Can muscle pain result in pain behind the ear and occipital area?

Muscle Pain Can Cause Pain Behind the Ear and Occipital Area

Yes, muscle pain can definitely cause pain behind the ear and in the occipital area, particularly when related to cervical strain, trigger points in neck muscles, or temporomandibular disorders. 1, 2

Cervical Muscle Pain Referral Patterns

• Cervical strain can cause persistent headache that is often occipital/suboccipital in location due to injury to neck structures leading to somatosensory dysfunction and aberrant signaling along cervical afferent pathways 1
• Muscle spasm in cervical paraspinal muscles is characterized by palpable tightness, limitation of neck motion, and pain with movement, which can be associated with occipital/suboccipital headaches 2
• Patients with cervical strain may have clinical signs of pain/tenderness in the cervical spine, including paraspinal and suboccipital muscle palpation, with pain/paresthesia in the occipital region during palpation or head movement 1

Trigger Points and Referred Pain

• Trigger points (TrPs) in the suboccipital muscles can refer pain to the side of the head over the occipital and temporal bones, often perceived as bilateral headache 3
• The referred pain area elicited by suboccipital TrPs is significantly larger than referred pain from other muscle TrPs, making it a particularly important source of occipital and behind-the-ear pain 4
• Multiple studies have found that active trigger points in neck-shoulder muscles, particularly the suboccipital muscles, can reproduce headache pain patterns that include the occipital area 5, 6

Specific Muscles Involved

• The suboccipital muscles are most prevalent (92%) in causing referred pain to the head, including the occipital area 4
• Other muscles that commonly refer pain to the occipital and behind-the-ear regions include:
  • Superior oblique muscles 4
  • Upper trapezius muscles 4
  • Sternocleidomastoid muscles 5
  • Levator scapulae muscles (which produce larger referred pain areas than other muscles) 4

Connection to Temporomandibular Disorders

• Referred pain from trigger points in masticatory and neck-shoulder muscles can reproduce pain patterns similar to temporomandibular disorders (TMD), including pain behind the ear 5
• The cheek area, ear, and forehead are the most frequently reported sites of referred pain in TMD patients 7
• Palpation of the trapezius muscle, lateral pterygoid area, and masseter muscle are common sources of referred pain to the craniofacial region, including behind the ear 7

Clinical Implications

• When evaluating pain behind the ear and in the occipital area, clinicians should assess for cervical strain, muscle spasm, and trigger points in the neck and shoulder muscles 2
• A thorough clinical assessment should include inspection for visible muscle spasm, palpation for tenderness and muscle tightness, and evaluation of range of motion 2
• Treatment approaches for muscle-related occipital and behind-the-ear pain may include NSAIDs, progressive rehabilitation with stretching and strengthening exercises, and activity modification 2

Differential Diagnosis Considerations

• It's important to rule out other causes of occipital and behind-the-ear pain, such as occipital neuralgia, which may require different treatment approaches 8
• Red flags that suggest a non-muscular cause include neck pain with fever, severe pain unresponsive to conservative treatment, neurological deficits, or neck stiffness with thunderclap headache 2, 9

Muscle pain is a common and well-documented cause of pain behind the ear and in the occipital area, with specific referral patterns from cervical muscles that have been extensively studied and mapped.