Pain in Temple or the Side of Head?

If you have a headache on one side of the head only ("Pain in temple") it can be any of the following:

Tension Headache Symptoms

The classic description of migraine is as a one-sided headache.

Episodes of pain in temple, if they have either a feeling of nausea or are worse with movement or make you want to lie down have a very high chance of being a migraine headache. Usually a migraine headache will build up over an hour or so before reaching its maximum. Migraine is not a sudden severe headache, there is almost always some sort of warning, build-up or prodrome.

Often people with migraine will want to try and compress the pain in temple, whereas in tension headache the tendency is to massage!

Cervicogenic Headache Symptoms

Cervicogenic headache will cause a pain on one side of the head.

Often the area of maximal pain is not where you expect for a pain that is due to a problem in a neck joint. It can be above the eye, or work its way down to the ear or behind the ear. However, some people will describe it like a band that runs through the head to become a pain in temple. It is usually quite intense, but does not have the features of migraine by causing a lot of nausea or intolerance of light.

Often this one-sided pain is worst after sleep - the neck is the source of the pain and an awkward sleeping position can make pains worse.

Prolonged car travel can also worsen this pain.

Ice-pick Headache

The headache called "ice-pick" is an attempt to describe the pain as an intense sharp sensation similar to that of being stabbed in the head with the tool used by a barman to get ice from a bucket.A pain in temple is a common site of ice-pick pain, although the classic site is the eye. People who have migraine and cluster headache will get a lot of these shooting or stabbing pains whose timing is completely unpredictable.

Nummular Headache

The temporal artery can be felt as a faint pulse just in fornt of the ear. The artery carries on up the side of the head, across the temple area.In older people (which means 50 years or over) this artery, for no good reason, can become inflammed leading to a condition called temporal arteritis. It can cause quite an intense temple headache, and the main feature of the headache is that the artery over the temple is tender to touch and loses its pulse. The scalp in general is also tender.

Some people feel generally unwell and may lose their appetite or lose weight.The loss of weight and appetite is such that tests for cancer get performed before the diagnosis of temporal arteritis is confirmed with a high blood ESR (westergren) test and an abnormal temporal artery biopsy (performed under local anaesthetic).

If temporal arteritis is ever suspected, steroid tablets should be started (usually about Prednisolone 40mg daily) until the results of a biopsy are known.

If there is a delay in treating this condition it can affect the blood supply to the eye causing permanent, although usually incomplete, loss of vision in one eye.

This is one of the more serious causes of "pain in temple"

SUNCT

The pain of paroxysmal hemicrania almost always involes the eye or face, but a pain in temple is known to occur. The quality of the pain is burning, sharp or stabbing.However, most people with this very rare headache condition will use more than one of these descriptioon for the quality of the pain.What sets paroxysmal hemicrania apart from the others is the short lived nature of the attacks. They are usually from between 5-30 minutes in duration and can occur several times a day - usually 5 or more episodes per day.

The pain is usually severe in intensity. Paroxysmal Hemicrania is therefore a rare cause of recurrent severe sharp pain headaches in the temple.

Carotid Artery Dissection

Most people who get carotid artery dissection will get a problem with their eyelid falling down slightly (called Horners Syndrome), and not just pain.

Others will have neurological symptoms (blurred or lost vision, weakness, difficulty speaking) from the stroke-like symptoms that occur as a result of reduced blood flow to the brain.However, the pain of carotid dissection can occur in the forehead or temple area. There are a few cases where a moderate to severe headache was the only symptom of carotid dissection.The onset of pain is usually rapid or abrupt, which is the main clue to its diagnosis. It is one of the causes of thunderclap headache, although in carotid dissection, the pain is one-sided on the same side of the head as the torn ("dissected") artery.

Hemicrania Continua

A craniotomy is the surgical procedure for opening the skull to allow surgery on the brain. Part of the temporal bone is lifted out and then screwed back in at the end of the procedure.Unsurprisingly, a localised headache can occur at the site of surgery.It usually settles within about 3 months of surgery. Although stating the obvious it is a legitimate cause of pain in temple / side of head!

Please note. This is not a definitive list. However, it is the causes of pain in temple / side of head that I think could occur with a reasonable frequency.

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