What Are the First Signs of Temporal Arteritis?

Temporal arteritis is an inflammation of the blood vessels around the temple. Headache is a signature symptom.

Temporal arteritis (giant cell arteritis, and also called arteritis cranialis, Horton disease, granulomatous arteritis, and arteritis of the aged) is a type of vascular inflammation that frequently occurs in older people and damages medium- and large-sized arteries. It is called temporal arteritis because it often affects the arteries in the head, near the temples.

Early signs of temporal arteritis (giant cell arteritis) include: 

• Loss of appetite
• Fever
• Muscle pain
• Night sweats
• Weight loss

These early signs may come on quickly or slowly, and may last a few days to a few weeks. 

Symptoms of temporal arteritis (giant cell arteritis) include: 

• Headache  
  • Usually a new headache in someone who has no history of headaches, or a new type of headache in a person with chronic headaches
  • Headache is localized to the temples and lower back of the skull, sometimes the upper part of the back of the neck
  • Throbbing
  • Continuous dull or burning pain
  • May be severe
  • Scalp may feel tender when brushing hair, wearing a hat, or wearing eyeglasses
• Neck, torso, shoulder, and pelvic pain consistent with polymyalgia rheumatica (PMR)
• Fatigue 
• Feeling unwell (malaise)
• Pain and discomfort in the jaw when chewing
• Fever 
• Generalized muscle aches and pains
• Cough and sore throat

Less common symptoms of temporal arteritis (giant cell arteritis) include: 

• Pain, discomfort, or numbness in the limbs
• Transient ischemic attacks (TIAs) or stroke
• Visual aura
• Carpal tunnel syndrome 
• Tongue or throat pain
• Double vision or drooping eyelids
• Vision loss
• Tongue numbness 

The cause of temporal arteritis (giant cell arteritis) is unknown. It is believed that genetic, environmental, and autoimmune factors may be involved.

Risk factors for developing temporal arteritis (giant cell arteritis) include:

• Age over 50
• Being female
• Family history of the condition 
• Northern European or Scandinavian descent
• Having polymyalgia rheumatica (PMR)

Temporal arteritis (giant cell arteritis) is diagnosed with a history, medical exam, and blood tests, especially tests for inflammation, such as:

• Erythrocyte sedimentation rate (ESR or "sed rate") 
• C-reactive protein (CRP)
• Complete blood cell count (CBC)

If the blood tests suggest temporal arteritis (giant cell arteritis) the diagnosis is confirmed, either by biopsy of the temporal artery or with imaging tests such as:

• Ultrasound
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan
• Cerebral angiography

The mainstay of treatment for temporal arteritis (giant cell arteritis) is high-dose corticosteroid therapy. 

Patients on long term steroid therapy may experience side effects from the medications, and so also typically receive prophylactic treatment including:

• Low-dose aspirin
• Proton pump inhibitors (PPIs)
• Bisphosphonate, calcium, and vitamin D

Alternative treatments to steroids include:

• Immunosuppressants (e.g., cyclosporine, azathioprine, methotrexate, cyclophosphamide, and dapsone) 
• Tocilizumab (Actemra) 
• Tumor necrosis factor (TNF) inhibitors (e.g., infliximab, etanercept)

With treatment, complications of temporal arteritis (giant cell arteritis) are uncommon, however, the risk of complications is high for patients who are not treated. 

Complications of untreated temporal arteritis (giant cell arteritis) include:

• Blindness
• Vision problems such as double vision 
• Death from heart attack, stroke, or dissecting aortic aneurysm

Temporal arteritis (giant cell arteritis) is usually treated with long-term use of steroids, which can also cause complications, such as:

• Collapsed vertebra
• Symptomatic steroid-induced muscle weakness
• Steroid psychosis