The frontal region is located, as the name suggests, in the front of the head, specifically the forehead and glabella (that region between your eyebrows). When this type of headache pain occurs secondary to nerve compression and/or irritation, it is often secondary to pathology within the supraorbital and/or supratrochlear nerves which are branches of the trigeminal nerve. In some cases, an anterior branch of the zygomaticotemporal nerve (see temporal link) may travel toward the side of the forehead and contribute to the overall, frontal headache complex. It used to be thought that the supraorbital and supratrochlear nerves were primarily compressed by the glabellar musculature, specifically the corrugator supercilii, procerus, and depressor supercilii muscles. However, more recently it has been demonstrated that compression of both nerves may also occur at the orbital rim (i.e. the top of the eye socket) as these nerves sometimes emerge from behind and above the eye through very tight fascial openings or through bony foramina as opposed to notches within the orbital rim. In these locations, adjacent vessels can also act as compressive structures.
Typically, people with nerve compression causing pain in the frontal region present with significant, pressure-like or throbbing pain in the forehead and around the eyes, sometimes emanating from behind the eyes and sometimes associated with hypersensitivity of the forehead or glabellar skin. Patients will often, but not always, say that pressure above the eye with a finger will temporarily relieve their pain, but that within a few moments of removing their finger, their pain returns, sometimes worse than it was before. These people often have hyperdynamic glabellar musculature, even in repose. However, as with pain in the nasal area, the temporal region and the occipital area, these descriptions are not exclusive hallmarks of the way in which people can present as everyone can experience their discomfort in a unique way.
As with evaluation of neuralgia in the other regions of the head/scalp, evaluation of the frontal neuralgia patient is important in making an accurate diagnosis. First, we evaluate the patient’s medical history, then perform a physical exam specifically focused on the possibility of supraorbital, supratrochlear, and/or zygomaticotemporal nerve pathology causing their headache symptoms and then perform a set of sequential, diagnostic nerve blocks in an attempt to discern which nerve or nerves are involved in any particular case. If the medical history is consistent with frontal nerve compression causing their symptoms, their physical exam is consistent with that etiology and they have a positive result with a nerve block(s), they may be an appropriate candidate for surgical intervention in the hopes of providing long-term relief of their headache symptoms.