Neck Pain and Yawning
Neck pain and yawning may be connected in some people without them even realising. Patients with temporomandibular joint dysfunction (TMJ) often experience face, jaw, or neck pain when yawning, as can those with trigeminal neuralgia, carotidynia, or cervical spinal stenosis. Some people develop chin cramps, headaches, ear pain, sinus pain, and shoulder, throat, or arm pain from yawning. Understanding why yawning is causing neck pain or other pain can help a patient to address the underlying problem as it is inevitable that yawning will occur again and again, sometimes triggering neck pain.
What is Yawning?
Yawning is a natural occurrence that usually signifies tiredness, hunger, boredom, or stress in humans. In some animals it is a pre-coital behavior trait and in others, such as dogs, it can act as a calming signal to pack members to show that something or somebody is not a threat. A number of different neurotransmitters are involved in yawning and several of these are also involved in the sensation of pain. Dopamine, glutamate, GABA, serotonin, ACTH, opioid peptides, and nitric oxide are just some of the influences on yawning. Understanding the mechanism behind yawning means that the occurrence of excessive or compulsive yawning can serve as a diagnostic tool in itself. Those suffering from frequent migraines, for example, may experience an increase in yawning as part of migraine prodrome which could then help them take steps to prevent the migraine or reduce its impact. Dopamine is also sometimes used in cases of excessive yawning along with sudden leg movements during sleep.
Yawning, Neck Pain, and Throat Cramps
A fairly common occurrence that can cause acute distress is sudden cramping in the chin, underneath the jaw, when yawning. The movement of the tongue during a yawn, as well as the muscles in the jaw and neck, can mean that cramp occurs. Unlike a cramp in the leg, a chin cramp is difficult to stretch out and it is often simply time that helps alleviate the condition. A warm compress may also help, as can drinking warm water. Where this occurs frequently it may indicate an underlying problem such as chronic inflammation from gum disease, swollen lymph nodes in the neck, or even an enlarged thyroid gland or other neck structure which requires evaluation. Dehydration, and electrolyte imbalance, are also contributing factors to cramps, as well as creating fatigue which precedes neck pain and yawning.
Symptoms of Neck Pain and Yawning
Neck pain and yawning may also be accompanied by acute or chronic shoulder pain, and intense arm pain (radiculopathy), or a chronic pain down the arms and into the hands. Problems breathing, or an inability to catch a full breath also accompany neck pain when yawning and some patients report the feeling of having something stuck in their throat or something having popped out of place. Sometimes the yawning and neck pain is accompanied by numbness, weakness, or sensory alterations in the arms, hands, and chest, which may all occur simultaneously or as a chronic problem exacerbated when yawning.
Yawning, Neck Pain, and Jaw Pain
Where yawning and neck pain are likely connected to a problem with the jaw, the pain may also occur when biting or chewing. The jaw joint may feel stiff, the lower lip numb, and there may be an issue with tooth decay or damage. A blow to the face can sometimes result in pain when yawning and whilst this could indicate a severe problem it may simply subside as bruising and inflammation goes down. Severe, sharp neck pain and jaw pain should be evaluated as soon as possible however to ensure no permanent damage has occurred to the jaw. A broken jaw that goes untreated may set incorrectly and create mobility problems and pain when yawning at a later date. A dislocated jaw can also lead to these problems and it is quite common for jaw dislocation to reoccur in some patients.
Temporomandibular Joint Disorder
Symptoms of temporomandibular joint disorder (TMJ) include headaches or aching muscles in front of the ears, sudden freezing of the jaw in one position, clicking noises or popping noises upon movement of the jaw and pain when yawning. Some of the more than twenty million TMJ sufferers in the US also experience difficulties in opening their mouth or moving the jaw laterally. Muscles around the jaw may be inflamed, sore and swollen which can cause referred pain elsewhere in the neck or face. Hearing loss or ringing in the ears, as well as buzzing or roaring sounds can also signify a problem with the temporomandibular joint. In some cases, such symptoms may be a result of a sinus infection however, making careful assessment essential.
Some patients suffer such severe throat and neck pain when yawning that they have difficulty swallowing, controlling saliva production, speech, and even facial expression. The acute onset of such difficulties during or immediately after yawning can cause extreme anxiety in a patient, and those around them, as the symptoms may mimic those of a stroke. Careful assessment of such symptoms is, therefore, vital to ensure that there is no underlying vascular issue which could cause permanent disability. It is often difficult to reproduce the severity of the symptoms during imitation yawning or forceful opening of the mouth.
Neck Pain and Yawning – Diagnosis
A variety of diagnostic tests and scans may be used to identify the nature and source of neck pain and other symptoms of yawning. CT scans of the head and neck may show silent lacunar strokes (undiagnosed strokes creating cavities after the stroke has healed), doppler ultrasound of the neck may identify stenosis caused by lesions, as well as thyroid enlargement or lesion, and panoramic X-Rays of the head and neck may be able to identify styloid elongation. Where a lesion is present, a biopsy might be considered the next step in order to rule out carcinoma. In some cases it may be that neurotransmitter imbalances are suspected, particularly dopamine and serotonin, which would affect both yawning and neck pain sensation. Blood tests may help identify the cause of the condition in some cases.
Neuralgia in the Neck, and Yawning
Neck pain triggered by yawning may be due to trigeminal, geniculate, or glossopharyngeal neuralgias, producing cephalic (head), pharyngeal (throat), or upper cervical (neck) pain. Inflammation, disc herniation or bulging, spinal stenosis, spinal slippage or curvature, muscle tension, infection, oedema, or ischaemia can all contribute to such painful triggers as the nerves in the neck experience acute compression during the act of yawning. Whilst there is no way to prevent yawning it may be possible to relieve chronic compression in the cervical spine, neck, throat, or shoulder that is predisposing the patient to such pain.
Primary or Secondary Yawning Pain?
Where pain spreads from the throat to the ear it may be similar in appearance to the symptoms of carotidynia and glossopharyngeal neuralgia. Eagle syndrome (ES) is a term used to describe a condition usually caused by calcification or elongation of the stylohyoid ligament; it may also be called secondary yawning pain as specific lesions or structural deficits are responsible for the neck pain. Primary yawning pain appears to occur without specific underlying lesions or dysfunction and patients may experience the neck pain only when yawning.
Yawning and Neck Pain Treatments and Prevention
Whilst yawning itself is impossible to prevent it may be possible to resolve the problem causing neck pain when yawning. In cases of temporomandibular joint dysfunction this may involve steps to prevent bruxism, surgery on the jaw, mouth guards and jaw re-education, or even medications to treat an oral infection causing inflammation in the temporomandibular joint.
Cervical Spinal Stenosis and Yawning Pain
Cervical spinal stenosis may be visible on diagnostic scans and steroid injections, oral steroids, NSAIDs, or neck surgery may help decompress the spine and relieve pressure on nerves that yawning exacerbates. Involvement of C3, C4, and C5 spinal cord segments may be identified and this could lead to abnormal innervation of the diaphragm which then affects respiratory function; cervical spinal surgery may be required if this is the case.
Underlying Illness, Neck Pain, and Yawning
Demyelinating illnesses, such as multiple sclerosis, can also be responsible for abnormal nerve communication and excessiveyawning accompanied by neck pain. Although no treatment is available to reverse myelin loss it may be that the patient can be prescribed medication to reduce the progression of lesions in the white matter, and there remains hope that a remyelinating agent or protocol may be found through stem cell research. Patients found to have calcification or elongation of the stylohyoid ligament may also need surgery to cut the ligament and resolve their neck pain from yawning.