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A headache that’s centered behind your ear may be caused by pinched nerves in your neck (occipital neuralgia), an infection in your inner ear (mastoiditis), temporomandibular joint disorder, or dental problems.
It’s unusual for headache pain to occur exclusively behind the ear. When pain behind the ear won’t ease up, you’ll want to figure out what’s causing it so you can find relief.
Read on to learn more about headache behind the ear and when you should see a doctor.
It’s not always possible to identify the cause of a headache. If you have persistent pain behind your ear, there are a few potential causes.
Occipital neuralgia is a type of headache caused by an injury or pinched nerves in your neck. Pinched nerves can happen when you keep your neck bent for a long time. It can also be due to arthritis in the neck and shoulders.
Occipital neuralgia can cause pain and throbbing in your neck, in the back or on one side of your head, and behind the ear. Some people feel pain in the forehead or behind the eyes. It can even cause scalp sensitivity. The pain usually starts in the neck and works its way upward.
The mastoid bone is located behind your ear. Mastoiditis is when bacteria cause the bone to become infected or inflamed. This can be the result of an untreated infection of the middle ear. Anyone can get mastoiditis, but it’s more common in children.
Temporomandibular joint (TMJ) disorder
The temporomandibular joint is the joint that helps your jaws open and close. If it’s out of alignment, injured, or damaged by arthritis, it can’t open smoothly. The joint can grind and crackle as you move your mouth.
TMJ disorder usually makes it hard to chew. You might feel the joint scraping or hear a clicking or popping sound as you move your jaws. It usually involves pain in the jaw area as well. In some cases, the joint can lock up so you can’t open or close your mouth. This situation can be fleeting or require medical intervention.
Problems with your mouth and teeth can cause referred pain. It’s entirely possible that headache pain behind your ear comes from an impacted or abscessed tooth, or another dental issue. Your dentist will be able to identify the problem upon examination.
Signs of dental problems may include bad breath, gum tenderness, or difficulty chewing.
Anyone can have a brief pain or headache. It doesn’t necessarily require a visit to the doctor. You should schedule a doctor’s appointment if:
- the pain intensifies
- you suspect you have an ear infection
- you’ve already been treated, but don’t feel improvement
- you’re running a fever
- you have unexplained weight loss
Seek immediate medical attention if you have:
- sudden, severe head pain
- a locked jaw
- high fever, nausea, or vomiting
- confusion or changes in personality
These could be signs of a serious medical condition.
If you’re concerned about your headache and don’t already have a primary care provider, you can view doctors in your area through the Healthline FindCare tool.
Your doctor will probably start with a physical exam, including a look in your ears. You may also need an ear culture and some blood tests. If it appears you have inflammation or infection of the ear, you may be referred to an ear, nose, and throat (ENT) specialist.
If your doctor suspects occipital neuralgia, they may give you an anesthetic nerve blocker. If this provides pain relief, your doctor may be able to confirm the diagnosis of occipital neuralgia.
To diagnose TMJ disorder, your doctor will likely refer you to a specialist or oral surgeon. The diagnosis may be confirmed using imaging tests.
If you have a persistent headache without obvious cause, the next step may be to see a neurologist. After taking a history of your symptoms and performing a neurological exam, diagnosis may involve imaging tests such as:
- computerized tomography (CT or CAT scan)
- magnetic resonance imaging (MRI)
Consider seeing a dentist for a thorough checkup. This can help rule out dental issues as the cause of your headache.
While awaiting diagnosis, you may be able to find temporary relief with over-the-counter medications. You can also apply an ice pack to the painful area. If you also have neck pain, heat therapy might help loosen neck muscles. Other treatments depend on what’s causing the headache.
Occipital neuralgia can be treated with pain relievers and anti-inflammatory medications. Local nerve blockers and muscle relaxants may also be helpful. In severe cases, corticosteroids can be injected directly into the trouble spot.
Since occipital neuralgia is caused by problems with your neck, try to avoid keeping your head and neck in the same position for too long. If you work with a laptop or handheld device, try to change position and look up and away from the device often.
Complementary therapies may also help. These include:
- heat therapy for your neck
- physical therapy and exercise
- relaxation and meditation
Mastoiditis is usually treated with antibiotics. If the infection is severe enough, you may receive antibiotics intravenously. If that doesn’t work you may need to have your middle ear drained. That procedure is known as myringotomy. Very severe cases may require removing part of the mastoid bone, which is known as mastoidectomy.
If you have TMJ, certain behaviors, such as grinding or clenching your teeth can make it worse. There are several treatments that can help TMJ, including:
- pain relievers, anti-inflammatories, or muscle relaxants
- oral splints or mouth guards
- physical therapy
- removal of joint fluid, known as arthrocentesis
- corticosteroid injections
- arthroscopic surgery
- open joint surgery
Complementary therapies may include:
- meditation and relaxation techniques
With rest and treatment, pain due to occipital neuralgia should improve. Continued stress on the neck can cause symptoms to return.
Symptoms of mastoiditis should improve within days of starting the antibiotics. Most people make a full recovery. To be sure the infection is gone, you must continue the full course of antibiotics, even if symptoms have improved.
In some cases, TMJ can get better without treatment. Recovery time depends on the severity of the condition and the treatment.
Chronic headaches may require long-term management.
To cut down on the risk of aggravating a headache behind the ear, try these tips:
- Be mindful of your posture. Slouching or keeping your head and neck in the same position for too long can lead to pinched nerves.
- Limit your use of handheld devices. When you use a handheld device, you tend to keep your neck at an awkward downward slant.
- Take a break. If you work at a desk all day, get up and walk around for a few minutes every hour. Frequent breaks can prevent stiffness in your neck and shoulders.
- Eat on schedule. Skipping meals can lead to headaches.
- Rest up. Stress and fatigue are risk factors for headaches. Get a good night’s sleep by going to bed around the same time and getting up at the same time every day.