Pain In The Crown : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 11/07/2022

Pain in the crown occurs with disorders of cerebral circulation, intracranial hypertension, meningitis, encephalitis, arachnoiditis, traumatic injuries of the head and neck, otolaryngological diseases, their intracranial complications. It is observed with muscle lesions, diseases of the spine, infections, intoxications, vegetative-vascular, neurotic disorders. More often pressing or bursting, it can be pulsating, twitching, aching. It is diagnosed on the basis of complaints, anamnesis data, general examination, otolaryngological and neurological examination, additional methods. Painkillers, NSAIDs, antibiotics, nootropics, neurometabolites, and other agents are used for treatment.

Why does the crown hurt

Physiological causes

Pain can occur the next morning after alcohol abuse, against the background of overwork, excessive physical exertion. In some people with weather dependence, pain when the weather changes is localized precisely in the parietal zone, although other options are possible (whiskey, back of the head, whole head). Sometimes the symptom is triggered by stress. A fairly typical situation is pain in the crown of the head during overheating, prolonged exposure to the sun without a hat.

Cerebral circulatory disorders

The symptom develops with transient disorders of cerebral circulation, pre-stroke conditions. Characterized by a sudden onset, a rapid deterioration in well-being. Blurred vision, weakness, nausea, sometimes vomiting, short-term disturbances of consciousness are observed. The list of possible vegetative-vascular reactions includes sweating, hot flashes, feeling hot or chills, trembling throughout the body.

Focal signs are determined by the topic. The duration of the attack ranges from several minutes to several hours. With PNMC, all manifestations completely disappear within 24 hours. In a pre-stroke state, further aggravation of cerebral and neurological symptoms, transformation into a hemorrhagic or ischemic stroke is possible.

intracranial hypertension

Symmetrical pain in the crown, forehead area is a characteristic manifestation of intracranial hypertension. The type of pain is determined by the rate of progression of liquorodynamic disorders. A rapidly developing disorder is manifested by an intense, rapidly increasing pain syndrome. Chronic pathology is accompanied by constant dull pain. In some patients, symptoms wax and wane.

Inflammatory processes of the CNS

With meningococcal meningitis, painful sensations are excruciating, throbbing, pressing or bursting, with a maximum in the forehead and crown. There is an increase under the action of stimuli (light, sounds), a change in the position of the head, at night. With other types of meningitis, pain often bothers in the occipital zone, from where it spreads to the crown of the head, other parts of the head. There are chills, fever, nausea, vomiting, lethargy, fatigue, positive meningeal symptoms.

Increasing headache is also noted with encephalitis. In patients with arachnoiditis, pain is bursting, of moderate intensity, aggravated by physical exertion, straining, coughing, in the morning. Communication with an increase in intracranial pressure causes predominantly parietal localization, a feeling of pressure on the eyes. Liquorodynamic crises are possible with a sharp increase in pain, the addition of dizziness, nausea, and vomiting.

Pain in the crown


Traumatic injuries

The most mild injury is a contusion of the crown. The pains are moderate, local, their intensity decreases rapidly. With a hematoma, a limited swelling is formed with a site of fluctuation, which then either resolves within a few weeks, or needs to be opened. Fractures of the cranial vault are also accompanied by the formation of a hematoma, but with them the pain is sharp, explosive, not subsiding over time, spreading to the entire head. An impression may be felt. The general condition is variable - from satisfactory well-being to shock or coma.

Pain in the crown can also be manifested by injuries of the upper cervical vertebrae. The symptom is most pronounced in damage to C2, observed in fractures, fracture-dislocations, subluxations, displacement of the vertebrae, including as a result of whiplash. Restrictions of movements, soreness of the neck are noted, neurological disorders are possible (numbness, weakness of the limbs, impaired pelvic functions).

Otolaryngological diseases

The symptom is quite widespread in diseases of the paranasal sinuses, nose, ear and complications of these pathologies. It has a predominantly radiating character, complemented by pain in the projection of the forehead or ear. It is observed in the following diseases:

  • Frontit. In patients with a mild form, the pain syndrome is mild. In the moderate form, patients complain of severe arching, throbbing pains in the projection of the eyebrows, radiating to the crown, temporal region. The severe form is accompanied by very intense, sometimes unbearable pain. Other manifestations include hyperthermia, intoxication syndrome, nasal congestion, photophobia, lacrimation.
  • Pansinusitis. The spread of the inflammatory process to all paranasal sinuses is fraught with the occurrence of very severe pain in the eyebrows, under the eyes, in the nape, crown, forehead, orbits. There is an increase in pain during movement and palpation, severe intoxication. Severe condition.
  • Thornwald's cyst. Congenital pathology, characterized by the presence of a cyst-like formation on the back wall of the nasopharynx. The main clinical manifestations are pain in the occipital and parietal region, nasal breathing disorders, bad breath. When infected, an increase in body temperature is detected.
  • Acute otitis media. The epicenter of pain in this disease is in the projection of the ear. Irradiation to the parietal and temporal regions is typical. There are congestion, tinnitus, hearing impairment, deterioration of the general condition.
  • Mastoiditis. Occurs simultaneously with acute otitis or a little later. It is manifested by a rapid deterioration in well-being, severe intoxication, severe pain in the ear and behind the ear, radiating to the crown, orbit, temple, and upper jaw. In some cases, the pain spreads to the entire half of the head.

Rhinogenic and otogenic intracranial complications are accompanied by pain in the fronto-parietal region against the background of increased intracranial pressure. They are provoked by acute and chronic otitis media, epi- and mesotympanitis, purulent labyrinthitis. Other possible causes include respiratory infections with the development of acute forms of rhinitis, sinusitis or exacerbation of chronic pathologies, trauma, boils and carbuncles of the nose, abscesses of the nasal septum.

With the spread of infection, arachnoiditis, meningitis, brain abscesses are observed. With sinusitis, thrombosis of the cavernous sinus is possible. The clinical picture is determined by the nature of the complication. Common manifestations, along with pain, are intoxication, vestibular disorders, insomnia, irritability, visual disturbances, a feeling of pressure from the inside on the eyes.

Diseases of the spine

Pain in the crown of the head often occurs with radicular syndrome caused by pathologies of the cervical spine, combined with hypesthesia of the skin of the occipital region, limiting tilts and turns of the head. The most common cause is osteochondrosis. The likelihood of pain syndrome increases with the formation of a hernia. In addition, compression of the roots can be observed in spondylosis, spondylarthrosis.

Muscle pathologies

With myositis of the cervical muscles, pain first appears in the neck, and from there it spreads to the back of the head, crown, and upper back. There is an increase in pain during movement. Another possible cause is myalgia due to muscle strain during prolonged driving, working at a computer or sewing machine.

Other reasons

Other pathological conditions that can cause crown pain include:

  • Infectious-toxic syndrome. Headaches can be widespread or localized with epicenter in the crown. Accompany influenza, SARS, inflammatory diseases of the kidneys and respiratory tract, local purulent processes.
  • Endogenous and exogenous intoxications . The symptom is observed in acute alcohol intoxication, food poisoning. It becomes a side effect or the result of an overdose of drugs, occurs in patients with malignant tumors, in specialists who work in hazardous chemical industries.
  • Vegetative-vascular, neurotic disorders . Pain in the projection of the crown sometimes worries patients with vegetative-vascular dystonia, it is observed in people with anxiety disorders, hypochondria, hysteria.


The cause of the symptom is determined by the neurologist. If you suspect a disease of the ear, nose, paranasal sinuses, the patient is referred to an otolaryngologist. According to indications, consultations of an infectious disease specialist, a traumatologist, a psychotherapist, and other specialists are prescribed. The doctor collects an anamnesis of life and disease, conducts an external examination to identify possible changes (for example, wounds, hematomas). To clarify the diagnosis are assigned:

  • Otorhinolaryngological examination . It involves an examination of the available ENT organs, supplemented by the use of special devices to improve visualization. The most common methods are otoscopy and rhinoscopy. Sinusoscopy during the diagnosis is rarely performed due to its high trauma.
  • Neurological examination . The specialist evaluates the symmetry of the face, pupils, palpebral fissures. Explores muscle strength, range of motion, physiological reflexes, various types of sensitivity. Determines pathological reflexes, meningeal symptoms. Performs clinical topical diagnostics taking into account the detected neurological disorders.
  • Radiography . It is a mandatory diagnostic technique for injuries. On the pictures of the skull, fractures of the parietal bone can be seen, on the radiographs of the spine - fractures, dislocations, subluxations, fracture-dislocations of the cervical vertebrae. X-ray of the paranasal sinuses is widely used for sinusitis and mastoiditis, confirms the presence of dense masses in the sinus cavity, inflammatory changes in the mastoid process.
  • Other Neuroimaging Techniques . In the diagnostic process, MRI, CT, dopplerography, duplex scanning are used. According to the research, injuries, hydrocephalus, hemorrhages or areas of ischemia, displacement of the median structures of the brain, sinusitis, mastoiditis are confirmed.
  • Lumbar puncture. Produced with intracranial hypertension, neuroinfections, craniocerebral injuries. Helps to confirm an increase in intracranial pressure, the presence of signs of inflammation or blood in the cerebrospinal fluid.
  • Laboratory tests . A sample of cerebrospinal fluid obtained during a lumbar puncture can be examined by inoculation on nutrient media, microscopy, PCR, ELISA. According to indications, general blood tests are performed to confirm inflammation, microbiological examination of discharge from the nose and ear.

Head injury treatment



Conservative therapy

Therapeutic tactics is determined by the nature of the pathology that provoked the appearance of the symptom:

  • Disorders of cerebral circulation . Showing drugs to improve blood rheology, acetylsalicylic acid, neurometabolites. With an increase in blood pressure, the introduction of medications with antihypertensive action is recommended. In the recovery period, therapy with sedatives is carried out.
  • intracranial hypertension . The combination of diuretics with potassium preparations is effective. Beneficial neurometabolites. Depending on the etiology of the disease, antibiotics, venotonics, detoxification agents are prescribed.
  • Inflammatory pathologies of the CNS . The basis is antimicrobial drugs (antimicrobial or antiviral). Vitamins, neuroprotectors, neurometabolites are used, symptomatic therapy is carried out. Treatment of arachnoiditis is carried out using antiallergic, antiepileptic, hormonal agents.
  • Traumatic injuries . TBI requires NSAIDs, antibiotics, neurometabolites, nootropics. In case of spinal injuries, immobilization is performed, drugs are prescribed to stimulate metabolic processes in the nervous tissue.
  • Otolaryngological diseases . In most cases, the main method of treatment is antibiotic therapy. Treatment regimens are supplemented with vitamins, anticongestants, antihistamines, local antiseptics. For sinusitis, lavages and punctures are performed, a pit catheter is installed.
  • radicular syndrome . Painkillers, anti-inflammatory, vascular, decongestants, chondroprotectors of general and local action are used. Conduct resolving therapy, drug blockade.


Patients with pain in the crown perform the following surgical interventions:

  • Intracranial hypertension : decompressive craniotomy, various shunt techniques, external ventricular drainage.
  • Traumatic injuries : operations for depressed skull fractures, fixation of the vertebrae.
  • Otolaryngological diseases : traditional and endoscopic frontotomy, polysinusotomy, mastoidotomy, myringotomy, tympanic bypass surgery, sanitizing operation on the middle ear.

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