Pain and Swelling Above the Temple: Possible Causes and Solutions

There is a swollen area of blood vessels above the temple, and it hurts when touched?

I am a 37-year-old male with no significant medical history, only experiencing common colds and fevers approximately once every 1.5 years.
However, this time I have developed a strange illness with persistent pain, and I am unsure of the cause.
Below is the timeline of my symptoms, and I hope someone can help me understand how to address this issue.
Thank you.
On February 23, while at work, I noticed pain in the "bone near my left temple," "bone below my ear," and "muscle at the back of my left neck" that hurt when touched.
I thought it might be due to sleeping awkwardly, so I ignored it.

On February 24, when I woke up, the pain persisted in the same areas.
Concerned it might be a precursor to a stroke, I took a day off to see a doctor.
At the clinic, the doctor performed tests for stroke symptoms and checked my blood pressure, all of which were normal, ruling out a stroke.
The doctor diagnosed me with musculoskeletal pain, suggesting it might be a precursor to a cold, and prescribed the following medications:
1.
Mylanta, dosage 1, indication: antacid / side effect: occasional constipation.
2.
Scanol, dosage 1, indication: antipyretic and analgesic.
3.
Ibuprofen, dosage 1, indication: antipyretic and analgesic / side effect: stomach pain.
4.
Ambroxol, dosage 1, indication: anti-inflammatory and expectorant / side effect: skin rash.
5.
Inderal, dosage 0.5, indication: peripheral blood circulation, tachycardia, hyperthyroidism / side effect: slowed heart rate, dizziness.
On February 25, I continued taking the medication.
After each dose, the pain would lessen, but once the medication wore off, the pain returned.
At 8 PM, I noticed a lump above my left temple that was painful to touch.
(The pain in the "bone near my left temple," "bone below my ear," and "muscle at the back of my left neck" persisted.)
On February 26, when I woke up, the lump from the previous night had disappeared, but my condition remained unchanged.
After taking the medication, the pain would lessen, but it would return once the effect wore off.
(The pain in the "bone near my left temple" and "bone below my ear" persisted, but the "muscle at the back of my left neck" was no longer painful.)
On February 27, my condition remained the same; after taking the medication, the pain would lessen, but it would return once the effect wore off.
(The pain in the "bone near my left temple" and "bone below my ear" persisted.)
On February 28, I visited the doctor again (blood pressure normal) and informed him about the lump that had appeared on my head on February 25.
The doctor seemed uncertain about the condition and its cause, suggesting it might be a "fungal infection" and advised me to try some medication.
This time, the doctor prescribed an additional medication, "Miconazole 250 mg," along with the previous medications.
(Today, the painful area has changed; above my temple, a section of blood vessels has become swollen and hard, and it hurts to touch.
My wife noted that the blood vessels looked swollen.)
On February 29 and March 1, my condition remained the same; the area above my temple, where the blood vessels are, is still swollen and hard, and it hurts to touch.
(After taking the medication, the pain continues without temporary relief as before.)
I would like to ask everyone:
1.
What could this illness be?
2.
What are the possible causes?
3.
If I need to go to a major hospital, which department should I consult?
I hope someone can help me.
Thank you.

Cai Xiansheng, 30~39 year old female. Ask Date: 2016/03/01

Dr. Ke Fangxu reply Surgery

Without directly observing and examining the lesion, a diagnosis cannot be made.
Although the physician has prescribed pain medication that has improved your symptoms, it is still advisable to have a surgical or dermatological evaluation to rule out the possibility of bacterial infection, skin tumors, or vasculitis.

Reply Date: 2016/03/01

More Info

Understanding pain and swelling above the temple can be quite complex, as it may stem from various underlying conditions. Based on your description, it seems you are experiencing localized pain around the left temple, near the ear, and in the neck area, along with some swelling that has appeared and disappeared. Here’s a breakdown of possible causes, potential diagnoses, and recommendations for further action.

Possible Causes
1. Muscle Strain or Tension: Given that you initially thought it might be due to sleeping in an awkward position, muscle strain or tension could be a primary cause. This can lead to pain in the temple area, especially if the muscles around the neck and jaw are involved.

2. Temporomandibular Joint Disorder (TMJ): TMJ disorders can cause pain in the jaw joint and surrounding muscles, which may radiate to the temple area. Symptoms often include pain when chewing, jaw clicking, or a feeling of fullness in the ear.

3. Sinusitis: Inflammation of the sinuses can lead to pain and swelling in the forehead, cheeks, and around the eyes. If you have had any recent upper respiratory symptoms, this could be a contributing factor.

4. Migraine or Tension Headaches: Migraines can cause localized pain, often accompanied by nausea, sensitivity to light, and other symptoms. Tension headaches can also cause discomfort around the temples.

5. Infection: The mention of a possible fungal infection by your doctor could indicate that there is an underlying infection, which might be causing inflammation and pain. This could include skin infections or deeper infections affecting the bones or tissues.

6. Vascular Issues: Conditions like temporal arteritis (inflammation of the blood vessels in the temples) can cause severe headaches and tenderness in the temple area. This is more common in older adults but can occur in younger individuals as well.

Recommendations
1. Follow-Up with a Specialist: Since your symptoms have persisted and evolved, it would be prudent to see a specialist. Given your symptoms, you should consider visiting a neurologist or an ear, nose, and throat (ENT) specialist. They can conduct a thorough examination and may recommend imaging studies like an MRI or CT scan to rule out any serious conditions.

2. Keep a Symptom Diary: Documenting when the pain occurs, its intensity, any associated symptoms (like nausea or visual disturbances), and any triggers can provide valuable information to your healthcare provider.

3. Pain Management: Continue taking the medications prescribed by your doctor, but also discuss with them any concerns regarding side effects or if the current treatment is not effective. Over-the-counter pain relievers like acetaminophen or ibuprofen can also help manage pain, but should be used as directed.

4. Physical Therapy: If muscle strain or TMJ is suspected, physical therapy may help alleviate symptoms through targeted exercises and treatments.

5. Lifestyle Modifications: Stress management techniques such as yoga, meditation, or gentle stretching can help reduce muscle tension. Ensure you maintain good posture, especially if you spend long hours at a desk.

6. Consider Allergy Testing: If sinusitis is suspected, allergy testing may help identify triggers that could be contributing to your symptoms.

Conclusion
In summary, while your symptoms could be attributed to a variety of causes, it is essential to seek further evaluation from a specialist to obtain a definitive diagnosis and appropriate treatment. Pain and swelling in the temple area should not be ignored, especially if it persists or worsens. Early intervention can often lead to better outcomes, so don’t hesitate to pursue further medical advice.

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