Pain behind the ear is not a common presenting complaint in a neurology clinic.
This list assumes that you have no sign of ear, nose or throat disease. If your family doctor sees you with a complaint of ear pain, and there is
Pain behind the ear is not a common presenting complaint in a neurology clinic.
This list assumes that you have no sign of ear, nose or throat disease. If your family doctor sees you with a complaint of ear pain, and there is not an obvious cause or if an Eear Nose Throat specialist has seen you and not been able to give you a diagnosis, this is the list to look at.
This is the most detailed list you will find - I've literally searched thorugh hundreds of publications to create this list of 17 proven causes of pain in this area.
The causes are in order from most common to least common.
Pain in or around the ear can be difficult to diagnose, as the nerve supply of the ear is complicated.
The nerves that supply the area behind the ear are complicated and involves 5th (auriculotemporal), 7th (facial), 9th (glossopharyngeal) and 10th (vagus) cranial nerves.
The area behind the ear is mostly from the C2 and C3 nerves, so diseases of the upper part of neck and spinal cord can produce symptoms here.
In patients who attend me, pain referred from the cervical spine is by far the most common cause.
However, pain in the ear can come from almost anywhere in the head or neck.
The 10th cranial nerve supplies the back (posterior) half of the
external ear canal - the bit that is open to the outside. (The Romans
used to stimulate the ear with a feather to induce vomiting - this
stimulated the vagus nerve which also controls the stomach and
Pain behind the ear that is neurological in orgin, is often intermittent and shooting - called neuralgic pain.
If a nerve has been more permanently damaged, neuropathic pain can be burning or cold and often has a creepy or itchy quality to it.
This is pain referred up the back of the head from degenerative (arthritic-type) change in joints of the upper neck. The pain can be dull or occasionally shooting type. In younger people this sort of pain can occur without significant evidence of joint damage but can be due to stifness of the joints following minor trauma like a fall, or poor posture during hours of desk work or studying. If you have this sort of pain treatment by a physiotherapist can be a very effective means of reducing the pain. Pain is often worse on wakening, and can spread through to the forehead or eye. It is not unusual for it to remain located just behind the ear. This headache affects about 4% of the population, accounts for about 17% of severe headaches and is present in about 50% of people who have had neck injuries like whiplash.
Extracephalic Idiopathic Stabbing pains - Ice-pick Headache
These pains are classically found in the eye, but can occur in or behind the ear too. They are not provoked by movement or touch, and last seconds. Indomethacin can relieve cases with very frequent pain episodes. There is also a "split-second" variant called "epicrania fugax" - which is also benign, but the pain seems to take a "zig-zag" course through the head!
Ice-cream Headache / Cold-stimulus Headache
About 4% of people with ice-cream headache will experience their pain behind or in the ear. This type of headache is more common in people with a history of migraine.
This is a chronic daily one-sided headache that should respond to strong anti-inflammatory drugs such as Indomethacin. There are cases of a relatively localised pain behind the ear, although usually pain in Hemicrania is more widespread. It is also possible that people who describe Hemicrania Continua are actually experiencing referred pain from the cervical spine.
A trial of physiotherapy to perform upper cervical mobilisations may be beneficial. Most cases do not have an underlying cause identified
Red Ear Syndrome
Pain is often part of the Red Ear Syndrome, but some will have no pain and just reddening and warmth or burning of the ear. Pain is usually around the ear, so I've included in the list of pain behind the ear.
Primary Yawning Headache
Yawning can produce pain in the head, or behind the ear. The classic cause is an elongated styloid process, but there are cases described without any cause being found, and they are called Primary Yawning Headache.
This used to be a "catch-all" diagnosis for unexplained throat or ear pain. The classic description of Eagle's Syndrome is pain in the throat which spreads to the ear and worsens with swallowing. This can be attributed to an elongated styloid process, 