His headache radiates from the TMJ to the left temple, then to the left eye, followed by the left side of the head behind the left ear, and finally to the neck. How should we understand this headache? Is it TMJ pain that radiates to the head, or is it pain due to the auriculotemporal nerve radiating to the left side of the head? Alternatively, could it be pain from the lesser occipital nerve, leading to the headache?

TMJ pain is likely since there is a TMJ disorder. However, I do not think it is radiating pain due to the TMJ disorder alone, because there is a sensitive area at the back of the head, indicating possible nerve damage.

The auriculotemporal nerve branches off from the trigeminal nerve’s mandibular (lower jaw) branch, extending to the temple. It is responsible for the sensory area of the temple.

The lesser occipital nerve branches off from the cervical spine, extending to the back of the head close to the ear. It is responsible for the sensory area of the back of the head.

It is obvious that the two nerves have different functions, one responsible for the front of the head and another for the back of the head. For the patient, his back head is sensitive, and there is more tenderness at the point below the head, so his headache is neuralgia due to an injury to the lesser occipital nerve.

So we know he has a TMJ disorder and neuralgia. We will have two plans when doing acupuncture: one for the TMJ disorder and one for the lesser occipital neuralgia.

The occipital neuralgia was not due to the TMJ surgery; it is a separate problem.

Understanding the cause of his pain allows us to develop an effective and accurate acupuncture plan.

he feels much better, headache is gone, and little pain in the TMJ after three sessions acupuncture.

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