Although migraine can have many causes, many patients can attribute their headaches to the auriculotemporal nerve. In this article, we’ll briefly talk about why it’s 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 a terminal branch of the trigeminal nerve. As one can see from this diagram, this nerve typically runs on the top part of the jawbone, travels up near the ear, and goes up to innervate the scalp.
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. This is particularly important for migraine headaches, since irritation, inflammation and compression to the this nerve can trigger one-sided headaches that can be very painful. The auriculotemporal nerve has other lesser functions, like controlling the blood vessels around the ear and jaw.
Q3: How can the auriculotemporal nerve be damaged?
The auriculotemporal nerve can be compressed by fascial tissue bands, squeezed by an overlying blood vessel, or damaged by parotid surgery. Damage to the auriculotemporal nerve can trigger headaches or facial pain, especially around the temporomandibular joint near the ear. This pain is typically worsened by opening the mouth widely, or pressing hard on the jaw bone joint.
Q4: How can auriculotemporal nerve headaches be treated?
After ruling out dangerous secondary causes of headache such as blood clots or aneurysms, there are several treatment options for auriculotemporal nerve headaches, including nerve blocks using local anesthetics, trigger point injections, or BOTOX therapy. The exact mechanisms of how these treatments are still being investigated, but 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.
Q5: How is BOTOX administered to the auriculotemporal nerve?
Although a BOTOX treatment typically consists of many small pinches around the scalp, face and neck, special care is made to inject near the distribution of the auriculotemporal nerve (see above). 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 later 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