Unexplained Forehead Pain and Purple Bruising: What to Do Next?

Headache with unexplained purpura between the eyebrows?

Hello Doctor, yesterday around 4 PM, I suddenly felt an unexplained pain around my forehead and eye socket.
The pain felt like a dull, constricting sensation, rating about a 5 out of 10.
After resting for a bit, the pain subsided, and I decided to take a hot shower.
I then noticed an unexplained bruise at the glabella (the area between the eyebrows), which appeared deep purple with a reddish outline.
I confirmed that there was no trauma, and the bruise is not painful or itchy, nor is there any swelling.
I consulted an ENT specialist, but they could not provide a conclusion, stating it looks like a hematoma.
Should I undergo further examination? Which specialty should I consult? Thank you, Doctor.

Mr. Huang, 20~29 year old female. Ask Date: 2020/03/06

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, it does seem that the likelihood of bruising is higher.
However, I recommend consulting an ophthalmologist to check for any abnormalities in your eyes.
If the eyes are normal, you may continue to monitor the situation.
However, if the bruising increases, it would be advisable to see a hematologist to evaluate your coagulation function.
Thank you for your inquiry.

Reply Date: 2020/03/06

More Info

Experiencing unexplained forehead pain accompanied by purple bruising can be concerning, and it's important to approach this situation with careful consideration. The symptoms you've described—localized pain in the forehead and the sudden appearance of a bruise—could be indicative of several underlying conditions, and further evaluation is warranted.

First, let's address the forehead pain. The sensation of dull, constricting pain around the forehead and eye area can be associated with various conditions, including tension headaches, sinusitis, or even migraines. However, the sudden onset of pain, especially if it is accompanied by other symptoms like bruising, may suggest a more acute issue.
The appearance of the purple bruise, particularly if it is not associated with any trauma, raises additional concerns. Bruising can occur due to a variety of reasons, including:
1. Vascular Issues: Conditions that affect blood vessels, such as vasculitis or other vascular disorders, can lead to bruising without direct trauma.

2. Coagulation Disorders: If your blood does not clot properly, you may experience unexplained bruising. This could be due to conditions like thrombocytopenia (low platelet count) or other clotting factor deficiencies.

3. Infections or Inflammatory Conditions: Certain infections or inflammatory conditions can lead to localized bruising and pain.

4. Dermatological Issues: Conditions affecting the skin or underlying tissues can also manifest as bruising.

Given these possibilities, it is advisable to seek further medical evaluation. Since you have already consulted an ENT specialist without a definitive conclusion, the next step would be to see a healthcare provider who specializes in internal medicine or hematology. These specialists can perform a more comprehensive assessment, including blood tests to evaluate your platelet count and clotting factors, as well as imaging studies if necessary.

In the meantime, monitor your symptoms closely. Take note of any changes in the pain, the size or color of the bruise, or the development of any new symptoms such as swelling, fever, or changes in vision. If you experience any worsening of symptoms or new concerning signs, seek immediate medical attention.

In summary, while the initial evaluation by an ENT specialist did not yield a clear diagnosis, the combination of forehead pain and unexplained bruising warrants further investigation. Consulting with an internal medicine or hematology specialist would be a prudent next step to rule out any serious underlying conditions. Your health and well-being are paramount, so do not hesitate to pursue further evaluation to ensure that any potential issues are addressed promptly.

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