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

• Why Does It Pulsate In The Temples
• Physiological Causes
• Chronic Cerebral Ischemia
• Migraine
• Hydrocephalus
• Vegetative-Vascular Dystonia
• Temporal Arteritis
• Neuralgia Of The Ear Node
• Intoxication
• Other Reasons
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Pulsation in the temples is observed in cerebral atherosclerosis, essential and symptomatic hypertension, hydrocephalus, migraine, VVD, temporal arteritis, and some intoxications. It can be long-term or short-term, one-sided or two-sided. The cause of the symptom is established based on the results of the survey, physical examination, additional diagnostic procedures. Treatment includes antihypertensive and lipid-lowering drugs, other medications. Sometimes surgery is indicated.

Why does it pulsate in the temples

Physiological causes

Due to the lack of oxygen, the symptom can be observed when staying in stuffiness. In some people, pulsation in the temples appears with strong emotions (mainly negative: fear, anger, anxiety), in a state of stress. Sometimes the cause of discomfort is lack of sleep or sleeping in insufficiently comfortable conditions, for example, when trying to take a nap on a long-distance bus or at work during a night shift.

Due to the short-term increase in blood pressure with the abuse of caffeinated drinks, pulsation occurs even in people who do not suffer from hypertension. The symptom is also often disturbing during the period of complete rejection of cigarettes or caffeine. It is based on a change in the state of the vessels with the disappearance of the usual stimulants. The disturbance disappears within a few days or weeks.

Chronic cerebral ischemia

Chronic ischemia of cerebral structures is a polyetiological pathology, which is most often based on cerebral atherosclerosis in combination with hypertension. The following variants of arterial hypertension become the cause of pulsation in the temples:

• Essential. It is observed in patients of the older age group, often smokers and are overweight. There is a hereditary predisposition.
• Neurogenic. Occurs against the background of diseases and traumatic injuries of the central nervous system. It is a consequence of neoplasms of the brain, ischemic and hemorrhagic strokes, encephalitis, meningitis, TBI.
• Nephrogenic. It is provoked by kidney diseases: pyelonephritis, glomerulonephritis, hydronephrosis, nephrosclerosis, amyloidosis, polycystosis, nephroptosis. It can be observed in rheumatic diseases with damage to the renal tissue (vasculitis, SLE), pathologies of the kidney vessels (thrombosis, atherosclerosis, aneurysms).
• Endocrine. It develops with damage to the pituitary gland, adrenal glands and thyroid gland. It is detected in hyperplasia of the adrenal cortex, Conn's syndrome, pheochromocytoma, thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, acromegaly. Some women develop during menopause.
• Hemodynamic. It is determined in patients with diseases of the heart and main vessels. Diagnosed with aortic insufficiency, coarctation of the aorta, stenosis of the carotid and vertebrobasilar arteries, aortosclerosis.
• Medicinal. Sometimes a pulsation in the temples, caused by a rise in blood pressure, is detected when taking indomethacin, levothyroxine, contraceptives with estrogen or progesterone, glucocorticoids and mineralocorticoids.

The symptom often appears in the morning. Unpleasant sensations are localized in the temporal and occipital regions, combined with a feeling of "squeezing" of the head, fog or flies before the eyes, aggravated by straining, tilting. Along with pulsation, cardialgia, shortness of breath during physical exertion are possible, with the progression of the disease - a decrease in memory, attention, and performance.

Pulsation in the temples

Migraine

Paroxysmal pulsation is observed with migraine. A distinctive feature is the unilateral nature of the pain. The right side of the head is more commonly affected. For a simple migraine, the absence of an aura is typical; before the onset of an attack, weakness, drowsiness, and deterioration in mood are possible. During the period of paroxysm, nausea, vomiting, increased sensitivity to light and sounds are noted. The duration of the episode ranges from several hours to 3 days. In addition, pulsation in the temples is detected in the following forms of migraine:

• Vegetative. The attack is accompanied by a feeling of suffocation, lacrimation, palpitations, chills.
• Migraine with aura. The development of paroxysm is preceded by motor, sensory, speech or visual disturbances.
• Associative. Along with the pulsation in the temple, a transient neurological deficit is determined.
• Sleep migraine. Occurs when waking up or during sleep.
• Menstrual. The appearance of pulsation in the temple correlates with the phase of the menstrual cycle.

Hydrocephalus

Pulsation in the temples with hydrocephalus is a consequence of increased intracranial pressure. It is associated with a feeling of pressure on the eyes, nausea, vomiting, intense cephalalgia, which is not eliminated with the help of analgesics. Depending on the rate of increase in intracranial hypertension, it can develop acutely or progress gradually. In the latter case, the sensation of pulsation first occurs sporadically, then becomes prolonged or constant. The symptom is observed in the following pathologies:

• traumatic brain injury;
• inflammatory diseases: meningitis, encephalitis, meningoencephalitis, arachnoiditis;
• vascular damage: intracerebral hematomas, hemorrhagic stroke, ventricular hemorrhage;
• space-occupying formations: ganglioneuromas, germinomas, astrocytomas, colloid cysts.

Vegetative-vascular dystonia

The manifestations of VVD differ in considerable diversity, they can be permanent or occur episodically in the form of crises. In addition to pulsation in the temples, tachycardia, interruptions in the heart, increased respiration, a feeling of lack of air, congestion in the chest, fluctuations in blood pressure, thermoregulation disorders, dyspeptic and dysuric disorders are possible. The symptom is most pronounced at the time of the sympathoadrenal crisis.

Temporal arteritis

Horton's disease has an autoimmune nature, often develops after SARS. Manifested by intense pulsating dull pain in the temple. Depending on the prevalence of lesions, cephalalgia can be one- or two-sided. The pain gradually increases over 2 or 3 weeks, is combined with fever, intoxication syndrome, myalgia, visual impairment. The temporal arteries are hardened and painful.

Neuralgia of the ear node

One-sided severe burning pains, pulsation in the temple with irradiation to the back of the head, ear, neck and lower jaw are characteristic. It is possible to spread the pain syndrome to the shoulder girdle, arm, upper chest. Paroxysms in case of damage to the ear node are provoked by local hypothermia, hot food intake, experiences or physical exertion. On average, they last a few minutes, sometimes up to an hour or more.

intoxication

The most common variant of intoxication, accompanied by a pulsation in the temples, is a hangover. The intensity of pain varies from mild to severe. Nausea, weakness, weakness, tachycardia are revealed. The symptom can also be observed with carbon monoxide poisoning. Cephalgia is dull, moderate, aching in nature, complemented by frivolity, inappropriate behavior, inability to realize the seriousness of what is happening.

Other reasons

Sometimes pulsation in the temples is provoked by the following conditions:

• Allergic reactions. Slight or moderate throbbing pain may accompany angioedema, allergic rhinitis.
• Cyclical fluctuations in hormone levels. In some women, pressure, fullness and other discomfort in the temples appear during menstruation or during premenstrual syndrome.
• Mental disorders. The symptom is found in hysteria, depression, anxiety spectrum disorders (GAD, panic attacks, phobias, etc.).

Neurologist's consultation

Diagnostics

Diagnostic measures are carried out by a neurologist. If indicated, patients are referred to rheumatologists, allergists, psychiatrists and other specialists. During the survey, the doctor finds out the time of appearance and the nature of the pulsation in the temples, specifies the duration, intensity and frequency of the symptom. Determines the features of the clinical picture of the disease, the dynamics of its development over time.

As part of a physical examination, a specialist assesses the pulse, measures blood pressure, detects edema in kidney disease, signs of changes in the arteries with temporal arteritis, external manifestations characteristic of endocrine disorders, etc. A neurological examination helps to detect the presence of relevant disorders: increased or weakened reflexes, sensitivity disorders and movements. Additional examination includes procedures such as:

• Ultrasonography. In vascular pathologies, dopplerography and duplex scanning are informative. To establish the causes of secondary hypertension, ultrasound of the kidneys, sonography of the adrenal glands, ultrasound of the thyroid gland can be prescribed.
• Other hardware methods. To identify signs of intracranial hypertension, tumors, infectious lesions, strokes, TBI, x-ray of the skull, CT and MRI of the brain are performed. In vascular disease, MR angiography may be recommended.
• Lumbar puncture. It is necessary for TBI, hydrocephalus, neuroinfections. Allows you to confirm the increase in ICP, the presence of blood impurities in the cerebrospinal fluid. To clarify the nature of the disorders, the cerebrospinal fluid is examined by microscopy, PCR.

In patients with migraine, imaging and laboratory techniques are not indicative. The main role in the diagnosis is played by the presence of typical symptoms in the absence of signs of other pathologies.

Treatment

Conservative therapy

Therapeutic tactics is determined by the cause of the pulsation in the temples:

• Cerebral atherosclerosis. Correction of cholesterol levels is required by prescribing a special diet and lipid-lowering drugs, normalizing body weight, quitting smoking and drinking alcohol. To improve blood supply, metabolic processes in the nervous tissue and cognitive abilities, antiplatelet agents, neurometabolites, nootropics are used.
• Arterial hypertension. As in the previous case, it is necessary to eliminate common risk factors. Patients with symptomatic hypertension require treatment of the underlying pathology. As part of drug therapy, antihypertensive, hypoglycemic and hypolipidemic agents, beta-blockers, diuretics, antiplatelet agents are used.
• Migraine. To stop paroxysms with minor or moderate symptoms, simple and combined painkillers, caffeine-containing drugs are prescribed. Sometimes a good effect is observed after a therapeutic blockade. With prolonged and intense attacks, medicines from the triptan group are indicated.
• VSD. Methods of non-drug correction of the state come to the fore: normalization of the regime, ensuring regular physical activity, eliminating stress, rational nutrition. Useful massage, water treatments, reflexology, drug electrophoresis. With insufficient effectiveness, sedative herbal remedies, nootropics, tranquilizers, antidepressants, beta-blockers, herbal psychostimulants are recommended.
• Temporal arteritis. The main role is played by glucocorticoids. The drugs are used for a course of at least a month, followed by a gradual decrease in dosage. The total duration of the course is at least 2 years. In acute visual impairment, pulse therapy using high doses of hormones is necessary. With the ineffectiveness of glucocorticoids, cytostatics are prescribed. Symptomatic therapy includes vasodilators, anticoagulants, NSAIDs.
• Hydrocephalus. With a history of TBI, inflammatory processes, hemorrhages, therapy of the provoking disease is required. Diuretics are used to reduce hydrocephalus. In other cases, treatment is predominantly surgical.

Surgery

Taking into account the etiology of pulsation in the temporal zone, the following operations can be performed:

• Cerebral atherosclerosis: endarterectomy, prosthetics of the brachiocephalic trunk, creation of extra-intracranial anastomoses.
• Symptomatic hypertension: stenting or balloon dilatation of the renal arteries, surgical removal of pheochromocytomas, adrenal surgeries for hypercortisolism.
• Hydrocephalus: removal of intracranial hematomas, dissection of adhesions in patients with arachnoiditis, excision of abscesses, various shunting options (external ventricular, lumboperitoneal, ventriculoperitoneal, cystoperitoneal).