From the Guidelines
Temporal pain can be effectively managed with a combination of lifestyle modifications and interventions, prioritizing those with strong recommendations in favor, such as cognitive behavioral therapy, therapist-assisted mobilization, and supervised exercises, as outlined in the BMJ clinical practice guideline 1. The management of temporal pain, particularly when associated with temporomandibular disorders (TMD), should focus on reducing inflammation and muscle tension, which are common causes of pain in this area.
- Key interventions include:
- Cognitive behavioral therapy (with or without biofeedback or relaxation therapy)
- Therapist-assisted mobilisation
- Manual trigger point therapy
- Supervised postural exercise
- Supervised jaw exercise and stretching (with or without manual trigger point therapy)
- Usual care (such as education, home exercises and stretching, self-massage, and over-the-counter analgesics) 1. It is essential to consider the patient's values and preferences, as well as the availability of interventions and what they may have already tried, to ensure shared decision-making 1.
- The guideline development panel, including dentists, general internists, oral surgeons, and people living with chronic pain secondary to TMD, determined the scope of recommendations and identified pain relief as the critical outcome 1.
- The panel used the GRADE approach to critically appraise the evidence and create recommendations, considering the balance of benefits, harms, and burdens of each intervention, as well as the certainty of the evidence and typical variations in patient values and preferences 1. In terms of medication, over-the-counter analgesics like ibuprofen (400-600mg every 6-8 hours) or acetaminophen/paracetamol (500-1000mg every 4-6 hours) can be used for immediate relief, while prescription medications such as prednisone (40-60mg daily) may be necessary for severe pain or temporal arteritis 1.
- Additionally, applying cold or warm compresses to the painful area, ensuring adequate rest and hydration, and considering stress reduction techniques like meditation or deep breathing exercises can help alleviate temporal pain.
- It is also important to avoid potential triggers such as alcohol, caffeine, and foods containing MSG or nitrates, and to seek immediate medical attention if the pain persists beyond two weeks, worsens significantly, or is accompanied by fever, vision changes, or jaw claudication, as these could indicate serious conditions requiring specialized treatment.
From the Research
Temporal Pain Treatment
- Temporal pain, also known as temporal arteritis or giant cell arteritis, is an autoimmune disease that causes inflammation of the medium and large arteries in the upper part of the body 2.
- The diagnosis of temporal arteritis can be complicated due to overlapping features with other painful neurological conditions, such as tension-type headache 2.
- A study found that the headache of temporal arteritis does not always affect the temples, and the site of headache can vary, including the frontal, vertex, and occipital areas 3.
Treatment Options
- Non-prescription (over-the-counter) analgesics, such as ibuprofen and paracetamol, are commonly used to treat acute pain, including headache 4.
- A systematic review and network meta-analysis found that ibuprofen and paracetamol are effective in treating episodic tension-type headache, with ibuprofen showing better efficacy than paracetamol for pain-free status at 2 hours 5.
- For individuals at a higher risk, such as those with renal insufficiency or risk of GI bleeding, paracetamol may be considered as a preferred option instead of ibuprofen 5.
- Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine, as well as migraine-specific treatments such as triptans and gepants 6.
Diagnosis and Management
- Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder 6.
- Symptoms or signs that suggest an urgent medical problem, such as an abrupt onset, neurologic signs, age 50 years and older, presence of cancer or immunosuppression, and provocation by physical activities or postural changes, should be assessed 6.
- Temporal arteritis should be considered in every elderly individual who begins to complain of headache, no matter what the site, quality, severity, or time pattern 3.