What would cause a strong pulse on the right side of your head between your ear and temple?
The pulse felt in the temples is from the superficial temporal artery, a branch of the external carotid artery that arises from the main carotid artery on either side of the neck. The pulse is best felt (palpated) about one inch in front of the ear just above the zygomatic arch which is the horizontal bony prominence going along the upper portion of the cheek. Another way to describe the area where this pulse is found is that it falls underneath the area traversed by the earpieces of a pair of sunglasses, just in front of the ear.
Pulses are often asymmetrical due to normal variations in anatomy. Pulses can be abnormally strong when the patient has an elevated pulse pressure. The pulse pressure is the difference between the systolic and diastolic blood pressure. Blood pressure is expressed as systolic over diastolic, for example 120/70 mmHg (millimeters of mercury). In this example, the pulse pressure would be 50 mmHg (120 minus 70). A person with markedly elevated systolic pressure and normal diastolic, such as 210/70, would have a markedly elevated pulse pressure of 140. This would result in a strong, bounding pulse that could also be asymmetric due to anatomic variation.
Asymmetric pulses may also indicate underlying vascular disease, some examples of which follow.
1. Arteriosclerosis: A patient might have arteriosclerosis in his main carotid arteries with greater involvement (occlusion) on one side. In this case, the temporal pulse would be reduced on the more severely diseased side.
2. Vasculitis: The patient might be suffering from various forms of artery inflammation which can involve the superficial temporal artery on one side (causing a reduced pulse on that side), or another vessel supplying the superficial temporal artery (such as the external carotid artery). Examples of vasculitis types include temporal arteritis, giant cell arteritis, polyarteritis nodosa and Takayasu’s arteritis. A discussion of these diseases is beyond the scope of this answer, but can be found if desired by ”googling” the terms.
In the case of asymmetric pulse due to disease affecting the vessel being palpated, one might also detect a bruit (pronounced brew-ee) by listening to the pulsating vessel with a stethoscope. A bruit is a murmur-like sound due to turbulence created when blood passes through a partially obstructed artery.
References given below are as follows:
1. Anatomy of the superficial temporal artery.
2. PowerPoint presentation on vasculitis, including an excellent chart on many forms of vasculitis and the vessel types involved.
You are feeling the pulse in your superficial temporal artery. This is normal - it's also common for the pulse to feel stronger or be easier to find on one side of the head than on the other, as veins and arteries are rarely mirror images from one side of the bidy to the other due to the way they develop.
A strong pulse or swelling in this particular artery is sometimes associated with migraine headaches.