Headache, facial pain, and TMJ dysfunction often overlap because the head, face, jaw, and upper neck share closely connected nerve pathways. At Manhattan Pain Medicine, we evaluate primary headaches, secondary headaches, facial pain, jaw pain, migraine, neck-driven headache, craniocervical instability, and TMJ dysfunction together, so we can understand what is driving the symptoms and what needs to be treated first.
Headaches and migraines can disrupt every part of your day. Dr. Siefferman explains how expert care can help.
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Hi, I’m Dr. Jason Siefferman. I’m medical director at Manhattan Pain Medicine. When we evaluate a patient with headache, we are looking to establish what is the headache and is there more than one kind of headache. We look for primary headaches as well as secondary headaches and we want to understand what triggers for those headaches are in play.
For example, migraine by itself is generally straightforward. If it’s chronic migraine, if it’s constantly being triggered, there’s an underlying reason for that trigger. We look more broadly to understand what those triggers are and how can we treat those triggers; that may include TMJ dysfunction, head-neck instability, autoimmune conditions, any variety of systemic processes may also trigger headache.
We want to understand which primary headaches are in play, which secondary headaches are in play, and what’s driving those headaches. What’s keeping them from getting better? By understanding what the reasons for these headaches are, we are best equipped to develop a comprehensive treatment plan across all of our specialists if needed to provide robust headache treatment for you.
Headache is not always just a headache. Pain in the head, face, jaw, and upper neck may be driven by migraine, TMJ dysfunction, cervical spine irritation, craniocervical instability, nerve sensitization, intracranial pressure changes, autoimmune disease, or other systemic processes.
Because the brain, face, jaw, and upper cervical spine share overlapping pain pathways, one problem can trigger or amplify another. A migraine can worsen neck guarding and jaw clenching. An unstable upper neck can trigger headache or facial pain. TMJ dysfunction can contribute to muscle tension, nerve irritation, and referred pain.
At Manhattan Pain Medicine, we evaluate headache and facial pain by asking what type of headache is present, whether more than one headache pattern is occurring, and what may be triggering or maintaining the pain.
Headache and facial pain may require collaboration across headache medicine, interventional pain, rehabilitation, rheumatology, pain psychology, regenerative medicine, and other clinical perspectives. At Manhattan Pain Medicine, care is coordinated around the patient’s full symptom pattern, including head pain, face pain, jaw dysfunction, neck mechanics, nervous system sensitization, and systemic contributors.
Patients may benefit from evaluation when headaches are frequent, disabling, treatment-resistant, associated with facial pain or jaw pain, triggered by neck position, worsened by movement or posture, linked with light or sound sensitivity, nausea, brain fog, dizziness, whooshing tinnitus, or occurring alongside hypermobility, TMJ dysfunction, or craniocervical instability.
In complex pain, headache often needs to be addressed early. When the brain is irritated by migraine, intracranial pressure changes, or upper cervical pain, the rest of the nervous system may become more reactive. Calming the headache pattern can make it easier to evaluate the neck, jaw, spine, pelvis, autonomic system, and other pain generators more accurately.
Your evaluation may include a detailed headache history, review of triggers, medication response, jaw and neck examination, imaging review, neurologic screening, and assessment for migraine, TMJ dysfunction, cervicogenic headache, craniocervical instability, intracranial pressure symptoms, nerve pain, or systemic contributors. In selected cases, diagnostic medication trials, dynamic imaging, or targeted nerve and joint blocks may help clarify the source.
Two patients may both have headache, but the drivers may be different. One may have migraine, another may have upper cervical instability, another may have TMJ dysfunction, and another may have intracranial pressure symptoms or trigeminal nerve sensitization. Understanding the source helps determine which treatment should come first.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Manhattan Pain Medicine evaluates many types of head and facial pain, including migraine, chronic migraine, cervicogenic headache, occipital neuralgia, trigeminal nerve pain, TMJ-related pain, cluster-type headaches, post-traumatic headache, intracranial pressure-related headache, and headache associated with craniocervical instability or systemic conditions.
Yes. The upper neck and head share overlapping pain pathways. Irritation from cervical joints, discs, ligaments, muscles, or nerves can be interpreted by the brain as headache, facial pain, or pain behind the eyes. This is often called cervicogenic headache.
Migraine can make the nervous system more sensitive and reactive, which may increase neck muscle guarding, jaw clenching, light sensitivity, nausea, brain fog, and autonomic symptoms. Neck pain can also trigger migraine. In many patients, both patterns interact and need to be evaluated together.
Yes. TMJ dysfunction can contribute to jaw pain, temple pain, facial pain, ear symptoms, headaches, neck tension, and muscle guarding. The jaw, face, and upper neck share nerve pathways, so dysfunction in one area can affect the others.
A cervicogenic headache is a headache that begins from a problem in the neck. It may be related to cervical joints, discs, ligaments, muscles, or nerves. It often worsens with posture, head turning, prolonged positioning, or movement from lying down to standing.
Craniocervical instability may contribute to headache when excessive motion at the head-neck junction irritates upper cervical joints, ligaments, nerves, blood flow, cerebrospinal fluid flow, or autonomic pathways. In selected patients, dynamic imaging and targeted diagnostic blocks may help clarify whether instability is contributing.
Some patients have migraine activity without a classic pounding headache. Symptoms may include brain fog, fatigue, light or sound sensitivity, nausea, motion sensitivity, mood irritability, dizziness, or a daily crash. These symptoms may still reflect migraine-related nervous system sensitization.
MPM may use the clinical history, symptom pattern, triggers, medication response, and selected diagnostic medication trials to determine whether migraine is contributing. If a migraine-specific treatment improves symptoms such as nausea, brain fog, light sensitivity, or head pressure, that response may help clarify the role of migraine.
Treatment depends on the driver. Care may include CGRP medications, migraine preventives, abortive medications, Botox or Xeomin, occipital nerve blocks, sphenopalatine ganglion blocks, cervical facet blocks, TMJ-focused injections, IV rescue therapies, rehabilitation, regenerative medicine for selected instability patterns, and pain psychology.
Migraine can amplify the nervous system and create significant background noise. When migraine is active, it may be harder to interpret neck pain, jaw pain, autonomic symptoms, or other pain generators. Calming migraine first can make the rest of the evaluation clearer.
In many headache disorders, opioids are not recommended because they can worsen headache patterns, contribute to medication overuse headache, increase nervous system sensitivity, and make long-term headache control more difficult. Medication decisions are individualized, but the goal is to treat the headache mechanism rather than only suppress symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
Jason W. Siefferman, MD
Headache, facial pain, and TMJ dysfunction are closely connected. The brain, face, jaw, and upper neck share overlapping nerve pathways, which means pain in one area can be felt or amplified in another. A neck problem can feel like a headache. A migraine can create jaw clenching and neck guarding. TMJ dysfunction can contribute to temple pain, facial pain, and headaches.
At Manhattan Pain Medicine, we evaluate head, face, and jaw pain by asking several questions at once: What type of headache is present? Is there more than one headache pattern? What triggers the headache? Is the pain driven by migraine, the upper cervical spine, the jaw, intracranial pressure, nerve sensitization, systemic inflammation, or a combination?
The head and upper neck share a critical pain-processing region known as the trigeminocervical complex. This pathway receives and processes signals from the face, head, jaw, and upper cervical spine. Because of this shared wiring, a painful joint, irritated nerve, unstable ligament, or muscle guarding pattern in the upper neck may be experienced as headache, facial pain, eye pain, or jaw discomfort.
This is why headache evaluation often needs to include the neck and jaw, and why neck or TMJ treatment sometimes fails when migraine or nerve sensitization has not been addressed first.
Migraine is not simply a bad headache. It is a neurologic condition that can make the brain and nervous system more reactive. Some patients have classic migraine with severe head pain, nausea, and light sensitivity. Others have lower-level migraine activity that shows up as brain fog, fatigue, motion sensitivity, sound sensitivity, irritability, dizziness, or a daily crash.
When migraine is active, it can amplify other pain generators. A neck injury may trigger migraine. Migraine may then increase neck guarding, jaw clenching, autonomic symptoms, and widespread sensitivity. For this reason, migraine often needs to be treated early in the sequence so the rest of the pain picture becomes easier to interpret.
Chronic migraine may involve frequent headache, but it may also appear as a persistent background state of neurologic irritation. Patients may experience light sensitivity, sound sensitivity, nausea, brain fog, fatigue, motion sickness, dizziness, or a need to lie down at predictable times of day. These symptoms may be migraine-related even when head pain is not the most obvious feature.
Cervicogenic headache begins from the neck. It may arise from cervical joints, discs, ligaments, muscles, or nerves. Patients often describe pain that starts at the base of the skull and travels upward, or pain that worsens with posture, head turning, prolonged sitting, or transition from lying down to standing.
The temporomandibular joint does not operate in isolation. Jaw mechanics are influenced by the upper cervical spine, posture, muscle tone, and trigeminal nerve activity. Migraine and neck pain can both increase clenching, bruxism, facial muscle guarding, and TMJ pain. TMJ dysfunction can then feed back into headache and facial pain.
Some headache disorders involve sharp, stabbing, or one-sided attacks with eye tearing, nasal symptoms, sweating, restlessness, or autonomic features. These patterns may include cluster headache or related trigeminal autonomic cephalalgias. In selected patients, upper cervical irritation or instability may be part of the trigger pattern.
Some headaches feel like pressure, fullness, or the skull being inflated. Patients may report blurry vision, pulsatile tinnitus, worsening when lying down, worsening with coughing or exertion, or symptoms that suggest altered cerebrospinal fluid or venous outflow. These symptoms may require a different diagnostic path than migraine or mechanical neck pain.
Discovery begins by separating the headache patterns. We look at location, timing, triggers, associated symptoms, posture, jaw behavior, neck mechanics, medication response, imaging, and systemic factors. We ask whether symptoms behave like migraine, cervical pain, TMJ dysfunction, intracranial pressure, nerve pain, or a combination.
Diagnostic medication trials may help clarify the driver. A short trial of a migraine-specific medication may help determine whether symptoms such as nausea, brain fog, light sensitivity, fatigue, or dizziness are migraine-related. In selected cases, other medication trials may help assess intracranial pressure patterns or specific headache syndromes.
Dynamic imaging may be considered when symptoms suggest craniocervical instability or vascular compression. Standard supine imaging may miss problems that occur only when the head and neck are loaded by gravity or placed in certain positions.
Targeted injections may also help isolate the source. These may include occipital nerve blocks, sphenopalatine ganglion blocks, cervical facet blocks, C1-C2 diagnostic injections, or TMJ-focused injections depending on the suspected pain generator.
Treatment depends on the headache type and the driver. In many complex cases, migraine is treated first because an irritated brain can amplify everything else. Once the migraine pattern is calmer, it becomes easier to determine how much pain is coming from the neck, jaw, nerves, inflammation, or structural instability.
If migraine, neck instability, TMJ dysfunction, and nerve sensitization are all present, treating the wrong piece first can create confusion. A structural injection may appear to fail if migraine is actively amplifying the system. TMJ treatment may be incomplete if cervical instability is driving jaw mechanics. Neck rehabilitation may flare symptoms if intracranial pressure or migraine is not controlled.
MPM’s approach is to identify the loudest driver and the most stabilizing first step. In many patients, calming migraine or nervous system sensitization makes the rest of the anatomy easier to evaluate and treat.
Maintenance begins when the headache pattern is clearer and the major triggers are better controlled. Patients learn how to identify early warning signs, avoid medication overuse, manage flare patterns, support neck and jaw mechanics, and distinguish migraine symptoms from structural or pressure-related symptoms.
The goal is not only fewer headaches. The goal is better control of the nervous system, clearer diagnosis, improved function, and a practical plan for preventing head, face, jaw, and neck pain from rebuilding into a larger cycle.
