Pain in the temples occurs with migraine, arterial hypertension, increased intracranial pressure, injuries, intoxication syndrome, trigeminal neuralgia, temporal arteritis, pheochromocytoma, cluster headache and tension headache. Pain can be prolonged, paroxysmal, acute, dull, pulsating, pressing, shooting, aching, burning. The reason is established according to the survey, examination, laboratory and instrumental techniques. Treatment – analgesics, anticonvulsants, glucocorticoids, blockades, surgical interventions.
Why there is pain in the temples
Physiological causes
Dull pressing pain in the temples is observed when staying in a stuffy room. If a person cannot go out into the fresh air, painful sensations increase, sometimes they become acute, pulsating. In some people, the symptom is provoked by strong emotions, most often by anxiety and fear. It can occur against the background of stressful situations. Another possible reason is fasting when trying to lose weight quickly, following strict diets, eating disorders.
Migraine
The pain is pressing, throbbing, one-sided. The zone of maximum soreness is located in the projection of the temple, eye or forehead. Sometimes there is an aura or prodrome in the form of weakness, impaired ability to concentrate. Typically, the change of the affected side from one attack to another. The symptom of migraine is aggravated by bright light, loud sounds, any physical activity. Patients try to “lie down” in solitude, silence and darkness.
Cluster headache
The pain is bothered during periods of exacerbation, lasting from 2 weeks to 2 months. They appear suddenly, reach a maximum in 1-3 minutes. The attack lasts from 15 minutes to 1 hour, less often up to 3 hours. Episodes occur at the same time, more often at night, can be repeated from one per day to two to four (sometimes eight) during the day. Painful sensations are one-sided, more often on the left.
They are localized in the eye, radiate into the temple, ear, cheek and teeth, extremely sharp, unbearable, stabbing or burning. They are accompanied by stuffy half of the nose, hyperemia of the face and conjunctiva. They are described by patients as “tearing the eye”, “stabbing in the eye”. Photophobia, nausea and vomiting are observed in 30% of cases. The patient is excited, rushes, because physical activity somewhat reduces the intensity of pain.
Tension headache
The symptom is mild or moderate. The headache is bilateral, non-pulsating, compressing or squeezing the head with a “hoop”, especially noticeable in the temples. There is no dependence on physical exertion, there is no nausea and vomiting. The duration of the attack varies from half an hour to 1 week. Soreness increases with strong emotions, decreases with emotional relaxation.
Primary and symptomatic hypertension
Along with essential hypertension, there are more than 50 diseases that cause an increase in blood pressure. An increase in blood pressure, regardless of the etiology, is accompanied by pain in the temples, the back of the head. Patients complain of tinnitus, “flies” in front of their eyes, shortness of breath, chest pain, anxiety or a feeling of fear. An external examination may reveal hyperemia of the skin. The symptom is observed in the following pathologies:
- Kidney diseases: pyelonephritis, glomerulonephritis, hypoplasia, polycystic, amyloidosis, ICD, tumors, diabetic nephropathy, kidney tuberculosis.
- Endocrine disorders: pheochromocytoma, Itsenko-Cushing’s disease and syndrome, primary aldosteronism.
- Pathology of large vessels: coarctation of the aorta.
Hydrocephalus
Due to an increase in the amount of fluid in the cerebrospinal fluid system, intracranial pressure increases with hydrocephalus. Along with pain in the temples and throughout the head, intracranial hypertension is manifested by impaired consciousness, nausea, vomiting, visual impairment, and sometimes convulsive seizures. The symptom is detected in conditions such as:
- malformations: Chiari anomaly, Dandy-Walker syndrome, Sylvian aqueduct stenosis;
- intrauterine infections and birth injuries;
- traumatic brain injuries;
- inflammatory processes: encephalitis, meningitis, arachnoiditis;
- vascular pathologies: hemorrhagic stroke, intraventricular hemorrhage;
- neoplasms: colloidal cysts, intracerebral ganglioneuromas, germinomas, astrocytomas, etc.
Traumatic brain injury
Headache is a constant symptom of TBI, observed with injuries of any severity. Accompanied by dizziness, nausea, vomiting, amnesia. Possible disorders of consciousness, paresis, decreased sensitivity, other manifestations. At first, the pain is usually diffuse. During the recovery period, painful sensations in the temporal areas sometimes prevail.
Temporal arteritis
It is caused by an autoimmune lesion of the temporal artery. It often occurs after viral infections. Horton’s disease develops in middle-aged and elderly patients. It is accompanied at first by aching, then – piercing, burning pain in one or both temples, increasing for 2-3 weeks. The symptom increases with chewing and talking. It is supplemented by loss of appetite, sweating, hyperthermia, weight loss, sleep disorders, myalgia, arthralgia.
Intoxication syndrome
Pain in the temples is one of the possible variants of headache with intoxication syndrome on the background of bacterial and viral infections, local purulent processes. It can be dull, squeezing, aching, throbbing. There is an increase in body temperature, weakness, bruising, dizziness, pain in joints and muscles. Other signs are determined by the cause of intoxication.
Trigeminal neuralgia
Prosopalgia has a paroxysmal character, it is a series of intense, shooting, burning pain impulses that resemble an electric shock and spread from the lateral surface to the center of the face. The duration of the episode is up to two minutes, the attacks are repeated repeatedly. With total involvement of the nerve, the entire half of the face suffers, with the defeat of the second branch, the pain is localized in the area of the temple, the outer corner of the eye, the adjacent part of the cheek, the upper lip.
Defeat of the temporomandibular joint
TMJ dysfunction is a problem that may be caused by the following factors:
- Dental pathologies: injuries, malocclusion, defects of dentition, poor-quality prosthetics, congenital anomalies.
- Muscle overstrain: bruxism, tonic spasm, overload of masticatory muscles, high speech load.
- Psychological factors: prolonged neuropsychiatric stress.
Typical are pains in the temples, eyes, ears, prosopalgia, headaches, difficulties and clicks when opening the mouth. Dizziness, sleep disorders, dysphagia, glossalgia, sleep apnea syndrome are possible.
Other reasons
Sometimes hormonal changes become a provoking factor. Girls may be disturbed by pain in the temples during the onset of menstruation. Some mature women note the occurrence of the symptom during menopause. Another possible reason is intoxication. Pain in the area of the temples is noted in a state of alcoholic intoxication, with an overdose of certain medications, carbon monoxide poisoning.
Diagnostics
The diagnostic program is compiled by a neurologist. If necessary, a maxillofacial surgeon, an infectious disease specialist, and other specialists are involved in the examination. To clarify the pathology , the following procedures may be prescribed:
- Survey and external inspection. During the conversation, the doctor finds out the time and circumstances of the appearance of the symptom. Asks about the nature and duration of pain, other manifestations, as well as the presence of similar symptoms in blood relatives. During examination, an increase in blood pressure, hyperemia of the skin, renal edema, signs of endocrine pathology and infectious diseases may be detected.
- Neurological examination. With hydrocephalus, vestibular and cerebellar ataxia, nystagmus are possible. In patients with TBI, general cerebral and focal symptoms are determined. With trigeminal nerve neuralgia, soreness at trigger points is detected, with bundle cephalgia – rhinorrhea, hyperhidrosis, drooping eyelid, conjunctival injection (during an attack).
- Neuroimaging. Radiography, CT, MRI, MRA and ultrasound techniques (duplex, Dopplerography) are informative for hydrocephalus, traumatic injuries, determining the genesis of trigeminal nerve compression. They help to determine the cause of hydrocephalus, to assess the severity of vascular damage in patients with arterial hypertension.
- Lumbar puncture. It is indicated to clarify the causes of increased intracranial pressure, performed as part of an examination for traumatic brain injuries and neuroinfections. The resulting cerebrospinal fluid is sent for microscopic, microbiological, and PCR studies.
In addition, ultrasound of the kidneys and endocrine organs, radiography and computed tomography of the TMJ, laboratory tests can be performed to assess the state of the body, determine the causative agents of common infections and purulent processes. With migraine, bundle cephalgia, tension pains, additional studies are not informative, differential diagnosis based on clinical signs of the disease comes to the fore.
Treatment
Conservative therapy
The plan of conservative measures is determined by the etiology of the pain syndrome:
- Migraine. To stop seizures, simple and combined analgesics are used, sometimes therapeutic blockades are performed. To prevent new paroxysms, antidepressants, anticonvulsants, psychotropic drugs are used.
- Tension headaches. Medicinal methods include NSAIDs, antidepressants, muscle relaxants, occipital nerve blockades, non-medicinal – massage, manual therapy, acupuncture, relaxation techniques.
- Bundle cephalgia. Paroxysms are eliminated with the help of triptans, oxygen inhalations are prescribed for intolerance, local anesthetics are injected into the nasal cavity. Calcium channel blockers are effective for preventive purposes.
- Hydrocephalus. With the acquired variant of pathology, the causal disease is treated, diuretics are prescribed.
- Arterial hypertension. Etiopathogenetic therapy is carried out. They recommend blood pressure monitoring, taking antihypertensive drugs.
- Temporal arteritis. The basis of drug therapy is glucocorticoid hormones. In the absence of a result, they switch to cytostatics. Vasodilators, anticoagulants, anti-inflammatory drugs are prescribed to eliminate symptoms.
- Trigeminal neuralgia. Anticonvulsants are considered a first-line remedy. Additionally, antispasmodics, microcirculation correctors, antihistamines, therapeutic blockades are used.
- TMJ dysfunction. It may be necessary to eliminate dental pathologies. Soft food is recommended. Pain is reduced with the help of NSAIDs, antidepressants, botulinum therapy, blockades with glucocorticosteroids, massage, physiotherapy.
Surgical treatment
The tactics of surgical intervention are chosen taking into account the peculiarities of pathology:
- Hydrocephalus: removal of abscesses and tumors, dissection of adhesions in arachnoiditis, bypass surgery.
- TBI: evacuation of hematomas, removal of depressed fractures of the skull, decompressive trepanation of the skull.
- Trigeminal nerve neuralgia: radiofrequency destruction, microsurgical decompression, stereotactic interventions.
- TMJ dysfunction: arthroplasty, condylotomy of the mandibular head, myotomy of the pterygoid muscle.
