What’s that constant headache pain in the temples? - Heidi Godman

One type of headache called temporal arteritis needs medical attention.

Published: February, 2018

Throbbing pain in the temples, especially on just one side of your head, is typically a 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, according to the Harvard Special Health Report Headache Relief.
Temporal arteritis causes and symptoms
Temporal arteritis is a condition caused by inflammation of the large temporal arteries located on either side of the head. Also known as cranial or giant-cell arteritis, this painful condition is twice as common in women as in men and usually 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 in which antibodies attack the blood vessel 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 so-called sedimentation rate. This simple blood test determines the rate at which your red blood cells settle to the bottom of a test tube. A rate that's higher than normal suggests there's inflammation in your body. The only 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 with a biopsy is crucial because the condition requires long-term treatment with drugs called steroids, which reduce inflammation. Your doctor will want to be sure the diagnosis is correct before prescribing steroids for an extended period. Your doctor may even begin steroid therapy as a precautionary measure before taking the blood vessel biopsy.
If your doctor does prescribe a steroid, such as prednisone, you will probably need to take it until all symptoms have disappeared and the results of further laboratory tests are normal. This usually takes at least a month. The dosage is then gradually decreased. Some physicians believe continuing low-dose steroids for a year or two may prevent recurrences.
What else causes constant headache?
Temporal arteritis isn't the only condition that can cause constant headaches. The pain of migraine headaches begins (and sometimes remains) on one side of the head, with pain stretching from the front to the back of the head. "Most of the time it's a throbbing, pounding pain," says Dr. John Pettinato,
a neurologist with Harvard-affiliated Beth Israel Deaconess Medical Center.
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.
An occasional headache is probably nothing to worry about. But when pain becomes chronic—more than once a week—or interferes with your life, it's time to tell your doctor.

– By Heidi Godman
Executive Editor, Harvard Health Letter