Pain behind the ear is an unusual headache location that can feel particularly unsettling. This area sits at a crossroads where your skull, neck, jaw, and ear structures all meet—which means pain here could originate from several different sources. Whether it’s a sharp stabbing sensation, a dull ache, or a burning feeling, understanding what might be causing your behind-the-ear headache helps you know when to try home remedies and when to seek medical attention.
While pain behind the ear is less common than forehead or temple headaches, it’s not rare. The occipital nerves, which can become irritated or compressed, run through this area. The temporomandibular joint (TMJ) sits just in front, and the mastoid bone—part of the skull behind the ear—contains air cells that can become infected. Any of these structures can produce pain that feels centered behind the ear.
Track your symptoms to find patterns
Because behind-the-ear headaches can have multiple causes, keeping a symptom diary helps identify what’s triggering your pain. Log when headaches occur, what they feel like, how long they last, and any associated symptoms. Note activities, postures, or jaw movements that might precede the pain. This information helps both you and your healthcare provider narrow down the cause.
What causes headaches behind the ear?
Several structures in this anatomical region can generate pain. Understanding the most common causes helps you identify what might be affecting you.
Occipital neuralgia
The occipital nerves run from the upper spine, through muscles at the back of the head, and up to the scalp. When these nerves become irritated, compressed, or inflamed, they produce a distinctive type of pain [1].
Characteristics:
- Sharp, shooting, stabbing, or electric-shock-like pain
- Often starts at base of skull and radiates behind the ear and up the back of head
- May affect one or both sides
- Scalp may become tender to touch (even brushing hair hurts)
- Can be triggered by neck movement
Causes of occipital neuralgia:
- Tight neck muscles
- Poor posture (forward head position)
- Neck injury or whiplash
- Arthritis in the upper cervical spine
- Compression from sleeping position
TMJ disorder
The temporomandibular joint sits just in front of the ear canal, and problems with this joint commonly cause pain that radiates to surrounding areas—including behind the ear.
Characteristics:
- Dull, aching pain that may radiate from jaw to behind ear
- Worse with chewing, talking, or opening mouth wide
- Jaw clicking, popping, or locking
- Morning headaches (suggesting nighttime grinding)
- Tenderness when pressing on jaw joint
TMJ disorder affects approximately 10-15% of adults and is more common in women [2].
Tension-type headache
While tension headaches classically wrap around the head like a band, they can cause localized pain in specific areas, including behind the ears.
Characteristics:
- Pressing or tightening sensation
- Bilateral (both sides) or may feel worse on one side
- Often related to stress, muscle tension, or fatigue
- May accompany neck and shoulder tightness
Cervicogenic headache
Headaches that originate from the neck can refer pain to various areas of the head, including behind the ear. The upper cervical spine shares nerve pathways with the head.
Characteristics:
- Pain that seems to start in neck or base of skull
- Worsens with certain neck positions or movements
- Reduced neck mobility
- Often one-sided
- May be accompanied by shoulder pain
Mastoiditis
The mastoid bone—the bony prominence you can feel behind your ear—contains air cells connected to the middle ear. Infection in this area (mastoiditis) is less common since antibiotics became available but still occurs, particularly as a complication of untreated ear infections [3].
Characteristics:
- Pain and tenderness behind the ear
- Swelling or redness behind the ear
- Ear discharge
- Fever
- Hearing changes
- The ear may protrude forward
This is a medical emergency requiring prompt antibiotic treatment to prevent serious complications.
Other causes
Shingles (herpes zoster): If the virus affects nerves in this area, it can cause burning pain behind the ear, sometimes before any rash appears.
Ear infections: Middle or external ear infections can cause pain that radiates behind the ear.
Dental problems: Issues with back teeth or molars can sometimes refer pain to this area.
Lymph node swelling: Infection or other conditions can cause swollen lymph nodes behind the ear.
What does a headache behind the ear feel like?
The sensation depends on the cause:
| Cause | Pain Quality | Other Features |
|---|---|---|
| Occipital neuralgia | Sharp, shooting, electric | Scalp tenderness, radiates upward |
| TMJ disorder | Dull, aching | Jaw symptoms, worse with chewing |
| Tension headache | Pressing, tightening | Bilateral, stress-related |
| Cervicogenic | Aching, radiating | Starts in neck, movement-triggered |
| Mastoiditis | Throbbing, deep | Fever, swelling, ear symptoms |
How can I find relief from headaches behind the ear?
Treatment depends on the underlying cause, but several approaches can help.
For occipital neuralgia
- Heat therapy: Warm compress on base of skull and upper neck
- Massage: Gentle massage of neck and occipital area
- OTC pain relievers: NSAIDs (ibuprofen, naproxen) may help
- Posture correction: Reduce forward head position
- Physical therapy: Stretching and strengthening for neck muscles
- Nerve blocks: For persistent cases, healthcare providers can inject local anesthetic near the occipital nerves
For TMJ-related pain
- Rest your jaw: Soft foods, avoid gum, minimize extreme jaw movements
- Warm compress: Apply to jaw area
- Jaw exercises: Gentle stretching as recommended by a provider
- Night guard: If you grind your teeth, a dental splint can help
- Stress reduction: Jaw clenching often relates to tension
For tension and cervicogenic headaches
- Heat or ice: Experiment to see which helps more
- OTC pain medication: Acetaminophen, ibuprofen
- Stretching: Gentle neck stretches throughout the day
- Posture improvement: Ergonomic workstation, take screen breaks
- Physical therapy: For persistent cervicogenic headaches
- Massage: Professional or self-massage for muscle tension
For infections (mastoiditis, ear infections)
- Seek medical care: These require professional treatment
- Antibiotics: Prescribed by your healthcare provider
- Pain relievers: For symptom management while treating infection
- Don’t delay: Mastoiditis can become serious if untreated
When should I see a doctor?
Seek prompt medical attention if you have:
- Fever along with pain behind the ear
- Swelling, redness, or warmth behind the ear
- Ear discharge or pus
- Hearing changes
- Recent ear infection that isn’t improving
See a doctor soon if:
- Pain is severe or getting worse
- Home treatments aren’t providing relief after a week
- Pain is affecting your daily activities or sleep
- You have recurrent episodes
- Scalp numbness, tingling, or other neurological symptoms
Seek emergency care if:
- Sudden, severe pain with stiff neck and fever
- Neurological symptoms (vision changes, weakness, confusion)
- Symptoms suggesting serious infection (high fever, confusion, severe swelling)
Understanding your behind-the-ear headaches
Pain behind the ear, while less common than other headache locations, usually has identifiable and treatable causes. By paying attention to the quality of your pain, associated symptoms, and what makes it better or worse, you can often narrow down what’s happening.
Start with simple measures: check your posture, address jaw tension, apply heat to tight muscles, and try OTC pain relievers. If your symptoms include fever, swelling, or ear-related issues, seek medical attention promptly—infections in this area need professional treatment.
For persistent behind-the-ear headaches, particularly those with sharp, shooting qualities suggesting occipital neuralgia, a healthcare provider can offer targeted treatments like nerve blocks that provide significant relief.
Your pain behind the ear is telling you something. Learning to interpret that message—and knowing when to seek help—puts you on the path to relief.