Causes frequent pain in the frontal part of the head

Pain in the forehead is one of the most common symptoms of various diseases. According to statistics, it occurs in 86-90% of adults and 30-35% of students from the primary and secondary. There is a clear relation between age and frequency of episodes of the disease: the older the person becomes, the more it bothers pain.

In many cases, the discomfort is so intense that partially or completely disrupt the activity and performance of the patient. In this regard, the search for effective treatments is an extremely important task which is impossible without a clear understanding of the mechanism of formation of the symptom. Localization and type of pain can tell a lot about its cause. Headache in the forehead, usually associated with diseases of ENT-organs, eyes, injuries, tension-type headache and migraine.

Types and the most common causes

In 2003, published the most extensive and detailed classification of types of headaches, which were members of the world society of neurologists dealing with this problem. It is based on the etiological principle of division, that is considered a headache in the forehead and other species. According to the classification, we can distinguish several basic types:

• migraine a distinct disease, the definitive cause has not been elucidated to this day;
• ubusuna – linked with abusalim (abuse) of painkillers NSAIDs;
• tension headache (TTH) is caused by the tension of the tendon helmet, facial muscles and scalp;
• cluster (beam) – her seizures associated with impaired release of histamine in the hypothalamic nuclei
• secondary – caused by other diseases (neuralgia, atherosclerosis, trauma, tumors).

The Mechanism for the formation of pain in the head in most cases not fully understood. Almost every day there are new findings in neuroscience that shed light on the problem.

Headache in the forehead caused by the irritation of pain receptors, which are located in:

• Dura mater in the area of sinuses
• meningeal and other intracranial arteries;
• the skin, muscles and tendons of the head;
• the mucosa of the frontal sinus;
• the tissues of the orbit.

There is a close link between the node of the trigeminal nerve, its branches and the formation of pain in the frontal part. His sensitive nerve fibers involved in the innervation of the skin in the forehead and cerebral vessels, forming trigemino-vascular system. Headache in the forehead occurs when changes in any of these structures, resulting in pathological impulses from pain receptors.

The child at the age of 7-8 years the nervous system is labile, the processes of excitation prevail over braking. In this regard, the forehead may ache because of mental strain, excessive bright positive or negative emotions. The child-the schoolboy is often a headache in the forehead after an intense practice-related eye strain: reading, writing, computer work.

Why headache in the forehead, we can assume the character of experienced sensations.

Migraine

Manifests intense, often unbearable pain in one half of the frontal part of the head, radiating to the temple, the eyes. She wears a pulsating character, bursting can be significantly enhanced by ordinary physical activity: walking, slopes. Significantly affected the General condition of man, sharply decreases performance.

The child Has lost appetite, a curiosity about the world, he is very fussy, little moves. To adolescence the pain may be bilateral, therefore, diagnosis of the condition is often delayed. Migraine is a paroxysmal in nature, during the attack the pain is constant, lasts from several hours to seven days.

In some patients pain preceded by aura in the form of auditory, audible, visual, or olfactory hallucinations. The most famous example illustrating this symptom is Intrusive smell of rose oil, which felt Pontius Pilate from "the Master and Margarita" a few days before migraine attack.

An Important feature of migraine is a combination pain with photophobia or nausea and vomiting. In a child with a high gag threshold is easy to confuse such a state with gastritis or intestinal infection. Usually, vomiting does not bring relief, and nausea continues to bother the patient.

Abouna

A pathological reaction to non-steroidal antiinflammatory drugs. Formed with regular intake of analgesics, when the treatment of headache of other origin. Noticed that taking painkillersanother purpose, for example, in the treatment of diseases of the joints, to aboutuse pain does not.

Forehead pain on both sides discomfort occur also in the neck area. She arises with the morning, aggravated by the slightest physical or mental activity. The pain is constant, is of a dull character, may be compressive or bursting, weak or moderate in intensity.

The Pain forces the patient to take on an ongoing basis analgesics, as they in some way facilitate his condition. Such abuses is a major factor in the transition of migraine into a chronic phase with increasing frequency and duration of attacks up to 15 days. The child has this form of pain is rare, because parents do not allow the abuse of painkillers.

Cluster

Suffer mostly men aged 20-40 years old, often the disease is hereditary. The pain is intense, sometimes unbearable, localized over the eye-socket with one hand. Often associated with lacrimation, conjunctival redness, nasal congestion on the same side.

The Pain occurs intermittently in the form of attacks, for many cases, characterized by spring-autumn seasonality. This state lasts from 15 minutes to three hours, and then docked independently. Typical appearance of the symptoms at night during sleep by the awakening of the patient, he becomes restless, aggressive, may take suicidal attempt.

tension Headache

The Most common type of primary headache, its prevalence reaches 70%. The pain occurs in the morning, immediately after waking up, and lasts all day. It is oppressive, constricting nature, its intensity is weak or moderate, is only slightly dependent on physical activity.

Forehead hurts from two sides, pain surrounds it, as a wrap. Such feelings bother patients continuously for 2-4 weeks, followed by a lucid interval. New attacks are provoked by negative emotions, stress, fatigue, positive emotions, in turn, prevent pain.

A child suffering from headache, reduced physical activity and school performance. He becomes irritable, reluctant to communicate, but his General condition suffers a rare. Nausea and vomiting are uncommon, in some cases endorses photophobia.

Secondary

An Extensive group of diseases, a symptom of which is pain in the forehead. Most often found:

1. Atherosclerosis – develops in older people, pain is associated with narrowing of the cerebral arteries and impaired blood supply to the brain. Often it is accompanied by dizziness, flashing flies before the eyes, impairment of memory, attention and decreased intelligence. The pain is constant, mild or moderate intensity, is enhanced when the atmospheric pressure is of a pulsating character.
2. Diseases of ENT organs – the forehead is sick with inflammation of the frontal sinus – the frontal sinusitis. The pain is of a bursting character, often combined with nasal congestion, increased body temperature, increases with head tilt.
3. Infectious disease – any infection of the nervous system can give pain in the frontal part of the head. The most common ones are tick-borne viral encephalitis, enteroviral meningitis, meningococcemia meningitis in HIV-infected patients with cryptococcal and tuberculous meningitis, toxoplasmosis of the brain. The child has meningitis and encephalitis can cause measles, chickenpox, mumps. Pain blunt, expander character, often accompanied by nausea, which persists even after throwing up, fever.
4. space-occupying lesions of the frontal lobe of the brain – occur at any age, can be benign or malignant. The pain is constant, dull, arching character. Gradually join neurological symptoms – epileptic seizures, disturbance of muscle tone, slowed thinking processes, reduced critical assessment of behavior.
5. head Injury – pain occurs no later than two weeks after mechanical impact and saved from eight weeks to several years. The character may be constant or paroxysmal, throbbing or dull, aching, intensity – from high to moderate and low. The more time passes after injury, the better the patient feels.
6. trigeminal Neuralgia occurs on one side, is very rarely bilateral. The pain is localized in the frontal part over the eye socket, paroxysmal, always occurs in the same place. The attack begins after the irritation of the skin of the face, chewing, brushing teeth. It lasts no longer than two minutes, but the pain in strength comparable to the electric current. Patients freeze in one position, sometimes rubbing his forehead, the skin's sensitivity is not affected.

Dangerous symptoms

There are indications that directly or indirectly indicates the lesion brain tissue. If they are detected, or the child should immediately consult a neurologist and be evaluated with MRI. Another warning symptoms include:

• gradual increase of headache in the longtime;
• lack of effect of narcotic analgesics;
• sudden "thundering" pain
• heaviness in the head in the morning, nausea, vomiting without relief;
• waking up in the night because of a headache;
• new-onset headache after 50 years.

Diagnosis

determining the cause of the headache involved neurologist. He collects history, examines the patient's symptoms and examines him. If necessary, he shall appoint other specialists, can do and direct on the different types of research:

• a common blood test for infections, the sinusitis will reveal increased white blood cells, ESR acceleration;
• biochemical analysis of blood – in the case of atherosclerotic lesions of cerebral vessels is determined by elevated levels of cholesterol, LDL and triglycerides in General;
• definition of serum antibodies to different pathogens of the CNS – allows you to establish the cause of meningitis or encephalitis;
• lumbar puncture with examination of CSF – infections, lesions, hemorrhages changing composition of cerebrospinal fluid and its quantity. Her blood pressure exceeds 150 mm Hg. Art, color white-yellow purulent meningitis, a yellow-red hemorrhage, does not change when serous meningitis and tumors. For mass lesions characterized by increased protein in the cerebrospinal fluid, infections – increase in cell count above 10 thirds for hemorrhage – red blood cells;
• the ocular fundus – optic disc, bulging with increased intracranial pressure;
• MRI scan of the brain reveals a mass is a cavity, hematoma in the brain tissue;
• ultrasound duplex scan – determined decrease in blood flow in carotid arteries with atherosclerosis, the blood vessels are constricted, blood flow is turbulent.

Differential diagnosis

The table below presents the main features pain in the frontal part of the head in various diseases.

pain/Symptoms	History	Symptoms	Inspection	Inspection	CSF	MRI, ultrasound, x-ray
Migraine	Repeated episodes of headache may begin from childhood	throbbing Pain, intense, is localized in the half of the forehead, may affect the temporal region, aggravated by physical load, it is accompanied by nausea, vomiting, photophobia	did Not reveal any pathology	Without deviation from the norm	Not changed	pathology
Voltage	Episodes of pain in a long time.	Pain of moderate or weak intensity, surrounding and compressing nature, not enhanced by day-to-day workload.	did Not reveal any pathology	Without deviation from the norm	Not changed	pathology
Abouna	Prolonged use of NSAIDs, combined analgesics (aspirin, kofitsil) preceding a migraine.	Occurs in the morning, the pain syndrome of moderate or low intensity, aggravated by exertion of any kind, the forehead hurts both parties.	did Not reveal any pathology	Likely increase ALT and AST in the biochemical analysis of blood in case of acquisition of drug liver damage.	Not changed	pathology
Cluster	More common in men aged 20-40 years, there may be mention of similar symptoms in the parents or other blood relatives.	attacks of Unilateral intense pain over the eye socket for up to three hours. Combined with lacrimation, nasal congestion, sweating, puffiness and drooping eyelids, dilated pupils. Attacks happen at night, disrupting sleep	did Not reveal any pathology	Without deviation from the norm	Not changed	pathology
Secondary: • 1.Atherosclerotic. • 2.Diseases of ENT organs. • 3.Infectious diseases. • 4.Space-occupying lesions of the frontal lobe (tumor). • 5.Injury. • 6.Trigeminal neuralgia.	• 1.Occurs in adulthood, usually in men. • 2.Headache is preceded by nasal congestion, fever. • 3.Information about contact with infectious patients. • 4.The pain gradually increases, the loss of body weight, changes in behavior. • 5.Occurs after traumatic brain injury. • 6.Most often affects women over 40 years of age, often develops after suffering a herpes zoster	• 1.The pain is pulsating, constant, medium intensity, often combined with dizziness, coronary heart disease. • 2.The pain is a dull, bursting, increases with the tilt of the head. • 3.The pain arching, blunt, double sided. • 4.The pain is dull, progressive, not relieved by analgesics. • 5.The pain is nagging, constant, bursting or pulsating in nature. • 6.Sharp stabbing, shooting, burning pain in the center of the forehead or above the eye socket that occurs after irritation in the nose area.	• 1.Noise during auscultation of the heart, on the carotid artery. • 2.The foreheadpercussion hurts more. • 3.Fever, positive meningeal signs. • 4.Perhaps the increase in regional lymph nodes. • 5.Visible damage in the frontal part or without pathology. • 6.Determined by tenderness on palpation of the supraorbital region.	• 1.An increase in triglycerides and cholesterol in the biochemical analysis of blood. • 2.Leukocytosis, increased ESR in the blood test. • 3.Antibodies to the pathogen in the serum. • 4.Increased levels of tumor markers in the blood, increased erythrocyte sedimentation rate, total protein. • 5.Anemia in the blood test or there is no change. • 6.IgG antibodies to Varicellazoster virus in the serum is higher than normal.	• 1.Not changed. • 2.Not changed. • 3.The cell count. • 4.High levels of protein. • 5.Xanthochromia. • 6.Not changed.	• 1.Narrowing of the carotid arteries. • 2.The fluid level in the frontal sinus. • 3.On MRI the lesions destruction of brain tissue with encephalitis. • 4.On MRI mass lesion in the brain tissue. • 5.Hematoma on MRI the meninges, the brain tissue. • 6.Without pathology.

Therapy

Treatment of headache spend medicamental and non-medicamental methods:

• NSAIDs (analgesics) – the main treatment, the child can only be applied after the appointment of a General practitioner (ibuprofen, nimesulide);
• antidepressants for the treatment in the interictal period (amitriptyline, prozac);
• glucocorticoids – treatment of conditions associated with inflammation and cerebral edema (dexamethasone);
• anti-convulsants treatment of seizures (valproic acid, carbamazepine);
• vasodilators – treatment of vascular disorders (verapamil, propranolol).

for cluster headache recommended inhalations of oxygen during the attack. Medication should be combined with physiotherapy: to perform acupuncture, darsonvalization, amplipuls, magnetic therapy, laser therapy. The child's use of physiotherapy, Spa treatment allows to reduce the dose of drugs and improve the safety of treatment.

Most types of primary headaches in the frontal parts have paroxysmal character, in the course of the disease can be distinguished periods of exacerbation and remission. If adequate treatment is not carried out, gradually the frequency of attacks increases, as lucid intervals between them grow shorter. Only timely treatment to the doctor will help to avoid chronicity of the process.

Complaints against the forehead of the child is a powerful reason examinations by a doctor with the use of MRI, CT and other additional methods. Every day of delay could become fatal for your baby if it is a tumor process. Uncontrolled self-medication in most cases, greatly worsens the prognosis and outcome of the disease.

Sources:

1. Neurology: national manual edited by Gusev, Konovalov, Skvortsova;
2. International principles of diagnosis of headaches. Problems of diagnostics of headaches in Russia. V. V. Osipova, Yu. e. Azimova, G. R. Tabeeva;
3. international classification of disorders, accompanied by headache. 2nd edition (revised). Full Russian version. Translated from English by V. V. Osipova, T. G. Voznesenskaya, Y. E. Azimova, A.V. Sergeev.