Forehead Pain: Causes and When to Seek Help

Q: Forehead Pain: Causes and When to Seek Help

Hello： Your symptoms are more indicative of a cervical myofascial issue. <br>However, the possibility of increased intracranial pressure cannot be ruled out, as lying down can elevate intracranial pressure, and there can also be an increase in intracranial pressure during defecat

Headache starting from the left forehead?

Hello, my headache starts on the left side of my forehead and gradually expands.
After lying down and waking up, it begins to hurt after sitting for about half an hour; standing up alleviates the pain, but sitting down or lying flat causes it to return.
Straining during a bowel movement makes the headache worse.
It seems that sleeping on my side does not trigger the headache.
I previously had a brain CT scan (when I was not experiencing a headache), and the doctor mentioned that the left frontal sinus was enlarged to twice its normal size, but there were no other abnormalities.
I also consulted an ENT specialist, and X-rays did not reveal any issues.
Could this be a problem with intracranial pressure, or is it possible that cerebrospinal fluid is accumulating in the frontal sinus? Should I go to the emergency room for a CT scan when the headache is severe?

Chen P, 40~49 year old female. Ask Date: 2021/04/11

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms are more indicative of a cervical myofascial issue.
However, the possibility of increased intracranial pressure cannot be ruled out, as lying down can elevate intracranial pressure, and there can also be an increase in intracranial pressure during defecation.
A brain CT scan is not necessary for every patient with headache symptoms due to radiation concerns; it is only arranged when neurological symptoms are present.
(If symptoms persist, a neurologist will assess the situation accordingly.) I recommend discussing further evaluation and treatment with a neurologist.
Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/04/11

More Info

Forehead pain can be quite distressing and may arise from various underlying causes. Based on your description, it seems that your pain is localized to the left side of your forehead and is exacerbated by certain positions, particularly when sitting or lying down. This pattern of pain could suggest several potential issues, including sinus-related problems, tension headaches, or even issues related to intracranial pressure.

Possible Causes of Forehead Pain
1. Sinusitis: Given that you mentioned a previous CT scan showing that your left frontal sinus is enlarged, it is possible that you are experiencing sinusitis. This condition occurs when the sinus cavities become inflamed, often due to an infection or allergies. The pain can worsen when you are in a horizontal position, as gravity can affect the drainage of the sinuses.

2. Tension Headaches: These are the most common type of headaches and can cause a dull, aching pain that may feel like a tight band around the forehead. They can be triggered by stress, poor posture, or prolonged periods of sitting, which might explain why you feel pain after sitting for a while.

3. Intracranial Pressure: While less common, changes in intracranial pressure can lead to headaches. If there is an accumulation of cerebrospinal fluid (CSF) or other issues affecting pressure within the skull, this could potentially lead to localized pain. However, this is typically accompanied by other symptoms, such as nausea, vomiting, or changes in vision.

4. Cervicogenic Headaches: These headaches originate from issues in the neck and can refer pain to the forehead. Poor posture while sitting could contribute to neck strain, leading to referred pain.

When to Seek Help
Given that your symptoms have persisted and are affecting your daily life, it is advisable to seek medical attention. Here are some guidelines on when to seek help:
- Persistent Pain: If the pain continues to worsen or does not improve with over-the-counter pain relief.

- Neurological Symptoms: If you experience any neurological symptoms such as vision changes, weakness, numbness, or difficulty speaking.

- Severe Pain: If the pain becomes severe or is accompanied by other concerning symptoms like fever, confusion, or stiff neck.

- Changes in Symptoms: If you notice any changes in the pattern of your headaches or if they start to occur more frequently.

Diagnostic Steps
If you decide to visit a healthcare provider, they may recommend further imaging studies, such as a repeat CT scan or MRI, to evaluate for any changes in your sinuses or brain structure. They may also conduct a thorough physical examination and possibly refer you to a specialist, such as a neurologist or an ear, nose, and throat (ENT) doctor, for further evaluation.

Conclusion
In summary, while your symptoms could be related to sinus issues, tension headaches, or other factors, it is essential to consult a healthcare professional for an accurate diagnosis and appropriate treatment. Keeping a headache diary, noting when the pain occurs, its intensity, and any associated symptoms, can be helpful for your healthcare provider in determining the underlying cause and the best course of action. Remember, timely intervention can often lead to better outcomes, so don’t hesitate to seek help if your symptoms persist or worsen.

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