Have you ever experienced that nagging discomfort behind your ears? That tender spot where your ear meets your head can become surprisingly painful, leaving you wondering what’s causing it and how to find relief. You’re not alone in this experience—pain behind the ears is a common complaint that can stem from various conditions.
This article will explore the common causes, symptoms, and treatment options for pain behind the ears. Whether you’re currently experiencing this issue or just curious, we’ll cover everything you need to know to better understand and manage this discomfort.
What is Pain Behind the Ears?
Pain behind the ears (retroauricular pain) can range from a dull ache to sharp, stabbing sensations. The area behind our ears contains important structures, including lymph nodes, nerves, blood vessels, and the mastoid process of the temporal bone. When any of these structures becomes irritated, inflamed, or infected, pain can result.
What makes diagnosing this type of pain challenging is that it can originate from the ear itself or be referred from nearby structures, such as the jaw, neck, or even the sinuses. This interconnectedness means finding the true source requires careful consideration of your symptoms and medical history.
Common Causes of Pain Behind the Ears
1. Ear Infections
One of the most frequent culprits behind ear pain is infection. Middle ear infections (otitis media) and outer ear infections (otitis externa, commonly known as swimmer’s ear) can both cause pain that radiates to the area behind the ear.
Middle ear infections typically occur when bacteria or viruses from the throat enter the middle ear through the Eustachian tube. These infections are particularly common in children due to their shorter, more horizontal Eustachian tubes. The infection creates pressure as fluid builds up in the middle ear space, leading to pain that can extend behind the ear.
Children between six months and two years old are especially vulnerable, with many experiencing multiple middle ear infections before they reach school age. The pain often worsens at night when lying down, as this position can increase pressure within the ear.
Swimmer’s ear develops when water remains in the ear canal after swimming or bathing, creating a moist environment where bacteria can thrive. The resulting inflammation can cause pain that extends beyond the ear canal to the area behind the ear. Unlike middle ear infections, swimmer’s ear often begins with itching before progressing to pain.
2. Mastoiditis
The mastoid bone, located directly behind your ear, can become infected in a condition called mastoiditis. This serious infection typically develops as a complication of an untreated middle ear infection. When bacteria spread from the middle ear to the mastoid bone’s air cells, they cause inflammation and deterioration of the bone.
Before antibiotics became widely available, mastoiditis was a common and dangerous condition. Today, it’s relatively rare but remains a serious medical concern requiring immediate attention. The infection can spread beyond the mastoid bone to surrounding tissues, potentially reaching the brain and causing life-threatening complications like meningitis or brain abscess.
Symptoms of mastoiditis include:
- Severe pain behind the ear
- Swelling and redness over the mastoid bone
- Protruding ear due to swelling
- Fever and irritability
- Drainage from the ear
- Headache on the affected side
- Hearing loss in the affected ear
Mastoiditis requires immediate medical attention as it can lead to serious complications if left untreated. Diagnosis typically involves physical examination, hearing tests, and imaging studies such as CT scans to assess the extent of bone involvement.
3. Temporomandibular Joint (TMJ) Disorders
The temporomandibular joint connects your jawbone to your skull just in front of your ears. When this joint becomes inflamed or dysfunctional, it can cause pain that radiates to the area behind the ears.
The TMJ is one of the most complex joints in your body. Unlike most joints, which typically allow movement in one or two directions, the TMJ permits movement in multiple planes. This allows you to open and close your mouth, move your jaw from side to side, and push it forward and backward. This complexity makes it particularly vulnerable to dysfunction.
People with TMJ disorders often experience:
- Jaw pain or tenderness
- Difficulty or discomfort while chewing
- Clicking or popping sounds when opening or closing the mouth
- Earaches without an infection
- Pain behind the ears, especially after extended talking or chewing
- Facial fatigue or pain
- Locked jaw (inability to open or close the mouth completely)
- Headaches, particularly in the temples
- Dizziness in some cases
- Ringing in the ears (tinnitus)
Many people don’t realize that their ear pain stems from jaw issues. Michael, a 42-year-old marketing executive, described his journey: “I spent months seeing doctors for what I thought was an ear problem.
Multiple antibiotics didn’t help, and it wasn’t until a dentist noticed how worn my teeth were from grinding that we discovered my pain was actually from TMJ disorder. Wearing a night guard and doing jaw exercises has significantly reduced my symptoms.”
Women between 20 and 40 years of age are most commonly affected by TMJ disorders, though they can occur in anyone. The connection between TMJ problems and ear pain is so strong that many patients initially seek treatment from ear specialists rather than dentists.
4. Occipital Neuralgia
This neurological condition occurs when the occipital nerves, which run from the top of the spinal cord up through the scalp, become injured or inflamed. Since these nerves pass behind the ears, irritation can cause intense pain in this area.
The greater and lesser occipital nerves emerge from between vertebrae in the upper neck and travel upward through muscles at the back of the head. These nerves provide sensation to much of the scalp, extending from the base of the skull all the way to the forehead. When compressed, injured, or irritated, they can produce severe pain patterns that include the area behind the ears.
Occipital neuralgia pain is typically described as:
- Sharp, shooting, or electric-like
- Occurring on one or both sides of the head
- Extending from the base of the skull to behind the ears and sometimes into the scalp
- Triggered or worsened by neck movement
- Coming in sudden, severe bursts that may last from a few seconds to several minutes
- Accompanied by sensitivity to light in some cases
- Sometimes, there is pain behind the eye on the affected side
- Often made worse by touching the affected area
People with this condition often find that even a light touch to the area can trigger pain, making simple activities like hair brushing challenging.
5. Cervical Spine Issues
Problems with the upper cervical spine (neck) can refer pain to the area behind the ears. Conditions such as cervical spondylosis (age-related wear and tear of spinal discs), herniated discs, or muscle strain can all lead to pain that radiates upward.
The cervical spine contains seven vertebrae (C1-C7) with the top two (C1 and C2) having specialized roles in supporting and moving the head. Between these vertebrae lie discs that absorb shock and facilitate movement. Over time, these discs can degenerate, vertebrae can develop bone spurs, and supporting muscles can become strained or imbalanced.
This type of pain often:
- Worsens with neck movement
- It is accompanied by a reduced range of motion in the neck
- May include numbness or tingling in the arms
- Gets worse after long periods of poor posture
- Intensifies after prolonged sitting, especially when looking down at phones or computers
- Improves with rest or changes in position
- Gradually worsens over the course of the day
- May cause morning stiffness that improves with movement
The connection between neck problems and behind-the-ear pain highlights how interconnected our body’s pain pathways can be. The upper cervical nerves (particularly C2 and C3) provide sensation to the area behind the ears, creating a direct pathway for referred pain.
6. Lymph Node Inflammation
Several lymph nodes are located behind and below the ear. When these become swollen due to infection or other conditions, they can cause pain and tenderness in the retroauricular area.
Lymph nodes are small, bean-shaped structures that serve as filtering stations for your lymphatic system—a critical component of your immune system. They contain white blood cells that help fight infections and filter out harmful substances. When your body is fighting an infection, these nodes can enlarge as they work to trap and destroy pathogens.
Common causes of swollen lymph nodes behind the ears include:
- Upper respiratory infections
- Ear infections
- Scalp infections
- Dental abscesses
- Skin infections near the scalp or face
- Mononucleosis (“mono”)
- Rare conditions like lymphoma
- Autoimmune disorders
- Cat scratch disease
- Toxoplasmosis
While uncomfortable, swollen lymph nodes are often a sign that your body is fighting an infection effectively. However, lymph nodes that remain enlarged for more than two weeks, continue to grow, or are accompanied by unexplained weight loss, night sweats, or persistent fever should be evaluated by a healthcare provider.
7. Ear Trauma or Pressure Changes
Physical trauma to the ear or rapid changes in air pressure can cause pain behind the ears. This might occur during air travel, scuba diving, or after a direct blow to the ear.
Barotrauma, the medical term for injury caused by pressure differences, can damage the eardrum and middle ear structures, leading to pain that extends to the area behind the ear. This commonly occurs during airplane descent, when the pressure inside the middle ear needs to equalize with the rapidly changing cabin pressure.
The Eustachian tube, which connects your middle ear to the back of your throat, normally allows air to flow in and out of the middle ear, maintaining equal pressure on both sides of the eardrum.
When this tube becomes blocked or doesn’t function properly, pressure differences can cause pain, reduced hearing, and sometimes damage to the middle ear structures.
8. Dental Problems
It might surprise you, but dental issues can cause referred pain behind the ears. Tooth abscesses, impacted wisdom teeth, or severe dental decay can all radiate pain to the ear region.
This connection exists because of shared nerve pathways between the teeth and the ears. The trigeminal nerve, which supplies sensation to the face, teeth, and ears, can transmit pain signals from one area to another. Additionally, the roots of upper molars are positioned close to the sinuses, which themselves have connections to the middle ear via the Eustachian tube.
Common dental conditions that can cause behind-the-ear pain include:
- Abscessed teeth, particularly upper molars
- Impacted wisdom teeth
- Severe tooth decay reaching the nerve
- Bruxism (teeth grinding)
- Cracked teeth
- Advanced periodontal (gum) disease
- Failed dental restorations that allow bacteria to enter the tooth
- Dental infections that spread to the surrounding tissues
The pain from dental issues tends to be more variable than pain from direct ear problems. It may come and go, worsen when eating hot, cold, or sweet foods, or intensify when lying down (as blood pressure to the affected area increases).
If you’re experiencing behind-the-ear pain that’s accompanied by tooth sensitivity, visible swelling in the gums, or a bad taste in your mouth, consider scheduling a dental examination even if you haven’t noticed tooth pain directly.
9. Neurological Conditions
Several neurological conditions beyond occipital neuralgia can cause pain behind the ears. These include:
Trigeminal Neuralgia: Although this condition typically causes facial pain, some variants can present with pain that extends to the ear region. Trigeminal neuralgia is characterized by episodes of severe, shooting pain along the distribution of the trigeminal nerve. These episodes can be triggered by everyday activities like brushing teeth, eating, or even feeling a breeze against the face.
Glossopharyngeal Neuralgia: This rare condition involves the glossopharyngeal nerve (ninth cranial nerve), which supplies sensation to the back of the throat, tongue, and ear. Pain typically occurs in the throat but can radiate to the ear and the area behind it. Swallowing, coughing, or yawning often triggers the pain.
Cervical Neuralgia: Inflammation or compression of the cervical spinal nerves can cause pain that radiates to the ear region. This condition often results from degenerative changes in the cervical spine, such as herniated discs or bone spurs.
Auriculotemporal Neuralgia: This condition involves the auriculotemporal nerve, a branch of the trigeminal nerve that supplies sensation to the temple and ear regions. People with this condition experience pain in front of and above the ear that can radiate backward.
10. Vascular Issues
Problems with blood vessels near the ear can sometimes cause behind-the-ear pain. These include:
Temporal Arteritis (Giant Cell Arteritis): This inflammatory condition affects the temporal arteries, which run along the temples and behind the ears. It typically occurs in adults over 50 and causes throbbing headaches, scalp tenderness, jaw pain when chewing, and sometimes pain behind the ears. This condition requires prompt medical attention as it can lead to vision loss if untreated.
Carotid Artery Dissection: Though rare, a tear in the inner lining of the carotid artery can cause pain that radiates to the head, face, and ear region. This serious condition can occur after trauma or spontaneously and requires emergency medical care.
Venous Congestion: Problems with blood flow through the jugular veins, which pass near the ear, can sometimes cause discomfort or pressure sensations behind the ear.
Treatment Options for Pain Behind the Ears
Treatment varies widely depending on the underlying cause of your pain. Here are the most common approaches for various conditions:
1. For Ear Infections:
- Antibiotics: Prescribed for bacterial infections, typically taken orally for 7-10 days
- Ear drops: Containing antibiotics and sometimes steroids to reduce inflammation
- Pain relievers: Over-the-counter medications like ibuprofen or acetaminophen can help manage pain and reduce fever
- Warm compresses: Applying gentle heat to the affected ear can provide relief
- Keeping the ear dry: Particularly important for swimmers’ ear
2. For Mastoiditis:
- Hospitalization: Often required for intravenous antibiotics
- Surgical drainage: May be necessary to remove infected material
- Mastoidectomy: In severe cases, surgical removal of infected portions of the mastoid bone
- Follow-up care: Critical to ensure the infection is completely resolved
3. For TMJ Disorders:
- Jaw exercises: To strengthen muscles and improve mobility
- Night guards or splints: To prevent teeth grinding and reduce pressure on the joint
- Pain relievers and anti-inflammatories: To reduce pain and swelling
- Heat or cold therapy: Applied to the jaw joint area
- Stress management techniques: Since tension can worsen TMJ problems
- In severe cases: Corticosteroid injections or surgery may be considered
4. For Occipital Neuralgia:
- Pain medications: Including nerve pain medications like gabapentin
- Local nerve blocks: Injections to temporarily block pain signals
- Physical therapy: To address any contributing neck muscle issues
- Heat therapy: To relax tight muscles
- Nerve stimulation techniques: Such as transcutaneous electrical nerve stimulation (TENS)
- In persistent cases: Surgical decompression of the occipital nerves may be considered
5. For Cervical Spine Issues:
- Physical therapy: To improve neck strength, posture, and range of motion
- Pain relievers and muscle relaxants: To reduce pain and muscle spasms
- Hot and cold therapy: Applied to the neck area
- Cervical collar: In some cases, to temporarily limit movement
- Ergonomic adjustments: Especially important for desk workers
- Chiropractic care or massage therapy: May help some individuals
- Surgery: Reserved for severe cases with nerve compression or instability
6. For Lymph Node Inflammation:
- Treatment of the underlying infection: Often with antibiotics
- Pain relievers: To reduce discomfort
- Warm compresses: To soothe the area
- Rest: To allow the body to recover
7. For Ear Trauma or Pressure Changes:
- Time and rest: Many cases resolve on their own
- Equalizing pressure techniques: Such as yawning, swallowing, or the Valsalva maneuver
- Pain relievers: To manage discomfort
- In cases of eardrum perforation: Keeping the ear dry and possibly using antibiotic drops
- For severe cases: Surgical repair may be needed
8. For Dental Issues:
- Dental treatment: Addressing the specific problem (filling cavities, treating abscesses, and extracting problematic teeth)
- Antibiotics: For infections
- Pain management: Both prescription and over-the-counter options
- Referral to specialists: For complex dental issues
When to See a Doctor？
While some mild, temporary pain behind the ears may resolve on its own, certain situations warrant prompt medical attention:
- Severe pain that interferes with daily activities
- Pain accompanied by fever, especially high fever
- Dizziness or balance problems
- Hearing loss or changes in hearing
- Discharge from the ear
- Visible swelling or redness behind the ear
- Pain that persists for more than a few days
- Symptoms that worsen despite home treatment
Remember that early intervention often leads to faster resolution of symptoms and reduces the risk of complications.
