Can Migraine Cause Pain on Top of the Head, Side, and Ear Region?
Yes, migraine can absolutely present with pain on the top of the head extending toward the side and involving the ear and surrounding areas—this is a well-recognized presentation of migraine headache. 1, 2
Typical Migraine Pain Patterns
Migraine characteristically presents with unilateral location as one of its defining features, though the specific location can vary considerably 1, 2:
- Unilateral head pain affecting frontal, orbital, or parietal regions is the most common presentation 3
- Pain is typically moderate to severe in intensity and has a pulsating quality 1
- The pain is aggravated by routine physical activity (walking, climbing stairs) 1
Extension to Facial and Ear Regions
Migraine pain can extend beyond typical locations 3:
- Facial pain occurs in approximately 8.9% of migraine patients, with pain involving both the head and lower half of the face 3
- When facial pain is present, patients experience significantly more trigemino-autonomic symptoms (47.8% vs. 7.9% in typical migraine) 3
- Pain can involve the maxillary or mandibular region, and rarely isolated facial pain may be the only presentation 3
Associated Symptoms to Confirm Migraine Diagnosis
To distinguish this as migraine rather than another headache disorder, look for 1, 2:
- At least one of the following during headache:
- Duration of 4-72 hours when untreated (2-72 hours in children/adolescents) 1
- At least 5 lifetime attacks meeting these criteria for definitive diagnosis 1
Important Differential Considerations
Cervical Strain
If pain is predominantly occipital/suboccipital with neck stiffness, consider cervical strain as a concussion-associated condition, which presents with 1:
- Neck pain and stiffness
- Tenderness with cervical spine palpation
- Pain with cervical motion
- Persistent headache in occipital region
Vestibular Migraine
If accompanied by dizziness or vertigo, vestibular migraine should be considered, as it can closely mimic other conditions and shares features with classic migraine 1
Clinical Pitfalls to Avoid
- Do not dismiss atypical location as "not migraine"—the pain distribution you describe (top of head, side, ear region) fits within migraine's variable presentation patterns 3
- Assess for orthostatic component: If headache dramatically improves (>50% reduction within 2 hours) when lying flat and worsens when upright, consider spontaneous intracranial hypotension rather than migraine 4
- Movement vs. posture: Migraine is aggravated by movement/activity, not by specific postures, and does not typically improve when lying flat 4