Pain localized behind the ear is a distinct symptom. While headaches usually affect the forehead or temples, discomfort in this posterior area suggests unique underlying causes. The origin of this localized pain is diverse, stemming from issues with nerves, infections, or strain in adjacent musculoskeletal structures. Determining the source is necessary for effective treatment.
Occipital Neuralgia
A primary cause of focused pain behind the ear is irritation or injury to the occipital nerves, known as occipital neuralgia. This neuropathic pain arises from the greater and lesser occipital nerves, which extend from the upper cervical spine through the muscles at the base of the skull into the scalp. When compressed or inflamed, these nerves generate intense discomfort.
The pain is described as a sharp, shock-like, or stabbing sensation. This severe, intermittent pain originates at the base of the skull and radiates upward, sometimes localizing directly behind the ear. Unlike a common tension headache that is dull and throbbing, occipital neuralgia involves distinct, sudden bursts of pain lasting a few seconds to a few minutes.
Chronic tension in the neck muscles, whiplash, or trauma can lead to nerve entrapment or damage. Simple neck movements or light pressure on the scalp can trigger an episode. The area around the nerves is often tender, and some individuals may experience increased sensitivity to light.
Infections and Inflammation
Infections centered in the ear or adjacent bone structure can cause deep, throbbing pain. A serious cause is mastoiditis, which involves a bacterial infection and inflammation of the mastoid bone. This honeycomb-like bone contains air cells that can become infected when a middle ear infection spreads.
Mastoiditis presents with severe pain and tenderness, along with visible signs of inflammation, such as redness and swelling behind the ear. The swelling can sometimes push the earlobe outward. Symptoms like fever, fatigue, and ear discharge are common indicators of this active infection.
An untreated infection carries the risk of spreading because the mastoid bone is positioned near the brain. An unresolved middle ear infection (otitis media) can also cause referred pain to the mastoid area. The pain from these conditions is persistent and worsens over time, unlike the brief pain of nerve disorders.
Musculoskeletal and Referred Pain
Pain felt behind the ear may originate from structural problems in adjacent areas. A common source is the cervical spine, leading to a cervicogenic headache. These headaches are caused by disorders in the neck, such as joint dysfunction or muscle tightness in the upper vertebrae.
The pain often begins in the neck and radiates upward to the back of the skull, frequently localizing behind the ear or eye. Individuals often report a reduced range of motion, and certain neck movements may aggravate the headache. The underlying issue is often chronic tension or poor posture straining the neck muscles.
Another mechanical source of referred pain is a disorder of the temporomandibular joint (TMJ). Dysfunction in this joint—caused by teeth grinding, clenching, or inflammation—can manifest as pain behind the ear due to its proximity to the ear canal. This discomfort may include a clicking or popping sound when moving the jaw, difficulty chewing, or a dull ache extending into the ear and temple area.
When to Seek Medical Attention
While many causes of pain behind the ear are manageable, certain symptoms require immediate professional evaluation. Any sudden, severe headache described as the “worst headache of your life” warrants emergency medical attention, especially if accompanied by a stiff neck, which can signal meningitis.
Urgent care is necessary if the pain is combined with signs of a spreading infection, such as a high fever, redness, or swelling that continues to worsen. Neurological symptoms are also warning signs, including:
- Facial weakness.
- Sudden hearing loss.
- Vision changes.
- Difficulty with coordination.
Additionally, seek assessment if the pain begins immediately following a head or neck injury.
Persistent pain that does not improve after several days of over-the-counter pain relievers, or pain that interferes with daily activities, should prompt a visit to a healthcare provider. A doctor can identify the source of the pain through examination and testing.