What's that constant headache pain in the temples?

One type of headache called temporal arteritis needs medical attention.

Throbbing pain in the temples, especially on just one side of your head, is a common symptom of migraine pain. But when throbbing turns into a constant headache, and it's accompanied by pain when you touch your temples, it may be a sign of temporal arteritis.

Temporal arteritis causes and symptoms

Temporal arteritis is a condition caused by inflammation of one or more large arteries. It typically strikes either or both large temporal arteries located on the side of the head. Also known as cranial or giant-cell arteritis, this painful condition is more common in women than men and almost always occurs in people ages 50 or older.

People with temporal arteritis describe the pain as severe, throbbing, and burning—most often at the temple on one side of the head. Other symptoms, such as a low-grade fever, fatigue, loss of weight or appetite, or a tender scalp or temple may also occur. Chewing may cause aching in the jaw muscles.

Doctors don't know what triggers the problem, but it involves a misguided immune response causing inflammation of artery walls. The resulting swelling can progressively narrow the affected vessels, reducing blood flow. In severe cases, arteries become totally blocked. If this happens in the artery supplying the retina, it threatens the vision in that eye. If an artery that serves the brain is impaired, a stroke could result. However, when caught and treated early, temporal arteritis responds well to medication.

Diagnosis and treatment

A doctor who suspects temporal arteritis will check your blood's erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP). A high level of one or both suggests there's inflammation in your body. In some centers, ultrasound of the temporal arteries can confirm the diagnosis. But the most sure way to diagnose the condition, however, is to remove part of the blood vessel and examine it under a microscope for changes in the artery wall.

Confirming temporal arteritis is crucial because the condition requires long-term treatment with drugs to reduce inflammation. Therapy with high dose corticosteroids should start as soon as possible. Your doctor will often  begin corticosteroid therapy as a precautionary measure before having an ultrasound or taking the blood vessel biopsy.

You will probably need to take prednisone or other corticosteroid at a high dose until symptoms have disappeared and the results of further laboratory tests are close to normal. This usually takes at least a month. The dosage is then gradually decreased. Your doctor may suggest adding another anti-inflammatory drug, such as tocilizumab, to help more rapidly reduce the dose of prednisone. 

What else causes constant headache?

Temporal arteritis isn't the only condition that can cause constant headaches. The pain of migraine headaches can be similar, since they often begin (and sometimes remain) on one side of the head, with pain stretching from the front to the back of the head.

How would you know if that constant headache is a migraine or temporal arteritis? Migraines make people sensitive to light and sound, may cause nausea and vomiting, and can last a few hours or even days. But don't try to diagnose and treat yourself.

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