What is this Headache in My Forehead?

Overview of Common and Rare Causes of Frontal Headaches

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Do You Have a Frontal Headache?. JGI/Jamie Grill/Blend Images/Getty Images

You have a headache smack dab on your forehead—what is it? Forehead headaches (or frontal headaches) are common and here are some potential culprits.

Tension versus Migraine Headache

Through pure statistics, the likelihood that your forehead headache is a tension headache or a migraine is high. This is because tension and migraine headaches are the two most common primary headache disorders—headaches that originate on their own, and are not caused by another medical condition.

A tension headache is characterized by a dull tightening or pressure on both sides of the head, like a band or a large hand gripping your scalp. It typically starts at the forehead and radiates around to the back of the head. A migraine, on the other hand, usually occurs on one side of the head (but can be both) and causes a throbbing sensation, like a drum beating on your skull. Migraine headaches tend to be more severe than tension headaches, usually requiring a respite from work or play (a tension headache can usually be tolerated at work or social gatherings). 

Unlike a migraine, a tension headache is not associated with nausea or vomiting or with a migraine aura. Although, people with tension headaches do sometimes report a loss of appetite, and they may also report sensitivity to light or sound (one or the other though, not both).

A number of factors can trigger both tension and migraine headaches like hunger, sunlight or bright light exposure, and sleep deprivation.

Other shared triggers include travel, physical activity, reading, and exposure to cold or warm temperatures.

As you can tell, your suspected headache trigger is likely not going to be helpful in distinguishing between migraines and tension headaches. That being said, avoiding these suspected triggers in the future can prevent the headache from starting in the first place.

 

Cluster Headache

A cluster headache is an extremely painful and disabling headache that is one-sided and occurs around the eye, temple, or forehead. It's uncommon though, way more so than tension headaches and migranes, and causes a distinct pain, usually described as sharp, burning, or piercing. In addition, cluster headache attacks are accompanied by at least one autonomic symptom on the same side of the head pain. Examples of common autonomic symptoms include:

  • nasal discharge,
  • tearing of the eye
  • miosis (pupil constriction)
  • facial swelling.

It's helpful to note too that the vast majority of people with a cluster headache are agitated and unable to lie down—the pain is just that unbearable. 

Sinus Headache

Sinus headaches are often confused with migraines because both commonly cause head pain in the forehead. In fact, studies show that in the vast majority of cases, people (and their doctors) think they are suffering from a sinus infection, when they are really experiencing a migraine attack.

Clues that you have a frontal sinus infection include:

  • fever and/or chills
  • nasal discharge that is thick, colored, and profuse

To distinguish from other types of frontal headaches, an otolaryngologist (ENT doctor) can perform a nasal endoscopy and possibly a CT scan to see if you have a buildup of mucous in your frontal sinus. It can be tricky though because sometimes the CT scan will show a mucous buildup, but the cause of your headache is still not sinus disease (confusing, right?). This is just the reality of medicine, and why the diagnosis of your headache type can be a tedious process.

Hemicrania Contiua

Hemicrania continua is a painful, one-sided headache that occurs all the time (it never stops) on a daily basis without relief. It is a rare cause of headache, but can occur on the forehead, as well as the temples, around the eyes, or the back of the head. 

Rare Secondary Headaches

There are also secondary forehead-based headaches—headaches caused by a separate medical condition. Examples include:

These are way less common causes though, and there are usually other signs and symptoms that hint at their diagnosis.

That being said, it's important to seek medical attention right away if your headache is associated with other headache warning signs like impaired vision, speech, muscle weakness, or numbness and tingling. New headaches or a headache that is unique from prior headaches (lasts longer or feels different) warrants a medical evaluation. 

A Word from Verywell

Forehead headaches are common, but getting to the bottom of what is causing them is useful. Recording your symptoms and potential headache triggers in a phone note or journal will help you and your doctor piece together your diagnosis and treatment plan together.  

 

Sources:

Hague B, Rahman KM, Hoque A, Hasan AT, Chowdhury RN, Khan SU, etal. Precipitating and relieving factors of migraine versus tension type headache. BMC Neurol. 2012 Aug 25;12:82. 

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Schreiber CP, Hutchinson S , Webster CJ, Ames M, Richardson MS, Power C. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Arch Intern Med 2004 Sep;164(16):1769-72.

Schwedt TJ. Hemicrania continua.In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014. Accessed Nov 28th 2014.

Seiden AM & Martin VT. Headache and the frontal sinus. Otolaryngologic Clinics of North America. 2001;34(1):227-41.

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