What Are Trigger Point Injections?
Trigger point injections are a procedure where a clinician inserts a thin needle into a tight knot in a muscle and delivers a small amount of medication or saline to release the knot.[3] For TMJ and orofacial pain, the target muscles are usually the masseter, temporalis, and neck muscles that refer pain to the jaw and head.
A trigger point is a hyperirritable spot in a taut band of skeletal muscle. Pressing it produces local pain and often a referred pain pattern, meaning pain felt at a distance from the actual trigger point. Many patients with TMJ disorders carry trigger points that mimic toothache, ear pain, or tension headache.[3]
The procedure is performed in an office setting by an orofacial pain specialist, oral surgeon, or other qualified clinician. It typically takes 10 to 20 minutes per session. Most patients feel a brief pinch and sometimes a twitch response when the needle finds the trigger point.
How Trigger Point Injections Work
The injection works by mechanically disrupting the trigger point with the needle and chemically interrupting the pain cycle with the injected agent.[3] Both actions help the muscle release and restore normal blood flow.
Most clinicians use a small-gauge needle (commonly 25 to 27 gauge) and a local anesthetic such as lidocaine or bupivacaine. The clinician palpates the muscle, isolates the taut band between two fingers, and inserts the needle directly into the trigger point. A local twitch response, a brief involuntary muscle contraction, often signals correct needle placement.[5]
Some specialists use dry needling, which involves the same technique without injecting any medication. Others use botulinum toxin (Botox) for longer-lasting effect in select cases. Saline injection is another option.[3][4] Each approach has different evidence and trade-offs.
Common Injection Agents
Local anesthetics like lidocaine produce immediate numbing and short-term pain relief. Some research suggests the lasting benefit comes from the needle disrupting the trigger point rather than the drug itself.[5]
Botulinum toxin acts on the nerve endings that signal muscle contraction. A prospective study of botulinum injection into masticatory muscles reported reduced pain scores in patients with myofascial TMJ pain, though effects wear off over months and re-injection is needed.[4]
When Specialists Use Trigger Point Injections
Specialists use trigger point injections when muscle pain is a primary driver of TMJ and orofacial symptoms and conservative care has not resolved the problem.[2][3] The procedure is typically one part of a broader treatment plan.
Myofascial TMJ Pain
Myofascial pain is the most common reason for trigger point injections in dentistry. Patients describe a deep ache in the cheek or temple, pain on chewing, and tenderness when the muscle is pressed. A 2011 prospective clinical study of 20 patients reported meaningful pain reduction after trigger point injection in patients with myofascial TMJ pain.[5]
A 2024 randomized controlled trial compared occlusal splint therapy alone with splint plus masseter muscle injection. The injection group showed additional improvement in pain and function, supporting injections as an add-on for selected patients.[1]
Headache and Referred Pain Patterns
Trigger points in the temporalis and upper trapezius can refer pain into the head and behind the eyes, mimicking migraine or tension headache. Targeted injection of these points can break the referred pain cycle in patients whose headaches are tied to muscle dysfunction.[3]
Limited Jaw Opening
When muscle guarding restricts how wide a patient can open the mouth, releasing the trigger points can improve range of motion. This often allows physical therapy and stretching exercises to be more effective.
Evidence and Effectiveness
The evidence for trigger point injections in TMJ pain is moderate. Several small clinical studies and a few randomized trials show short-term benefit, but high-quality long-term data is limited.[2][3]
Lidocaine and bupivacaine are FDA-approved as injectable local anesthetics. Their use in trigger points is on-label for anesthesia but considered standard clinical practice for myofascial pain. Botulinum toxin type A is FDA-approved for several conditions and is used off-label for myofascial TMJ pain.[3]
The 2023 BMJ clinical practice guideline on managing chronic pain in TMD reviewed multiple interventions and made graded recommendations. The guideline favors conservative therapies first and gives weak recommendations for some procedural options based on the available evidence.[2]
Key Studies
Ozkan and colleagues (2011) ran a prospective clinical study in 20 patients with myofascial TMJ pain and reported significant reductions in pain scores and improved jaw function. The study did not include a control group, so its findings should be read as suggestive rather than definitive. The protocol used injections once a week for two weeks.[5]
Sidebottom and colleagues (2013) followed patients receiving botulinum injection into masticatory muscles for myofascial pain. Most reported reduced pain, with effects typically lasting three to four months.[4]
Saglam and colleagues (2024) compared occlusal splint alone versus splint plus masseter injection in a randomized trial. Combined therapy produced better outcomes for pain and function than splint alone.[1]
Benefits and Limitations
Trigger point injections offer rapid, targeted relief for muscle-driven jaw pain but are not a cure for TMJ disorders.[2][3] They work best as one part of a stepped care plan.
Advantages
Relief is often felt within minutes when local anesthetic is used. The procedure is brief, performed in the office, and avoids systemic medication side effects. It can also be diagnostic, since pain that resolves with injection confirms a muscle source rather than a joint or nerve source.[3]
Limitations and Risks
Benefits may be short-lived, and many patients need a series of injections over weeks or months. Common side effects include soreness, bruising, and brief soreness at the injection site. Less common risks include hematoma, infection, and, with deep injections, temporary weakness of nearby muscles.[3]
Trigger point injections do not address the underlying habits, joint problems, or sleep issues that often drive muscle pain. Without behavioral therapy, splint therapy, or physical therapy, results typically do not last.
Costs and Insurance Coverage
Trigger point injections in a dental office typically cost between $75 and $300 per session out of pocket. Costs vary by location, provider, and case complexity.
Coverage depends on the payer and how the procedure is billed. When billed under medical CPT codes for trigger point injection, some medical insurance plans cover the procedure for myofascial pain. Dental insurance generally does not cover injections for TMJ. Patients should ask the office in advance whether the visit will be billed to medical or dental insurance, and whether prior authorization is needed.
Botulinum toxin injections cost more, often $400 to $1,500 per session depending on the dose, and are usually paid out of pocket because most plans consider it investigational for TMJ. Costs vary by location, provider, and case complexity.
Questions to Ask Your Specialist
Choose a clinician with formal training in orofacial pain and direct experience giving trigger point injections in masticatory muscles.[6] Asking the right questions helps you understand what is planned and why.
- How will you confirm that my pain is coming from muscle trigger points and not from the joint or a nerve problem?
- Which agent will you inject (lidocaine, bupivacaine, saline, dry needling, or botulinum toxin) and why?
- How many sessions do you typically recommend, and how will we know it is working?
- What other treatments will you combine with the injections, such as a splint, physical therapy, or behavioral therapy?
- What are the most common side effects and risks for me specifically?
- Will the visit be billed to medical or dental insurance, and what will my out-of-pocket cost be?
Find an Orofacial Pain Specialist
Trigger point injections work best when delivered by a clinician trained to evaluate the full picture of TMJ and orofacial pain. Browse the orofacial-pain page in MSD's directory to find specialists who can evaluate muscle pain, recommend conservative care first, and offer injections when appropriate.
Search Orofacial Pain Specialists in Your Area