Pain In The Temples : Causes, Symptoms, Diagnosis & Treatment

• Why Does The Pain Occur In The Temples
• Physiological Causes
• Migraine
• Cluster Headache
• Tension Headache
• Primary And Symptomatic Hypertension
• Hydrocephalus
• Traumatic Brain Injury
• Temporal Arteritis
• Intoxication Syndrome
• Trigeminal Neuralgia
• Temporomandibular Joint Injury
• Other Reasons
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Pain in the temples occurs with migraine, hypertension, increased intracranial pressure, trauma, intoxication syndrome, trigeminal neuralgia, temporal arteritis, pheochromocytoma, cluster headache and tension headache. Pain sensations can be prolonged, paroxysmal, sharp, 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 does the pain occur 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 fresh air, the pain increases and sometimes becomes sharp, pulsating. In some people, the symptom is provoked by strong feelings, most often anxiety and fear. May occur during stressful situations. Another possible reason is starvation when trying to quickly lose weight, following strict diets, and eating disorders.

Migraine

The pain is pressing, throbbing, and one-sided. The zone of maximum pain is located in the projection of the temple, eye, or forehead. Sometimes there is an aura or prodrome in the form of weakness, and impaired ability to concentrate. Typically, the change the affected side from one attack to another. The migraine symptom is aggravated by bright light, loud noises, and any physical activity. Patients try to "lie down" in solitude, silence, and darkness.

cluster headache

Pain is disturbed during periods of exacerbation, lasting from 2 weeks to 2 months. Appear suddenly, reach a maximum in 1-3 minutes. The attack lasts from 15 minutes to 1 hour, rarely up to 3 hours. Episodes ocsimultaneouslytime, more often at night, and can be repeated from one per day to two to four (sometimes eight) during the day. Painful sensations are unilateral, more often on the left.

Localized in the eye, radiating to the temple, ear, cheek, and teeth, extremely sharp, unbearable, stabbing, or burnished were accompanied need by congestion of half of the nose, flushing of the face, and conjunctiva. Described by patients as "eye tear", "stabbed in the eye". In 30% of cases, photophobia, nausea, and vomiting are observed. The patient is agitated and rushing about, as physical activsomewhat reduces the pain intensity what.

Tension headache

The symptom is mild or moderate. The headache is bilateral, non-pulsating, squeezing or squeezing the head with a "hoop", especially noticeable in the temples. There is no dependence on physical activity, there is no nausea and vomiting. The duration of the attack ranges from half an hour to 1 week. Soreness increases with strong feelings and decreases with emotional relaxation.

Pain in the temples

Primary and symptomatic hypertension

Along with essential hypertension, there are more than 5 diseases that cause an increase in blood pressure. An increase in blood pressure, regardless of the etiology, is accompanied by pain in the temples, and the back of the head. Patients complain of tinnitus, "flies" before the eyes, shortness of breath, chest pain, anxiety, or 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, KSD, tumors, diabetic nephropathy, kidney tuberculosis.
• Endocrine disorders: pheochromocytoma, Itsenko-Cushing's disease, and syndrome, primary aldosteronism.
• Pathologies of large vessels: coarctation of the aorta.

Hydrocephalus

Due to the increase in the amount of fluid in the cerebrospinal fluid system, hydrocephalus increases intracranial pressure. Along with pain in the temples and throughout the head, intracranial hypertension is manifested by impaired consciousness, nausea, vomiting, blurred vision, and sometimes convulsive seizures. The symptom is detected in conditions such as:

• malformations: Chiari anomaly, Dandy-Walker syndrome, stenosis of the Sylvian aqueduct;
• intrauterine infections and birth trauma;
• traumatic brain injury;
• inflammatory processes: encephalitis, meningitis, arachnoiditis;
• vascular pathologies: hemorrhagic stroke, intraventricular hemorrhage;
• neoplasms: colloid 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, and amnesia. Disturbances of consciousness, paresis, decreased sensitivity, and other manifestations are possible. Initially, the pain is usually diffuse. In the recovery period, pain in the temporal regions sometimes prevails.

Temporal arteritis

Caused by an autoimmune lesion of the temporal artery. Often occurs after viral infections. Horton's disease develops in middle-aged and elderly patients. Accompanied first by aching, then by piercing, burning pain in one or both temples, growing over 2-3 weeks. The symptom is aggravated by chewing and talking. Complemented by loss of appetite, sweating, hyperthermia, weight loss, sleep disturbances, myalgia, and arthralgia.

Intoxication syndrome

Pain in the temples is one of the possible options for a headache in intoxication syndrome against the background of bacterial and viral infections, and local purulent processes. It can be dull, squeezing, aching, or pulsating. There is an increase in body temperature, weakness, weakness, dizziness, and pain in the joints and muscles. Other signs are determined by the cause of intoxication.

trigeminal neuralgia

Prosopalgia has a paroxysmal character, and 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 repeatedly repeated. With total involvement of the nerve, the entire half of the face suffers, with damage to the second branch, the pain is localized in the temple, the outer corner of the eye, the adjacent part of the cheek, and the upper lip.

Temporomandibular joint injury

TMJ dysfunction is a problem that can be caused by the following factors:

• Dental pathologies: injuries, malocclusion, defects in the dentition, poor-quality prosthetics, congenital anomalies.
• Muscle overload: bruxism, tonic spasm, masticatory muscle overload, high speech load.
• Psychological factors: prolonged neuropsychic stress.

Typical pains in the temples, eyes, ears, prosopalgia, headaches, difficulty, and clicks when opening the mouth. Possible dizziness, sleep disorders, dysphagia, glossalgia, and sleep apnea syndrome.

Other reasons

Sometimes hormonal changes become a provoking factor. Girls may experience pain in the temples during the onset of menstruation. Some women of mature age note the onset of a symptom during menopause. Another possible reason is toxicity. Pain in the temple area is noted in a state of intoxication, with an overdose of certain drugs, and 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 can be prescribed:

• Interrogation and external examination. During the conversation, the doctor finds out the time and circumstances of the onset of the symptom. Asks about the nature and duration of pain, other manifestations, as well as the presence of similar symptoms in blood relatives. On examination, an increase in blood pressure, skin hyperemia, renal edema, signs of endocrine pathology, and infectious diseases can be detected.
• Neurological examination. With hydrocephalus, vestibular and cerebellar ataxia, nystagmus is possible. In patients with TBI, cerebral and focal symptoms are determined. With neuralgia of the trigeminal nerve, pain is detected at trigger points, with beam cephalgia - rhinorrhea, hyperhidrosis, drooping of the eyelid, and injection of the conjunctiva (during an attack).
• Neuroimaging. X-ray, CT, MRI, MRA, and ultrasound techniques (duplex, dopplerography) are informative for hydrocephalus, and traumatic injuries, and for determining the genesis of trigeminal nerve compression. They help to establish the cause of hydrocephalus, to assess the severity of vascular damage in patients with arterial hypertension.
• Lumbar puncture. Indicated to clarify the cause 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, and laboratory tests to assess the state of the body, and determine the causative agents of common infections, and purulent processes can be performed. With migraine, beam cephalalgia, and tension pains, additional studies are uninformative, and differential diagnosis based on clinical signs of the disease comes to the fore.

Neurologist's consultation

Treatment

Conservative therapy

The plan of conservative measures is determined by the etiology of the pain syndrome:

• Migraine. For the relief of seizures, simple and combined analgesics are used, and sometimes therapeutic blockades are performed. To prevent new paroxysms, antidepressants, anticonvulsants, and psychotropic drugs are used.
• Tension headaches. Medical methods include NSAIDs, antidepressants, muscle relaxants, occipital nerve blocks, and non-drug methods - massage, manual therapy, acupuncture, biofeedback, and relaxation techniques.
• Tufted cephalgia. Paroxysms are eliminated with the help of triptans, in case of intolerance, oxygen inhalations are prescribed, and local anesthetics are injected into the nasal cavity. For preventive purposes, calcium channel blockers are effective.
• Hydrocephalus. With an acquired variant of the pathology, the causative disease is treated, and diuretics are prescribed.
• Arterial hypertension. Conduct etiopathogenetic therapy. Recommend control of blood pressure, and taking antihypertensive drugs.
• Temporal arteritis. The basis of drug therapy is glucocorticoid hormones. In the absence of a result, they switch to cytostatics. To eliminate the symptoms, vasodilators, anticoagulants, and anti-inflammatory drugs are prescribed.
• Trigeminal neuralgia. Anticonvulsants are considered the first line. Additionally, antispasmodics, microcirculation correctors, antihistamines, and therapeutic blockades are used.
• TMJ dysfunction. It may be necessary to eliminate dental pathologies. Recommended soft food. Pain is reduced with the help of NSAIDs, antidepressants, botulinum therapy, blockades with glucocorticosteroids, massage, and physiotherapy.

Surgery

The tactics of surgical intervention are selected taking into account the characteristics of the pathology:

• Hydrocephalus: removal of abscesses and tumors, dissection of adhesions in arachnoiditis, shunt interventions.
• TBI: evacuation of hematomas, removal of depressed skull fractures, decompressive craniotomy.
• Trigeminal neuralgia: radiofrequency destruction, microsurgical decompression, stereotaxic interventions.
• TMJ dysfunction: arthroplasty, condylotomy of the head of the lower jaw, myotomy of the pterygoid muscle.