Table of ContentsView AllTable of ContentsOccipital NeuralgiaOtitis MediaMastoiditisEarwax ImpactionOtitis ExternaRamsay HuntTMJDental ProblemsDiagnosisWhen to Seek Emergency Care
Table of ContentsView All
View All
Table of Contents
Occipital Neuralgia
Otitis Media
Mastoiditis
Earwax Impaction
Otitis Externa
Ramsay Hunt
TMJ
Dental Problems
Diagnosis
When to Seek Emergency Care
1. Occipital Neuralgia
Occipital neuralgiacan cause a severe stabbing, throbbing, shooting, or electric shock-like pain behind the ears.It also spreads through the upper neck andback of the head.
“Occipital” means the back of the head. Neuralgia is pain from damaged nerves. The occipital nerves start in your neck and run along the back of your scalp to the top of your head.
It’s not clear what causes occipital neuralgia. Some cases just spontaneously occur.Others may arise from chronic entrapment, irritation, or “pinching” of the occipital nerves.
This irritation may occur on its own or be associated with another medical condition, such as:
Symptoms
Other potential symptoms of occipital neuralgia include:
Treatment
Occipital neuralgia is treated with a combination of:
2. Otitis Media
Otitis media(or middle ear infection) occurs when the middle ear space, located between the eardrum and the inner ear, becomes inflamed and infected. This can cause pain behind the ear and inside of it.
Viral respiratory tract infections, like thecommon cold or flu, often trigger otitis media.
In adolescents and adults,ear infection symptomsmay include:
If pressure in the middle ear space gets too high, the eardrum can rupture with pus-like drainage from the ear. Young children with otitis media may pull on their ear and/or be feverish, fussy, and have difficulty eating and sleeping. They may also vomit or have diarrhea.
Mild ear infections may not require antibiotics to clear up. If they do, the most common antibiotic prescribed is amoxicillin. Acute otitis media, which can have a sudden onset and be severe, is usually treated with antibiotics.
3. Mastoiditis
Mastoiditisis an uncommon, but possible cause of pain behind the ear. This is an infection of themastoid bone, which is behind and below your ear. Mastoiditis can occur at any age but is most common in children under 2 years.
A common cause of mastoiditis is untreated or undertreated acute otitis media. There’s usually a very slight degree of infection or inflammation of the mastoid bone with acute otitis media. When that infection isn’t properly treated, it can get worse.
Antibiotics—used in the treatment of acute otitis media—help keep the risk of mastoiditis low.
In adults, symptoms of mastoiditis typically include:
Fever and headache also are common. Symptoms in young children include:
If children can’t yet talk to complain of ear pain, they may pull on the affected ear.
Mastoiditis is a serious infection that requires:
Untreated mastoiditis can lead to these serious complications:
4. Earwax Impaction
Earwax, also calledcerumen, is a substance that protects the lining of the outer ear canal.
Cerumen normally clears out of the canal on its own. If this normal process is compromised, cerumen can accumulate deep within the ear canal. There, it can become hardened and impacted, causing symptoms like pain behind the ear.
Factors that contribute toearwax impactioninclude:
If enough cerumen accumulates, symptoms may develop, including:
An earwax impactionmay call for:
5. Otitis Externa
Otitis externa, a.k.a. “swimmer’s ear,” develops when the ear canal becomes inflamed. It can be a result of an infection, allergy, or a chronic skin condition.
Factors that increase your risk of developing otitis externa include:
Symptoms include:
Otitis externa is generally treated with:
Antibiotics are typically only prescribed if the infection spreads beyond the ear canal or if you’re at high risk for further infection.
Foreign ObjectsForeign objects in the ear may cause otitis externa symptoms. This phenomenon occurs more commonly in young children, who have been known to harbor insects and tiny toys in their ears.
Foreign Objects
Foreign objects in the ear may cause otitis externa symptoms. This phenomenon occurs more commonly in young children, who have been known to harbor insects and tiny toys in their ears.
6. Ramsay Hunt Syndrome
This rare condition is associated with:
To treat Ramsay Hunt syndrome, healthcare providers generally prescribe:
7. Temporomandibular Joint Disorder
If you’re wondering why your ear hurts when you chew, it may be related to your temporomandibular joint (TMJ). The TMJ is located in front of your ear, where your jaw connects to your skull. Problems with this joint and the muscles surrounding it may cause what is known as aTMJ disorder.
Several factors may contribute to a TMJ disorder, including:
Symptoms of TMJ disorder include:
TMJ treatmentoften involves a trial and error process. It can involve:
8. Dental Problems
Many dental problems can manifest as pain behind the ear, especially if they’re left untreated. Some examples include:
Dental problems are a very common cause of ear pain. Many problems originate from the molars.
Associated symptoms may include:
A Word From VerywellPain behind the ear can be from a number of different causes. This article lists some of those reasons, but also keep in mind other potentially rarer causes, including cervical spine problems and temporal tendinitis. Contact a healthcare provider if you experience pain behind the ear to determine the cause and best treatment option.—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Pain behind the ear can be from a number of different causes. This article lists some of those reasons, but also keep in mind other potentially rarer causes, including cervical spine problems and temporal tendinitis. Contact a healthcare provider if you experience pain behind the ear to determine the cause and best treatment option.—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
Pain behind the ear can be from a number of different causes. This article lists some of those reasons, but also keep in mind other potentially rarer causes, including cervical spine problems and temporal tendinitis. Contact a healthcare provider if you experience pain behind the ear to determine the cause and best treatment option.
—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
Because so many conditions can cause pain behind the ear, your healthcare provider may need to test you for several things before arriving at the right diagnosis.
Depending on how serious it is, they may refer you to a specialist, such as the following:
Your healthcare provider will likely include:
Get emergency medical attention for pain behind your ear if you also experience:
Unintended weight loss and/or a neck mass can be a sign of cancer or another serious condition. Contact your healthcare provider to ensure an accurate diagnosis of the cause.
Summary
Causes of pain behind the ear can include infections, impacted earwax, dental problems, TMJ disorder, and nerve irritation. Accompanying symptoms can provide clues as to what’s causing pain behind your ear. For example, if your ear hurts when you chew, TMJ disorder is one possible culprit.
Talk to a healthcare provider to get to the bottom of your pain. Your provider will likely want to conduct a medical history and examination. The treatment will depend on the source of the pain.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gupta V, Dwivedi G, Sahoo L, et al.Incidence of otitis media with effusion in cases of head and neck malignancies undergoing radiotherapy: a prospective observational study.Indian J Otolaryngol Head Neck Surg. 2019; 71(S2):1621-1625. doi:10.1007/s12070-019-01698-8Guyuron B, Alessandri Bonetti M, Caretto AA.Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches.JPRAS Open. 2023 Dec 10;39:212-216. doi:10.1016/j.jpra.2023.12.002Johns Hopkins Medicine.Occipital Neuralgia.Harvard Health Publishing.Occipital Neuralgia: Symptoms and Treatments.Choi I, Jeon SR.Neuralgias of the head: occipital neuralgia.J Korean Med Sci.2016;31(4):479–488. doi:10.3346/jkms.2016.31.4.479UpToDate.Acute otitis media in adults.Gaddey HL, Wright MT, Nelson TN.Otitis Media: Rapid Evidence Review.Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361Kynion R.Mastoiditis.Pediatr Rev.2018;39(5):267-269. doi:10.1542/pir.2017-0128Earwood JS, Rogers TS, Rathjen NA.Ear pain: diagnosing common and uncommon causes.Am Fam Physician.2018;97(1):20-27.Horton GA, Simpson MTW, Beyea MM, Beyea JA.Cerumen management: an updated clinical review and evidence-based approach for primary care physicians.J Prim Care Community Health.2020;11:2150132720904181. doi:10.1177/2150132720904181Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ,et al.Clinical Practice Guideline (Update): Earwax (Cerumen Impaction).Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29. doi:10.1177/0194599816671491UpToDate.Patient education: external otitis (including swimmer’s ear) (Beyond the basics).Northwestern Medicine.Symptoms of Otitis Externa.Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A.Otitis externa.Dtsch Arztebl Int. 2019;116(13):224-234. doi:10.3238/arztebl.2019.0224Icahn School of Medicine at Mount Sinai.Ramsay Hunt syndrome.National Organization for Rare Disorders.Ramsay Hunt syndrome.American Association of Oral and Maxillofacial Surgeons.What is TMJ?National Institute of Dental and Craniofacial Research.TMD (temporomandibular disorders).World Health Organization.Meningitis.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gupta V, Dwivedi G, Sahoo L, et al.Incidence of otitis media with effusion in cases of head and neck malignancies undergoing radiotherapy: a prospective observational study.Indian J Otolaryngol Head Neck Surg. 2019; 71(S2):1621-1625. doi:10.1007/s12070-019-01698-8Guyuron B, Alessandri Bonetti M, Caretto AA.Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches.JPRAS Open. 2023 Dec 10;39:212-216. doi:10.1016/j.jpra.2023.12.002Johns Hopkins Medicine.Occipital Neuralgia.Harvard Health Publishing.Occipital Neuralgia: Symptoms and Treatments.Choi I, Jeon SR.Neuralgias of the head: occipital neuralgia.J Korean Med Sci.2016;31(4):479–488. doi:10.3346/jkms.2016.31.4.479UpToDate.Acute otitis media in adults.Gaddey HL, Wright MT, Nelson TN.Otitis Media: Rapid Evidence Review.Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361Kynion R.Mastoiditis.Pediatr Rev.2018;39(5):267-269. doi:10.1542/pir.2017-0128Earwood JS, Rogers TS, Rathjen NA.Ear pain: diagnosing common and uncommon causes.Am Fam Physician.2018;97(1):20-27.Horton GA, Simpson MTW, Beyea MM, Beyea JA.Cerumen management: an updated clinical review and evidence-based approach for primary care physicians.J Prim Care Community Health.2020;11:2150132720904181. doi:10.1177/2150132720904181Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ,et al.Clinical Practice Guideline (Update): Earwax (Cerumen Impaction).Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29. doi:10.1177/0194599816671491UpToDate.Patient education: external otitis (including swimmer’s ear) (Beyond the basics).Northwestern Medicine.Symptoms of Otitis Externa.Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A.Otitis externa.Dtsch Arztebl Int. 2019;116(13):224-234. doi:10.3238/arztebl.2019.0224Icahn School of Medicine at Mount Sinai.Ramsay Hunt syndrome.National Organization for Rare Disorders.Ramsay Hunt syndrome.American Association of Oral and Maxillofacial Surgeons.What is TMJ?National Institute of Dental and Craniofacial Research.TMD (temporomandibular disorders).World Health Organization.Meningitis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gupta V, Dwivedi G, Sahoo L, et al.Incidence of otitis media with effusion in cases of head and neck malignancies undergoing radiotherapy: a prospective observational study.Indian J Otolaryngol Head Neck Surg. 2019; 71(S2):1621-1625. doi:10.1007/s12070-019-01698-8Guyuron B, Alessandri Bonetti M, Caretto AA.Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches.JPRAS Open. 2023 Dec 10;39:212-216. doi:10.1016/j.jpra.2023.12.002Johns Hopkins Medicine.Occipital Neuralgia.Harvard Health Publishing.Occipital Neuralgia: Symptoms and Treatments.Choi I, Jeon SR.Neuralgias of the head: occipital neuralgia.J Korean Med Sci.2016;31(4):479–488. doi:10.3346/jkms.2016.31.4.479UpToDate.Acute otitis media in adults.Gaddey HL, Wright MT, Nelson TN.Otitis Media: Rapid Evidence Review.Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361Kynion R.Mastoiditis.Pediatr Rev.2018;39(5):267-269. doi:10.1542/pir.2017-0128Earwood JS, Rogers TS, Rathjen NA.Ear pain: diagnosing common and uncommon causes.Am Fam Physician.2018;97(1):20-27.Horton GA, Simpson MTW, Beyea MM, Beyea JA.Cerumen management: an updated clinical review and evidence-based approach for primary care physicians.J Prim Care Community Health.2020;11:2150132720904181. doi:10.1177/2150132720904181Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ,et al.Clinical Practice Guideline (Update): Earwax (Cerumen Impaction).Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29. doi:10.1177/0194599816671491UpToDate.Patient education: external otitis (including swimmer’s ear) (Beyond the basics).Northwestern Medicine.Symptoms of Otitis Externa.Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A.Otitis externa.Dtsch Arztebl Int. 2019;116(13):224-234. doi:10.3238/arztebl.2019.0224Icahn School of Medicine at Mount Sinai.Ramsay Hunt syndrome.National Organization for Rare Disorders.Ramsay Hunt syndrome.American Association of Oral and Maxillofacial Surgeons.What is TMJ?National Institute of Dental and Craniofacial Research.TMD (temporomandibular disorders).World Health Organization.Meningitis.
Gupta V, Dwivedi G, Sahoo L, et al.Incidence of otitis media with effusion in cases of head and neck malignancies undergoing radiotherapy: a prospective observational study.Indian J Otolaryngol Head Neck Surg. 2019; 71(S2):1621-1625. doi:10.1007/s12070-019-01698-8
Guyuron B, Alessandri Bonetti M, Caretto AA.Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches.JPRAS Open. 2023 Dec 10;39:212-216. doi:10.1016/j.jpra.2023.12.002
Johns Hopkins Medicine.Occipital Neuralgia.
Harvard Health Publishing.Occipital Neuralgia: Symptoms and Treatments.
Choi I, Jeon SR.Neuralgias of the head: occipital neuralgia.J Korean Med Sci.2016;31(4):479–488. doi:10.3346/jkms.2016.31.4.479
UpToDate.Acute otitis media in adults.
Gaddey HL, Wright MT, Nelson TN.Otitis Media: Rapid Evidence Review.Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361
Kynion R.Mastoiditis.Pediatr Rev.2018;39(5):267-269. doi:10.1542/pir.2017-0128
Earwood JS, Rogers TS, Rathjen NA.Ear pain: diagnosing common and uncommon causes.Am Fam Physician.2018;97(1):20-27.
Horton GA, Simpson MTW, Beyea MM, Beyea JA.Cerumen management: an updated clinical review and evidence-based approach for primary care physicians.J Prim Care Community Health.2020;11:2150132720904181. doi:10.1177/2150132720904181
Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ,et al.Clinical Practice Guideline (Update): Earwax (Cerumen Impaction).Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29. doi:10.1177/0194599816671491
UpToDate.Patient education: external otitis (including swimmer’s ear) (Beyond the basics).
Northwestern Medicine.Symptoms of Otitis Externa.
Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A.Otitis externa.Dtsch Arztebl Int. 2019;116(13):224-234. doi:10.3238/arztebl.2019.0224
Icahn School of Medicine at Mount Sinai.Ramsay Hunt syndrome.
National Organization for Rare Disorders.Ramsay Hunt syndrome.
American Association of Oral and Maxillofacial Surgeons.What is TMJ?
National Institute of Dental and Craniofacial Research.TMD (temporomandibular disorders).
World Health Organization.Meningitis.
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