A headache may affect every person at some point in their life but 1 in 5 adolescents and adults suffer with regular headaches. In the United States this accounts for as much as 4% of emergency room visits and is one of the top ten reasons for doctor visits. Headaches tend to be more common among females, affecting about 3 women for every 2 men. Often these headaches are transient and resolve within a few hours to days without any complications.
There are different types of headaches recognized by medical science but most people describe headaches based on its location, the nature of the pain and accompaying symptoms. It is therefore not uncommon to hear about headaches at the back of the head, top of the head, on the sides (temples), around or behind the eyes and at the front of the head. Similarly it may be described as a throbbing headache or a headache with nausea.
What is a frontal headache?
A frontal headache is pain that is experienced at the front of the cranium, the part of the skull that houses the brain. This largely correlates with the forehead, the area of the head that lies above the eyebrows and below the hairline. However, in terms of the latter border (i.e. the hairline) this can vary depending on whether a person has a high or low hairline or is bald.
Read more on forehead pain.
The term frontal is derived from the pain lying over the frontal bone of the skull. Sometimes this may be the area of the most intense pain but the headache is not limited to this specific area. There may be some degree of pain throughout the head or in other parts, for example the temples, along with the frontal head pain. The nature of the pain and intensity can vary in frontal headaches and often there are accompanying symptoms like eye discomfort.
Signs and Symptoms
Pain is a symptom and therefore frontal head pain may occur on its own or be accompanied by other signs and symptoms. These accompanying features may vary based on the cause of the frontal headache. However, in many cases the head pain may occur along with one or more of these symptoms:
- Sore eyes
- Sensitivity to light
- Vision disturbances such as blurring
- Excessive tearing
- Nasal pain
- Nasal congestion or runny nose
- Alterations of smell
Technically head pain would also include the face (facial pain), whereas a headache specifically refers to the rest of the head excluding the face.
Read more on location of headache.
Causes of Frontal Headaches
There may be diverse causes of frontal headaches. Usually it involves injury or inflammation of the surrounding structures like the soft tissues, including skin and muscles, cavities and linings (such as the nasal cavity or cranium) or organs such as the brain or eyes.
However, the causes may also arise with nerve problems despite there being no obvious injury and inflammation in the immediate area of the forehead. For example in occipital neuralgia, the nerves at the back of the neck may be compressed (“pinched”) which can cause pain to be felt at the front of the head.
Injury to the head, specifically the front of the head, can cause a frontal headache. This may include mechanical trauma (falls, blows to the head) as well as chemical trauma (toxic chemical exposure). The extent of the injury may be limited to the overlying soft tissue or extend to the bone.
In some cases there may also be internal injuries affecting the meninges, brain tissue and/or blood vessels in the cranium, which can lead to conditions like a concussion or traumatic subarachnoid hemorrhage. The latter can be serious and may even complicate into a stroke.
Strain of the muscles of the head, especially the frontalis muscle, may also be a cause of frontal headaches. This is one of the more common causes and is thought to be a major contributing factor of tension-type headaches. However, there may also be other factors responsible for these types of headaches, including psychogenic factors. Muscle strain arises when the muscles are overworked, with injury, psychological stress and other causes.
A number of eye conditions may contribute to head pain. The location may vary from the eyes itself to the sockets (around the eyes), behind the eyes and the forehead. Eyestrain is a common cause and often associated with excessive frowning. Similarly eye conditions like conjunctivitis, keratitis, uveitis and iritis may also lead to frowning or squinting which in turn can contribute to muscular head pain.
Nose and Sinuses
Various conditions that involve the nasal and paranasal sinus cavities may contribute to frontal headaches. Sinusitis is a common cause of frontal headaches particularly when the frontal sinuses are inflamed and congested. Often the nasal cavity is also involved. Infections are a common cause but various non-infectious conditions like a deviated septum or nasal polyps can also cause rhinitis (nose) and sinusitis which is collectively referred to as rhinosinusitis.
Brain and Meninges
Inflammation of the brain (encephalitis) or meninges (meningitis) may also cause headaches but the pain is not always isolated to the front unless the inflammation only involves this part of the brain or meninges. A host of other brain and meningeal conditions may also be responsible for frontal headaches, which may be caused by trauma, infections, hemorrhage (bleeding) or tumors.
Stress and Insomnia
Two factors that are often ignored as causes of frontal headaches are psychological stress and poor sleep. Psychological stress is now known to be a major contributing factor of tension-type headaches, along with muscle strain. Insufficient sleep can also contribute to headaches for several reasons. Both stress and insomnia may also be triggers for migraines.
A host of other factors may cause headaches, although it may be specific to frontal headaches. These causes include:
- Alcohol or illicit drug use, particularly after the intoxication subsides (hangover).
- Dehydration, which may also be a consequence of alcohol excess.
- Depression, anxiety and other mental health conditions.
- Foods and beverages, especially those containing nitrates and sulfites.
- Strict dieting and excessive fasting.
- Toothache and/or jaw problems, particularly of the temporomandibular joint (TMJ).