The temporal region is located at the side of the head/scalp - i.e. the temples. Most commonly, headache symptoms in these areas secondary to peripheral nerve irritation/compression are a result of 2 possible, offending nerves. One is called the auriculotemporal nerve and the other is called the zygomaticotemporal nerve and both are branches of the trigeminal nerve. The former is located just above the helical root which is where the external ear (i.e. pinna) meets the scalp and often sends branches ascending toward the vertex of the skull as well as in front of and occasionally behind the ear. In this area, the auriculotemporal nerve may be compressed by the adjacent connective tissue and superficial temporal artery and/or vein which may be enlarged, in an aberrant location, or even wrapping around the nerve itself like an anaconda. The zygomaticotemporal nerve is located just to the side of the eye socket toward the front of the temple. If you clench your back teeth, you might feel a bulge in this area as the temporalis muscle contracts. In this location, the zygomaticotemporal nerve may be entrapped by connective tissue overlying the temporalis muscle which is too tight and/or an adjacent blood vessel. In addition, the zygomaticotemporal nerve may have "downstream" branches that, like the auriculotemporal nerve, go towards the top of the scalp, anteriorly towards the forehead or posteriorly toward the ear. There can be an overlap in the sensory distribution of these two nerves in the mid-portion of the temple which can make it difficult to discern which one of these nerves or both nerves are involved in temporal pain generation.
Headache symptoms emanating from the temporal region are the most common symptoms in patients who have compression of the auriculotemporal and/or zygomaticotemporal nerves as a cause for their pain. People will often complain of throbbing or pounding which makes sense if you imagine that adjacent blood vessels are compressing the adjacent nerves noted above with each pulsation. Patients may have significant tenderness to palpation over the temple region and may have a history of clenching/grinding of the teeth. However, since pain is inherently a subjective parameter, the description of symptoms can run the gamut in terms of character and may be quite distinct from those features noted above.
As with evaluation of the occipital neuralgia patient, evaluation of the temporal neuralgia patient is a three-pronged approach. First, we evaluate the patient’s medical history, then perform a complete physical exam specifically focused on the possibility of temporal nerve compression/irritation causing their headache symptoms and then perform a set of sequential, diagnostic nerve blocks in an attempt to discern which nerve or nerves are involved in any particular case. If a person has a history which is consistent with temporal nerve compression causing their headaches, a physical exam that is consistent with that diagnosis and a positive result with a nerve block(s), they may be an appropriate candidate for surgical intervention in the hopes of providing long-term relief of their headaches.