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.