Muscle Knots on your jaw, face and neck can lead to Headache - Here’s What to Do About Them

Muscle knots on your jaw, face, and neck can lead to headaches, facial pain, ear symptoms, and even dizziness. 

These knots are clinically called myofascial trigger point, a common but often overlooked source of pain, especially in patients with TMJ disorders, chronic headaches, or neck strain.

Two commonly recommended treatments for these muscle knots are dry needling and trigger point injections. While they may look similar, they are not the same, and choosing the right approach depends on proper diagnosis

Trigger Point Injections and Dry Needling are commonly used primary musculoskeletal pain management technique and are often considered diagnostic (to diagnose) as well as therapeutic (to treat).

What Are Muscle Knots (Trigger Points)?

Muscle knots, or trigger points, are tight, hyperirritable bands within a muscle that fail to relax. When pressed, they often reproduce familiar pain sometimes far away from the actual muscle.

Trigger points in the jaw, face, and neck can cause:

• Tension-type headaches and migraines

• Jaw pain and TMJ symptoms

• Facial pain or toothache-like pain

• Ear fullness, ringing, or pain

• Neck stiffness and reduced mobility

Because these muscles are closely connected, pain frequently refers to the head, temples, eyes, or ears.

What Is Dry Needling?

Dry needling is a technique that uses a very thin, solid needle (without medication) inserted directly into a trigger point.

How dry needling helps:

• Releases tight muscle fibers

• Produces a local twitch response

• Improves blood flow to the muscle

• Reduces abnormal muscle signaling

Dry needling works through mechanical and neurologic effects, helping the muscle reset and relax over time.

Common reasons dry needling is used:

• Jaw or neck muscle tightness

• Mild to moderate myofascial pain

• Postural muscle overload

• Muscle-related TMJ pain

Because no medication is injected, relief may be gradual and often improves with a series of treatments.

What Are Trigger Point Injections?

Trigger point injections (TPI) also target muscle knots, but with one important difference: a small amount of solution is injected into the trigger point. This may include a local anesthetic or a medication, depending on the diagnosis. The pain relief is often quick at the onset but needs multiple sessions to sustain the relief.

How trigger point injections help:

• Immediately relax the contracted muscle

• Reduce pain signals from the trigger point

• Interrupt the pain-spasm-pain cycle

Trigger point injections are considered a medical procedure often involves delivering medications into the area and require advanced anatomical training.

Common reasons trigger point injections are used:

• Moderate to severe muscle pain

• Headaches driven by jaw or neck muscles

• TMJ-related muscle pain not responding to conservative care

• Patients who cannot tolerate dry needling alone

Dry Needling vs Trigger Point Injections: What’s the Difference?

Feature	Dry Needling	Trigger Point Injections
Medication used	No	Yes
Needle type	Solid filament (Acupuncture)	Hollow injection needle
Speed of relief	Gradual	Often faster
Best suited for	Muscle tightness, dysfunction	Persistent or severe pain
Recommended for	Needle phobic	Chronic pain

What Dry Needling Is and Isn’t

Dry Needling IS	Dry Needling ISN’T
Treats myofascial pain and trigger points	Based on Traditional Chinese Medicine
Uses thin filiform needles (similar in appearance to acupuncture needles)	Involves needle retention like acupuncture
Focused on mechanical disruption of trigger points to relieve pain	Originated from traditional acupuncture
Derived from trigger point injection principles (without medication)	The same as acupuncture, despite using similar needles

Which Treatment Is Right for You?

There is no one-size-fits-all answer.

The best treatment depends on:

• Severity and duration of symptoms

• Whether pain is muscular, joint-related, nerve-related, or mixed

• Presence of headaches or migraines

• Extent of muscle involvement

• Overall medical history and pain sensitivity

• Past failed treatments

  
  

In many patients, dry needling and trigger point injections can be used together as part of a adjunctive and comprehensive treatment plan that may also include oral appliances, BOTOX, posture correction, physical therapy, medications and behavioral pain strategies. Sometimes, dry needling and trigger point injections can be used interchangeably depending on patient response to the procedure.

Why Proper Diagnosis Matters

The muscles of the jaw, face, and neck lie close to:

• Major nerves

• Blood vessels

• Salivary glands

• Airway structures

  
  

Treating muscle knots without understanding the true source of pain can lead to incomplete relief or symptom flare-ups. That’s why evaluation by a residency-trained and board-certified orofacial pain specialist is critical, especially when headaches, facial pain, or TMJ symptoms are involved.

Insurance Coverage for Trigger Point Injections (TPI)

Trigger point injections are generally considered a medically necessary procedure when used to treat documented myofascial pain and are therefore more consistently covered by medical insurance than many other muscle-based treatments.

Most commercial plans, Medicare, and Medicaid may cover TPI when performed by a licensed medical provider and supported by an appropriate diagnosis, objective clinical findings (such as palpable trigger points reproducing the patient’s pain), and documentation of failed or insufficient response to conservative care.

Coverage is subject to plan-specific rules, including deductibles, copays, coinsurance, and, in some cases, prior authorization or limits on frequency. As with all medical procedures, coverage varies by policy, and benefit verification is recommended prior to treatment.

The Bottom Line

• Muscle knots in the jaw, face, and neck are a common cause of headaches, jaw and neck pain.

• Dry needling and trigger point injections treat these knots in different ways.

• The right treatment depends on accurate diagnosis, not just the technique.

  
  

If your headaches or facial pain haven’t improved despite treatment, the underlying cause may still be unaddressed.

At Advanced TMJ Maxillofacial Pain & Sleep Center in Seattle, we provide expert evaluation and treatment for TMJ disorders, facial pain, headaches, and neck pain. Dry needling and trigger point injections are offered only after a thorough diagnosis to ensure care is precise, safe, and tailored to each patient’s needs.