INTRODUCTION: Temperature measurement is important during routine neurocritical care especially as differences between brain and systemic temperatures have been observed. The purpose of the study was to determine if infra-red temporal artery thermometry provides a better estimate of brain temperature than tympanic membrane temperature for patients with severe traumatic brain injury. METHODS: Brain parenchyma, tympanic membrane and temporal artery temperatures were recorded every 15-30 min for five hours during the first seven days after admission. RESULTS: Twenty patients aged 17-76 years were recruited. Brain and tympanic membrane temperature differences ranged from -0.8 degrees C to 2.5 degrees C (mean 0.9 degrees C). Brain and temporal artery temperature differences ranged from -0.7 degrees C to 1.5 degrees C (mean 0.3 degrees C). Tympanic membrane temperature differed from brain temperature by an average of 0.58 degrees C more than temporal artery temperature measurements (95% CI 0.31 degrees C to 0.85 degrees C, P < 0.0001). CONCLUSIONS: At temperatures within the normal to febrile range, temporal artery temperature is closer to brain temperature than is tympanic membrane temperature.