and underwent dental scaling without difficulty. The result represents only this short-term course.

What did the patient mean by ocular pain?

In this story, ocular pain means the patient's subjective pain felt inside or around the eye. It does not mean that eye disease or elevated intraocular pressure was demonstrated.

Eye-surface or ocular disease, pressure-related problems, migraine and other headaches, sinus disease, neuropathic pain, temporalis or masticatory-muscle referred pain, and other ophthalmic or neurologic causes must be distinguished.

The words eye pain or ocular pain alone do not establish a TMJ diagnosis.

Symptoms at presentation

The patient said: “My TMJs do not hurt much. I came because the headache and ocular pain are severe, and both sides hurt.” Symptoms had continued for about three to four months by recall.

Little jaw pain does not completely exclude a jaw or muscle contribution, but headache and eye pain do not establish the jaw as the cause either.

Earlier evaluation and treatment

The patient said he had attended ophthalmology and was told there was no unusual finding. He had also received orthopedic manual therapy and recalled being told that no specific problem was identified.

These were the patient's descriptions; the complete records from those facilities were not reinterpreted here. “Nothing unusual” was not treated as a new definitive diagnosis.

Online information about possible links between headache, eye pain, and the jaw prompted the visit, but search results cannot establish the cause.

Prior masseter botulinum-toxin injections

The patient reported periodic cosmetic-clinic injections into the jaw area, including a masseter injection at a dermatology clinic in late March 2024 before the dental visit.

Because product, dose, precise site and depth, symptom change, and adverse reactions were not confirmed, the earlier injection was not assumed to have caused or treated the current headache and eye pain.

Such history is still relevant when assessing masticatory-muscle status and previous treatment response.

Why assess the TMJs and muscles when the jaw does not hurt?

TMJ and masticatory-muscle dysfunction is not always felt primarily as jaw pain. Some people notice greater discomfort at the temples, head, eyes, cheekbones, in front of the ears, neck, or shoulders.

Assessment can compare comfortable and maximum opening, jaw path and deviation, sounds or catching, masseter and temporalis tension and tenderness, clenching or grinding, timing of headache and eye pain, change with jaw use, and prior eye or neurologic findings.

The public record does not contain every opening measurement or palpation result. Unrecorded examination findings were not inferred backward from the treatment response.

Order of evaluation for eye pain and jaw function

1. Check ocular warning signs

Sudden vision loss or field change, severe redness with abrupt intense eye pain, double vision, halos, marked pain on eye movement, or severe headache with vomiting requires ophthalmic or emergency assessment.

2. Check neurologic warning signs

Sudden slurred speech, facial or limb sensory change, unilateral limb weakness, altered consciousness, difficulty walking, or a sudden very severe headache requires urgent neurologic or emergency assessment.

3. Compare symptoms with jaw function

Clinicians can assess whether headache and periocular discomfort vary after jaw movement or clenching, whether familiar pain is reproduced by temporalis or masticatory-muscle palpation, whether opening or joint sounds change, and whether muscle tension follows the same time course.

Jaw assessment may be added when ocular causes are not clear and symptoms vary with jaw function, but it does not replace repeat eye evaluation when symptoms persist or worsen.

How the three visits were conducted

The course included TMJ injection treatment and TMJ physical therapy over three visits. The public record does not support assigning a precise procedure sequence to every visit, and the injection medicine and detailed sites are not disclosed.

Procedure type, site, and dose vary by symptoms and examination findings and cannot be applied identically to another person.

Change about three weeks after the first treatment

The patient said the right side remained swollen and bruised and somewhat uncomfortable, but headache had not returned. Because ocular pain usually accompanied headache, it had not occurred during that headache-free period either.

Touching near the right corner of the mouth caused a vague discomfort, possibly related to bruising. Opening was difficult early after treatment but gradually returned to the usual state.

Headache and ocular pain changing together was an important patient-observed pattern, but it did not prove the TMJ was their original cause. Swelling, bruising, and opening difficulty were tracked separately as post-treatment findings.

How swelling and bruising were interpreted

Injection treatment can be followed by local swelling, bruising, tenderness, temporary movement discomfort, or injection-site pain. These effects should not be hidden simply because other symptoms improved.

Rapidly increasing swelling, severe pain, marked warmth or redness, fever, sensory change, clear facial-movement change, or swallowing or breathing difficulty requires prompt contact with a clinician.

What did simultaneous disappearance of headache and ocular pain mean?

The patient usually experienced ocular pain with headache. About three weeks after the first treatment, neither had recurred, so the two symptoms followed the same time course in this case.

TMJ and masticatory-muscle pain, temple headache, and periocular pain can interact or be perceived together through trigeminal sensory and referred-pain mechanisms, so a possible clinical connection was considered.

This synchrony is a clue, not proof that the TMJ was the sole cause. Natural headache variation, sleep, fatigue, stress, medication, prior eye and orthopedic care, previous botulinum toxin, and ophthalmic or neurologic factors may all contribute.

The third visit ended the short course

The patient said, “There is no jaw pain at all.” He could open comfortably and underwent scaling without difficulty that day.

There was no jaw pain or opening difficulty and no report of recurrent headache or ocular pain. Care ended after three visits. This does not guarantee long-term nonrecurrence or equivalent results for others.

Key points

Jaw function can be assessed even when jaw pain is slight

The main complaint was headache and eye pain, not jaw pain. Assessing the jaw did not mean declaring it the cause.

A reported normal eye examination did not establish a jaw diagnosis

Complete prior records were not reviewed here. Eye warning signs and other causes remained primary while jaw function was considered additionally.

Improvement and adverse effects were recorded separately

Headache and ocular pain did not recur during that interval, while right swelling, bruising, mouth-area discomfort, and early opening difficulty remained.

Co-improvement is a clue, not proof

The shared time course supports considering a connection, but treatment response cannot determine the original cause in reverse.

Previous masseter injection history matters

The history was recorded, but uncertain product, dose, and site prevented causal conclusions about current symptoms.

Summary

The patient presented in 2024 with about three to four months of bilateral headache and severe eye or ocular pain despite little jaw pain. Discomfort persisted after reported ophthalmic assessment and orthopedic manual therapy.

A prior dermatology masseter botulinum-toxin injection was documented without inferring benefit or harm. TMJ injection treatment and physical therapy were included across three visits.

About three weeks after first treatment, headache and ocular pain had not recurred, but swelling, bruising, vague mouth-area discomfort, and transient opening difficulty were present.

By visit 3, jaw pain and opening difficulty were absent and no recurrent head or eye pain was reported.

The case supports adding jaw-function assessment when eye and headache symptoms persist after appropriate evaluation, while preserving ophthalmic and neurologic boundaries and avoiding causal claims from one response.

Research cited with this case

Schiffman E, et al. Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia. 2012;32(9):683–692. DOI: 10.1177/0333102412446312. The criteria emphasize headache change with jaw function and reproduction during movement or temporalis palpation.

Tchivileva IE, et al. The Journal of Headache and Pain. 2021;22:42. DOI: 10.1186/s10194-021-01255-1. The study compared headache attributed to TMD with primary headache in people with chronic myogenous TMD.

Fernández-de-Las-Peñas C, et al. The Clinical Journal of Pain. 2007;23(9):786–792. DOI: 10.1097/AJP.0b013e318153496a. Temporalis trigger-point stimulation could produce referred pain toward the temple and behind the eye; this is mechanistic context, not proof for this case.

Sharma S, et al. Pain. 2023;164(4):820–830. DOI: 10.1097/j.pain.0000000000002770. The paper supports distinguishing headache secondary to TMD from a separate headache that coexists with TMD.

Frequently asked questions

Can jaw function be assessed without jaw pain?

Yes. Clinicians can compare headache or facial and eye discomfort with jaw movement and muscle tension, without assuming or excluding causation solely from absent jaw pain.

Does a normal eye examination mean the jaw is the cause?

No. It is important information but does not establish jaw-related referred pain. Persistent or changing symptoms may require renewed eye, neurologic, and headache assessment.

Does disappearance of eye pain after care prove a TMJ cause?

No. Timing is a clue, but natural variation and other treatments or factors must also be considered.

Can swelling or bruising occur after injection treatment?

It can occur locally. Rapid enlargement, severe pain, fever, sensory or facial-movement change, or swallowing or breathing difficulty requires prompt clinical contact.