Auriculotemporal Nerves and Headache: Top 5 Questions
By: Dr. Deena Kuruvilla, MD, and Brooklyn A. Bradley, BS
Although migraine can have many causes, many patients can attribute their headaches to the auriculotemporal nerve. In this article, we will briefly talk about why it is important to learn about this nerve and discuss how it influences headaches.
Q1: What is the auriculotemporal nerve?
The auriculotemporal nerve is a nerve in the face. More specifically, it’s an end part of the trigeminal nerve. It has been identified as one of the peripheral trigger sites for migraine headaches [1]. As one can see in Figure 1 [3], the auriculotemporal nerve typically runs on the top part of the jawbone, travels up near the ear, and goes up to innervate the scalp. Thus, this nerve helps you feel things on the front part of your ear, the back part of your temple, and even on your scalp [2]. It also helps your body with some special functions, like controlling sweat on your scalp and helping your parotid gland work (gland in your cheek that produces saliva) [2].
Figure 1. Diagram of facial nerves [3].
Auriculotemporal Nerve Entrapment | SpringerLink [3]
Q2: What does the auriculotemporal nerve do?
The primary function of the auriculotemporal nerve is to carry sensation from the ear and the skin on the temple [2]. This is particularly important for migraine headaches, since irritation, inflammation and compression to this nerve, known as auriculotemporal neuralgia, can be very painful. The auriculotemporal nerve has other lesser functions, like controlling the blood vessels around the ear and jaw. It also helps your body with some special functions, like controlling sweat on your scalp and helping your parotid gland work (gland in your cheek that produces saliva) [2].
Q3: What causes auriculotemporal neuralgia?
Auriculotemporal neuralgia can be caused when the auriculotemporal nerve is compressed by fascial tissue bands (layers of connective tissue that surround and support the auriculotemporal nerve), squeezed by an overlying blood vessel, or damaged by parotid surgery [4, 5]. Damage to the auriculotemporal nerve can trigger headaches or facial pain [1, 4]. Pain may be felt around the temporomandibular joint near the ear. This pain is typically worsened by opening the mouth widely, or pressing hard on the temporomandibular joint.
Q4: How can auriculotemporal nerve headaches be treated?
It is important to first rule out any dangerous secondary causes of headache such as blood clots or aneurysms. Once these causes are ruled out, there are several treatment options for auriculotemporal nerve headaches, including nerve blocks using local anesthetics [6], trigger point injections, or BOTOX therapy. The exact mechanisms of how these treatments are still being investigated. However, these treatments can decrease muscle contractions overlying the nerve, reduce neurogenic inflammation, and decrease the release of pain-inducing neurotransmitters like CGRP and substance P [7].
Q5: How is BOTOX administered to the auriculotemporal nerve?
Although a BOTOX treatment typically consists of many small injections around the scalp, face and neck, special care is made to inject near the distribution of the auriculotemporal nerve. After checking to find the location of nearby blood vessels, we carefully identify a reference point based on an orthogonal reference line based on the eye and ear and inject a tiny dose superficially above the temporalis muscle.
While it’s possible to have headaches from isolated damage to the auriculotemporal nerve, it’s more common to see headaches present as a result of migraine. In this scenario, auriculotemporal nerve discomfort is coupled with discomfort from other peripheral facial nerves, including the occipital, supraorbital, and supratrochlear nerves. It’s also common to see headaches associated with muscle tension in the surrounding head and neck muscles, including the frontalis muscle, temporalis muscle, occipitalis muscle, trapezius muscle, and the cervical paraspinal muscle group. In future articles, we’ll walk through the previously listed muscles and nerves and present research how these structures influence headaches.
Although this particular article focused on addressing nerves individually, it’s important to note that the most successful approach to headache involves a multi-pronged approach that integrates wellness, mindfulness, stress and trigger reduction, and medications when indicated. At the Westport Headache Institute, we believe that knowledge is power, and we hope to give you the tools and treatment to live a life free of headaches! Stay well! – Dr. K
References:
- Chim H, Okada HC, Brown MS, et al (2012) The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations. Plast Reconstr Surg 130:336–341. https://doi.org/10.1097/PRS.0b013e3182589dd5
- Janis JE, Hatef DA, Ducic I, et al (2010) Anatomy of the auriculotemporal nerve: variations in its relationship to the superficial temporal artery and implications for the treatment of migraine headaches. Plast Reconstr Surg 125:1422–1428. https://doi.org/10.1097/PRS.0b013e3181d4fb05
- Trescot AM, Rawner E (2016) Auriculotemporal Nerve Entrapment. In: Trescot AM (ed) Peripheral Nerve Entrapments: Clinical Diagnosis and Management. Springer International Publishing, Cham, pp 105–115
- Greenberg JS, Breiner MJ (2024) Anatomy, Head and Neck: Auriculotemporal Nerve. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
- Bertozzi N, Simonacci F, Lago G, et al (2018) Surgical Therapy of Temporal Triggered Migraine Headache. Plast Reconstr Surg Glob Open 6:e1980. https://doi.org/10.1097/GOX.0000000000001980
- Fernandes L, Randall M, Idrovo L (2021) Peripheral nerve blocks for headache disorders. Practical Neurology 21:30–35. https://doi.org/10.1136/practneurol-2020-002612
- Scuteri D, Tonin P, Nicotera P, et al (2022) Pooled Analysis of Real-World Evidence Supports Anti-CGRP mAbs and OnabotulinumtoxinA Combined Trial in Chronic Migraine. Toxins (Basel) 14:529. https://doi.org/10.3390/toxins14080529