Common Forehead Headaches: Causes and Treatments

Common reasons for forehead headache

It is common to experience a headache occasionally (1). Headaches have different patterns and associated features. What are the common forehead headaches causes, then? Some headaches involve the forehead predominantly, while others target the back of the head (occipital region) or sides of the head (temples) (2).

Headaches are of two types (1):

1. Primary headaches: They originate from the disturbances in pain-controlling mechanisms of the brain.
2. Secondary headaches: Those are a symptom of an underlying medical disease.

The types of headaches that involve the forehead include:

Cluster headaches

These types of headaches occur suddenly without warning signs (3). Cluster headaches cause sharp pain in and around the eye and extend to one side of the forehead. Pain can then spread to the other side of the head and face. Other associated symptoms of cluster headache are (3):

• Severe restlessness (5)
• Sweating on the forehead or face
• Nasal congestion
• Teary eyes
• Redness or swelling of the eye
• Drooping of the eyelid
• Nausea
• Sensitivity to light or sound

Cluster headaches last for a while (weeks to months) and then resolve for months to years (3). One headache episode usually lasts 30 minutes to 3 hours and can reoccur multiple times a day (4). The prevalence of cluster headaches is almost 0.1 percent around the world and is more often found in men (4).

The location of cluster headaches can be (4):

• Supraorbital: above the eye 
• Retro-orbital: behind your eye
• Temporal: side of your head (temple)

They are sometimes called alarm clock headaches because they may wake you up (4).

Cluster headaches are usually diagnosed through the doctor’s examination (4). Your doctor may order imaging to rule out serious disease.

Tension headaches

Tension headaches belong to a primary type. You feel like someone has tightened a rope around your forehead and temples (6). It gives the sensation of pressure on the forehead and sides of the head.

Depending on the frequency of occurrence, tension headaches are classified as (6):

• Infrequent episodic: one day a month or less 
• Frequent episodic: more often than one, and up to 14 days a month for three consecutive months 
• Chronic: 15 times a month or more, for three consecutive months 

Tension headaches are the most prevalent primary headache type that almost 70 percent of people experience (6).

These headaches can also cause dull aches in the neck and shoulders (5) and are associated with enhanced sensitivity to light or sound (6).

This type of headache can have various causes (6). One possible reason is the muscle tightness between the head and neck. Other possible reasons are reading or using the computer for long hours, temporomandibular joint disorder (TMJ), anxiety, depression, sleep disorders, or degenerative arthritis in the neck (age-related changes in joints in the neck) (6).

Imaging is usually not needed to diagnose tension-type headaches (6). Your doctor can diagnose it based on your history of symptoms, including frequency, pattern, pain triggers, and other associated symptoms.

Migraine headaches

Migraine headaches usually start on one side around the eye, forehead, and side of the head before radiating towards the back of the head (5). Migraine headaches are severe in intensity and often throbbing or pulsating. They are most common in women.

Changes in blood flow to the brain and variations in nerve activity are the causes of migraine headaches (5).

These headaches can occur with or without aura (5). Aura is a set of neurological symptoms associated with migraine headaches. These can include flashing lights, halos, sparkles, numbness, or tingling on the body or face (5).

Migraines are usually associated with triggers (9). These triggers can be changes in sleep patterns, stress, hormonal pills, skipping meals, weather variations, exercises, loud noise, or bright lights. 

Migraines usually have four phases (9):

1. Prodromal stage: The prodromal stage usually starts a day before migraine attack and includes mood variations, sleep disturbance, or disturbance in concentration. 
2. Aura stage: As mentioned above, aura is a set of neurological symptoms (motor or sensory) that appear as warning signs before a headache or sometimes with headaches. They include changes in vision, hearing voices, seeing flashes of light, muscle weakness, etc.
3. Nausea or vomiting stage: Headache can last from 4 to 72 hours. The pain is usually located on one side of the head and is associated with nausea or vomiting.
4. Postdrome stage: The postdrome stage, also known as migraine hangover, is associated with fatigue, difficulty in focusing, or neck rigidity.

Migraines run in families. If you have migraine headaches, you may also have biological relatives with the same condition (9). Other risk factors are psychiatric disorders such as depression or anxiety, sleep disorders, or smoking.

Your primary care physician can usually diagnose migraines based on proper history and physical examination (9).

Tension headaches vs. migraines  

Sometimes, it is difficult to differentiate between migraines and tension headaches (7). Besides that, some people may suffer from both migraines and tension headaches. 

People with migraines often have associated symptoms such as nausea, vomiting, or vision changes, which are not found in tension headaches (7). Another difference is that tension headaches do not manifest with auras or changes in vision. What is more, exercise can exaggerate migraines but does not affect tension headaches (7).  

Sinus headaches

Sinuses are hollow spaces inside the facial bones (8). When air travels through the nose to the lungs, it also goes to the sinuses through the opening of the nose. The inner lining of the sinus produces mucus to entrap germs and allergens. 

Sometimes, these sinuses get infected with microorganisms (sinusitis), which leads to increased mucus production and blocks the outlet to drain it. This results in pressure symptoms over the sinus area and pain in the face and forehead (sinus headaches) (8).

Sinus headaches cause constant dull pain and discomfort behind the eyes, over the cheekbones, and on the forehead (8). Once the infection clears up, sinus headaches typically resolve.

Common triggers for sinus headaches are allergies, a weakened immune system with recurrent infections, common colds, smoking (including second-hand smoke), deviated nasal septum, and nasal polyps (8). 

Other associated symptoms with sinus headaches are nasal congestion, green mucus discharge, post-nasal drip, pain that worsens with bending over, fever, ear pressure, cough, and fatigue (9).

Doctors usually diagnose sinus headaches through a physical examination. Chronic cases may require further investigations, such as an X-ray of the sinus or a CT scan (8).

There are many other causes of headaches in the forehead region (2, 10):

• Dehydration or fasting
• Poor posture
• Eye strain from constant reading or using a phone or computer
• Chronic stress

When to worry about headaches

Some features of headaches are concerning and need urgent evaluation. These include (1, 5, 12):

• Sudden and severe headache, the worst you have ever experienced, interrupting you from performing your daily activities
• Headache and a fever may indicate infection of the brain or its covering membranes
• Headache with loss of consciousness or balance disturbance
• Headache associated with high blood pressure
• Headaches that begin after the age of 50 
• Headaches that are progressively getting worse day by day
• Headaches that are associated with painful red eyes
• Headache after an accident or trauma to the head
• Headaches associated with seizures
• Headaches associated with changes in vision or blurriness
• Headache right after doing some physical activity such as jogging or even intercourse
• Headaches associated with pain on palpation (tenderness) near the temple
• Headache if you have cancer or a weak immune system due to any reason 

How to reduce headache pain

There are a few things that can help in alleviating pain from headaches (1, 13, 14):

• Adequate hydration: Drinking water and staying hydrated are important to prevent and reduce headaches.
• Stress management: Stress triggers many headaches. Deep breathing and relaxation techniques can help manage stress.
• Biofeedback: Learn how your body reacts to stressful situations and different mechanisms to control it.
• Painkillers: Simple painkillers such as paracetamol/acetaminophen or ibuprofen. It is important to follow the directions on taking over-the-counter medications and not overdose.  
• Rest: Make sure you have a proper rest and sleep.
• No smoking: Avoid smoking, as tobacco triggers some headaches.
• No alcohol: Avoid alcohol.
• No skipping meals: Avoid skipping meals or fasting for prolonged periods.
• Eye strain reduction: Reduce eye strain from increased screen time or reading. Consider using blue-blocking glasses when looking at computer screens. 
• Posture maintenance: Maintain your posture to relieve back and neck tension while reading or doing computer work.
• Hot or cold compress: Apply a hot or cold compress to your head and neck.
• Massage therapy
• Cognitive behavioral therapy: Think about this kind of therapy which helps with any stress, anxiety, or depression. 

Moreover, there are specific treatment options for different types of headaches, including various prescription medications (14). For example, triptans are used to treat migraines. However, you should consult your doctor to determine treatment options for other specific types of headaches.