There may be certain parts of the muscles or tendons (connective tissue connecting the muscles to bones) that are especially painful when pressed
Trigeminal neuralgia: attacks of shooting pain down the face that may be triggered by touching the face or temperature changes
Dental pain from cavities or an abscess
Oral cavity carcinomaConditions causing irritation of the facial nerve (cranial nerve VII) or glossopharyngeal nerve (cranial nerve IX):
Tonsillitis: infection/inflammation of the tonsils
Post-tonsillectomy: pain following surgical removal of the tonsils
Pharyngitis: infection/inflammation of the throat
Sinusitis
Parotitis: inflammation of the parotid gland, the salivary gland right in front of the ear
Carcinoma of the oropharynx (base of tongue, soft palate, pharyngeal wall, tonsils)Conditions causing irritation of the vagus nerve (cranial nerve X):
GERD
Myocardial ischemia (inadequate oxygen supply to the heart muscle)Conditions causing irritation of cervical nerves C2-C3:
Cervical spine trauma, arthritis (joint inflammation), or tumor
Temporal arteritis: an autoimmune disorder leading to inflammation of the temporal artery, a large artery in the head. This condition tends to occur in adults older than 50. Pathophysiology
Primary ear pain
The ear can be anatomically divided into the external ear, the external auditory canal, the middle ear, and the inner ear. These three are indistinguishable in terms of the pain experienced. Secondary ear pain
Many different nerves provide sensation to the various parts of the ear, including cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus), and the great auricular nerve (cervical nerves C2-C3). These nerves also supply other parts of the body, from the mouth to the chest and abdomen.
The diagnosis is made by the combination of symptoms and examination of the tympanic membrane for redness, bulging, and/or a middle ear effusion (collection of fluid within the middle ear).Complications of otitis media include hearing loss, facial nerve paralysis, or extension of infection to surrounding anatomic structures, including:
Mastoiditis: infection of the air cells in the mastoid process, the area of the skull located right behind the ear
Petrositis: infection of the petrous portion of the temporal bone
Labyrinthitis
Meningitis
Subdural abscess
Brain abscess
Cerebral venous sinus thrombosis

Trauma
Barotrauma: results from changes in atmospheric pressure that occur when descending in a plane or deep diving. As atmospheric pressure increases with descent, the eustachian tube collapses due to pressure within the middle ear being less than the external pressure, which causes pain. In severe cases, middle ear hemorrhage or tympanic membrane rupture can result. Tympanic membrane rupture: disruption of the eardrum. This can be caused by a blow to the ear, blast injury, barotrauma, or direct penetration of the tympanic membrane by an object entering the ear. Referred ear pain
A variety of conditions can cause irritation of one of the nerves that provides sensation to the ear. Conditions causing irritation the trigeminal nerve (cranial nerve V):
Temporomandibular joint syndrome: inflammation or abnormal movements of the joint between the jaw and skull. These disorders are most common in women of childbearing age, and are uncommon in children younger than 10 years old. Myofascial pain syndrome: pain in the muscles involved in chewing.