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.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
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.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
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...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
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.
