Is pain with Temporal Arteritis typically located in front of or behind the ear?

Pain Location in Temporal Arteritis

In temporal arteritis, pain is typically located in front of the ear, specifically over the temporal artery region. 1

Characteristic Pain Patterns in Temporal Arteritis

Temporal arteritis (also known as giant cell arteritis or GCA) presents with several distinctive pain patterns:

• Temporal region pain: The most characteristic pain is located in the temporal region, in front of the ear where the temporal artery runs superficially 1
• Scalp tenderness: Patients often experience tenderness when touching the scalp over the inflamed temporal artery 1
• Jaw claudication: Pain in the jaw muscles when chewing or talking, occurring in approximately 40% of patients 1
• Headache: Present in nearly 90% of patients, typically described as diffuse and progressive in severity over days to weeks 1

Distinguishing Features

Several features help differentiate temporal arteritis pain from other conditions:

• Temporal artery abnormalities: Physical examination may reveal:

  • Temporal artery thickening (sensitivity 44.4%, specificity 90.6%) 1
  • Loss of temporal artery pulse (sensitivity 38.2%, specificity 88.2%) 1
  • Temporal artery tenderness (sensitivity 36.0%, specificity 81.4%) 1

• Associated symptoms:

  • Constitutional symptoms (fever, fatigue, weight loss)
  • Visual symptoms (blurry vision, diplopia, vision loss)
  • Polymyalgic symptoms (shoulder and hip girdle pain)

Clinical Pearls and Pitfalls

• Important distinction: Pain in temporal arteritis is typically located anterior to the ear, while pain from conditions like temporomandibular joint disorders tends to be directly over or just posterior to the ear 1

• Common misdiagnoses: Temporal arteritis is frequently misdiagnosed as:

  • Migraine headache
  • Trigeminal neuralgia
  • Temporomandibular joint syndrome 2
  • Dental pain (toothache) 3

• Critical warning: Temporal arteritis is a medical emergency due to the risk of permanent vision loss, which occurs in 14-18% of patients 1. Pain in the temporal region in patients over 50 years should prompt immediate consideration of this diagnosis.

Diagnostic Approach

When temporal arteritis is suspected based on pain location and pattern:

1. Laboratory testing: Check ESR and CRP (ESR >50 mm/hr has 78.9% sensitivity) 1

2. Temporal artery biopsy: Remains the gold standard for diagnosis 1

   • Should be performed within 2 weeks of starting glucocorticoids
   • Long-segment biopsy (>1 cm) is preferred

3. Imaging: In centers with appropriate expertise, temporal artery ultrasound may be considered 1

Remember that temporal arteritis should be considered a medical emergency, and high-dose steroids should be initiated immediately when the diagnosis is suspected, even before confirmatory testing 4.