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

Last Updated: 05/07/2022

Pain in the forehead is observed with sinusitis, inflammation of cerebral structures, increased blood pressure, intracranial hypertension, vertebrobasilar insufficiency, eye diseases, neuralgia, tumors. Often spreads to the temple, eye socket. It can be pressing, arching, twitching, pulsating, sharp, dull, prolonged, short-term. Diagnosed according to the survey, otolaryngological, ophthalmological, neurological examination, additional studies. Treatment is carried out using antimicrobial, analgesic, antihypertensive, antihistamines. Sometimes surgery is indicated.

Why does my forehead hurt

sinusitis

Sinusitis is a common cause of forehead pain. Pain syndrome occurs as a result of the inflammatory process, the accumulation of discharge in the paranasal sinuses. The symptom is more disturbing in the morning, because a lot of fluid accumulates in the sinuses during the night. It is observed in the following diseases:

  • Frontit. With a mild form of pain, minor, signs of rhinitis prevail. The moderate form is accompanied by hyperthermia, intense local pulsating, bursting pain in the brow area. Irradiation to the temple, crown, feeling of pressure behind the eye is possible. In severe form, the pain is very strong, sometimes unbearable. Severe intoxication, swelling of the eyelids, puffiness of the face, lacrimation, photophobia are noted.
  • Sinusitis. It manifests itself as febrile, less often subfebrile temperature, pain in the projection of the maxillary sinus, forehead, cheekbones, root of the nose, sometimes radiating to the temporal region, half of the face. Lachrymation, profuse discharge from the nose are observed, first liquid, then thick, greenish, cloudy.
  • Etmoiditis. As a rule, it develops against the background of other pathologies, so the first signs of the disease go unnoticed. The predominant symptom is a headache with an epicenter behind the eyes, under the bridge of the nose. The pain radiates to the forehead, aggravated by tilting the head. The sense of smell, nasal breathing are disturbed, the temperature rises, an intoxication syndrome occurs.
  • Pansinusitis. The most severe form of sinusitis, in which inflammation spreads to all sinuses. It is characterized by intense pain in the area of ​​the eyebrows, orbits, forehead, occiput, crown, aggravated by palpation, sometimes radiating to the lower jaw. Painful sensations spread to the entire head, aggravated by movement. Revealed violations of nasal breathing, anosmia, severe intoxication.

Inflammatory lesions of the CNS

The cause of pain in the forehead in inflammatory diseases of cerebral structures is intracranial hypertension due to increased production of cerebrospinal fluid. With meningitis, severe pain in the back of the head prevails, which can spread to the forehead or the entire head. Severe intoxication, increased tone of the occipital muscles, positive meningeal symptoms are noted.

Painful sensations of similar localization also occur with various types of encephalitis. Significant hyperthermia, weakness, nausea, vomiting, dizziness are observed. Possible muscle weakness, impaired salivation, signs of damage to the cranial nerves. In some forms of encephalitis, convulsions occur, sometimes hallucinations, and other mental disorders.

Vascular pathologies

Arterial hypertension can be primary (essential hypertension) or provoked by other diseases (symptomatic hypertension). Secondary forms are caused by pathologies of the central nervous system, endocrine organs, kidneys, renal and extrarenal vessels. The characteristic features of the pain syndrome are symmetry, the occurrence in the forehead or nape. The pains are throbbing, bursting, aggravated by sudden movements, loud sounds.

In patients with spondylogenic vertebrobasilar insufficiency, pain appears suddenly against the background of awkward movements. Covers half of the head. It spreads from the back of the head to the forehead, temple, orbit, sometimes extends to the upper limb. At the time of the attack, a fall occurs without loss of consciousness or syncope. The skin of the neck becomes pale, with a marble pattern, a veil, “flies” appear before the eyes.

Pain in the forehead

 

intracranial hypertension

Pain is the main symptom, localized in the region of the crown and forehead. Symmetric, accompanied by pressure on the eyes from the inside, increases with a change in the direction of gaze. In some cases, nausea, vomiting are observed. In the acute course, the pain syndrome is pronounced, rapidly intensifies, in the chronic course it is moderate, disturbs constantly or proceeds with periodic fluctuations. Intracranial hypertension is accompanied by the following pathological conditions:

  • Volumetric formations: primary and metastatic neoplasia, abscesses, hematomas, cysts, aneurysms.
  • Cerebral edema: ischemic stroke, hepatic encephalopathy, hypoxia, exogenous intoxications, brain contusion.
  • Increased blood supply to the brain: hypercapnia, hyperthermia, dyscirculatory encephalopathy.
  • Violations of the production and circulation of CSF: various forms of hydrocephalus due to congenital malformations, acquired lesions (for example, adhesions in arachnoiditis).

Ophthalmic diseases

The cause of pain in the eye sockets, the forehead area becomes a constant overstrain of the organ of vision. The symptom is observed in such pathologies as:

  • myopia;
  • farsightedness;
  • astigmatism;
  • glaucoma.

Characterized by an increase in discomfort by the end of the day, after prolonged work at the computer, reading books, performing small actions that require good visual control (for example, embroidery). Complaints are determined by the type and severity of the ophthalmic disease, there is an inability to clearly recognize distant objects or an inability to read finely written text.

Migraine

The patient complains of unilateral throbbing or pressing pains with an epicenter in the eye, forehead, temple. Some patients have weakness, absent-mindedness, visual phenomena before the onset of a migraine attack. Painful sensations are combined with light and sound fear, nausea, vomiting, depression or excessive irritability. As provoking factors are stress, physical activity, alcohol intake, certain products. Sometimes paroxysms develop for no apparent reason.

Nerve and ganglion lesions

Intense pain impulses, resembling an electric shock, passing from the lateral surface to the center of the forehead and orbit, are characteristic of neuralgia of the ophthalmic branch of the trigeminal nerve. The disease develops as a result of injury or inflammation of the nerve trunk, its compression by a neoplasm or an altered vessel. The duration of the paroxysm can reach 2 minutes, the attacks are repeatedly repeated. The pain is so sharp that patients freeze in place, afraid to move.

For ganglionitis of the pterygopalatine node, pain in the orbit, frontal region, upper jaw, hard palate is typical, sometimes spreading to the teeth, gums of the lower jaw, occiput, neck, ear, temple. Painful sensations are sharp, intense, unilateral. Occur spontaneously, more often at night. Accompanied by vivid vegetative reactions: redness, swelling of half of the face, profuse salivation, lacrimation, nasal discharge. They are provoked by inflammatory diseases of neighboring organs.

allergic reactions

Pain in the forehead is sometimes accompanied by allergic pathologies: angioedema, rhinitis, urticaria. The appearance of painful sensations is possible during an attack of bronchial asthma. The cause of the symptom is swelling of the mucous membranes, respiratory disorders, hypoxia. The pain may be dull or migraine-like. Disappears along with other manifestations of allergy after the termination of contact with the allergen, taking an antihistamine.

Fever Syndrome

Headache is a constant companion of fever, spreads throughout the head or is localized mainly in the frontal region. Observed with influenza, SARS. It is found in patients with bronchitis and pneumonia. It is noted in acute pyelonephritis, other diseases accompanied by febrile syndrome. Complemented by malaise, weakness, loss of appetite, myalgia, arthralgia.

Other reasons

Sometimes pain in the forehead becomes the result of a long stay in a room with too high a temperature, or, on the contrary, being in the cold without a hat. The symptom is detected in some diseases of the cardiovascular system, blood diseases, metabolic, endocrine disorders. Patients with neurotic disorders often complain of headaches: neurosis, neurasthenia, anxiety, hypochondriacal disorder. In hysteria, complaints can acquire an unusual, pretentious character.

Diagnostics

The neurologist is engaged in establishing the cause of the pain syndrome. According to the indications, the patient is referred for consultations to an otolaryngologist, ophthalmologist, and other specialists. The doctor finds out when the symptom first appeared, how often it appeared, how it changed over time, what manifestations it accompanied. Collects an anamnesis of life, clarifies the presence of chronic diseases that could cause pain.

During the examination, it is sometimes possible to detect external changes, such as tearing, redness, and swelling of the face, but in most cases, a physical examination is of little information. For the final diagnosis are assigned:

  • Otorhinolaryngological examination. Along with the standard techniques used during a general examination, the doctor conducts an examination using mirrors and special devices. With sinusitis, rhinoscopy is indicative, confirming the presence of edema, hyperemia, serous or purulent discharge. Sinusoscopy requires dilation of the natural openings of the sinuses, so it is rarely performed for diagnostic purposes.
  • Ophthalmic examination . Includes visometry, ophthalmoscopy, measurement of intraocular pressure, study of refraction, biomicroscopy of the eye, and other studies. Helps to determine the nature of visual impairment, the preferred option for correction, the need for surgical intervention.
  • Neurological examination . It involves an assessment of the symmetry of the palpebral fissures, pupils, facial features, the study of smell, checking the preservation of the function of the facial muscles, palpation of the exit points of the branches of the trigeminal nerve. The doctor examines movements, sensitivity, reflexes in the torso and limbs. Reveals pathological symptoms (for example, meningeal).
  • Radiography . With sinusitis, an x-ray of the paranasal sinuses is shown. The study reveals the accumulation of dense masses, in a chronic process - deformation of the bone walls of the sinuses. To increase the information content, it can be carried out with contrast. X-ray of the skull is required for suspected TBI. With long-term intracranial hypertension visualizes "finger impressions".
  • Ultrasonic Techniques . In the course of echoencephalography, hydrocephalus, cerebral edema, displacement of median structures in tumors, hematomas, and other volumetric processes are determined. Duplex scanning and dopplerography are recommended for patients with vascular lesions. They allow you to get an idea of ​​the speed of blood flow, the state of blood circulation in various parts of the brain.
  • Tomography . Computed and magnetic resonance imaging of the brain provide complete information about structural changes in brain tissue, size, location of pathological foci. They are used at the final stage of diagnostics. To assess the state of the vessels, the differentiation of tumor processes is performed with contrast enhancement. CT and MRI of the paranasal sinuses are required when basic diagnostic procedures are insufficiently informative, they confirm the presence of sinusitis and other pathologies (tumors, cysts).
  • Lumbar puncture. It is carried out to determine the pressure of the cerebrospinal fluid, to detect hemorrhages, inflammatory processes. During the subsequent microscopic examination of the cerebrospinal fluid, the composition of the cerebrospinal fluid is specified. For bacterial and viral infections, a microbiological analysis or PCR test is performed.

In some cases special tests are required. For example, ganglionitis of the pterygopalatine ganglion is confirmed if the symptoms disappear after lubrication of the nasal cavity with a solution of dicaine and adrenaline. With a number of pathologies, laboratory tests are necessary to confirm the inflammatory process, to determine the pathogen.

Neurological examination

 

Treatment

Conservative therapy

Therapeutic tactics is determined by the nature of the pathology:

  • Sinusitis . At the initial stage, drugs from the group of aminopenicillins or cephalosporins are prescribed, then, if necessary, the drugs are replaced taking into account antibiotic sensitivity. Apply NSAIDs, antihistamines, decongestants, vitamins, local antiseptics. Carry out punctures, washings, anemization of the mucous membrane.
  • Encephalitis, meningitis . The basis for the treatment of inflammatory processes of bacterial etiology is massive antibiotic therapy. Medicines are administered parenterally (intramuscularly, intravenously or endolumbally). With viral encephalitis, antiviral and symptomatic therapy is indicated.
  • Arterial hypertension . Blood pressure is normalized with antihypertensive drugs. Antiplatelet agents, beta-blockers, diuretics, drugs with hypolipidemic action are used. Patients with secondary hypertension require treatment of the underlying pathology.
  • intracranial hypertension . Diuretics are used, usually in combination with potassium-containing medicines. The causative pathology is treated by detoxification, the use of venotonics, antibiotics. Neurometabolic agents are prescribed.
  • Migraine . Relief of seizures is carried out with the use of painkillers and caffeine-containing drugs. Triptans are effective in preventing new paroxysms in the interictal period.
  • Defeat of ganglia and nerves . With trigeminal neuralgia, anticonvulsants, antispasmodics, microcirculation correctors, therapeutic blockades, and physiotherapy are indicated. With Slader's syndrome, anti-infectious, anti-inflammatory, anti-allergic agents are needed.

Patients with ophthalmic pathologies are corrected with glasses and contact lenses. In glaucoma, medications are prescribed to lower intraocular pressure. Treatment of diseases with intoxication syndrome involves the intake of large amounts of liquid or intravenous infusions, therapy with drugs with symptomatic and etiopathogenetic effects.

Surgery

The following surgeries may be recommended for patients:

  • Sinusitis : open or endoscopic frontotomy, maxillary sinusotomy, ethmoidotomy, polysinusotomy.
  • Intracranial hypertension : decompressive craniotomy, external ventricular drainage, various bypass options.
  • Eye diseases : laser correction of myopia, hyperopia and astigmatism, laser and traditional iridectomy, iridoplasty, trabeculoplasty, other interventions for glaucoma.
  • Trigeminal neuralgia : stereotaxic operations, microsurgical decompression, radiofrequency destruction.

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