Headaches are extremely common, but the precise location of the discomfort offers valuable diagnostic clues about the underlying cause. Headaches are signals from surrounding structures like the nerves, muscles, and blood vessels of the head and neck, not pain felt inside the brain. Understanding where the pain is centered, along with its quality, is the first step toward identifying the type of headache. While location is a strong indicator, this positional information helps narrow down possibilities before a definitive diagnosis based on symptoms and medical evaluation.
Pain Across the Forehead and Temples
Headaches presenting with generalized pain across the forehead, temples, and scalp are most frequently categorized as tension-type headaches. They are characterized by a dull, aching sensation, often described as a tight band squeezing the head. The pain is typically non-throbbing, mild to moderate, and affects both sides of the head simultaneously.
These headaches are often linked to muscle contractions in the head and neck, triggered by emotional stress, physical strain, or poor posture. Tension headaches build slowly and generally do not cause nausea, vomiting, or heightened sensitivity to light and sound, unlike migraines. The pain may involve tenderness in the neck and shoulder muscles, contributing to the pressure felt across the brow and temples.
Sinus headaches are another type of frontal pain, occurring in the areas where the sinuses are located (cheeks, brow, and bridge of the nose). This constant pain is driven by inflammation and pressure buildup within the sinus cavities, often due to infection or allergies. The pain often worsens when bending forward or lying down due to the shift in pressure. Many people who self-diagnose a sinus headache are actually experiencing a migraine with sinus-like symptoms, such as congestion. A true sinus infection headache is typically accompanied by thick, discolored nasal discharge and sometimes a fever, which are not common features of migraine.
Pain Focused on One Side or Behind the Eye
When head pain is concentrated severely on a single side, often pulsating or throbbing, it points toward one-sided headache disorders, primarily migraine. Migraine attacks are neurological events presenting with moderate to severe pain, frequently localized to one side, though they can sometimes affect both. The pain is often described as drilling or throbbing and is aggravated by physical activity.
Migraines are distinguished by accompanying symptoms, such as nausea, vomiting, and hypersensitivity to light (photophobia) and sound (phonophobia). Some individuals experience an aura before the headache phase, involving transient neurological symptoms like visual disturbances. While often one-sided, the pain location can sometimes switch sides between attacks.
A different, rare, and extraordinarily painful one-sided headache is the cluster headache, typically centered in or around one eye. Cluster headaches are characterized by excruciating, sharp, or stabbing pain that reaches maximum intensity quickly and occurs in cyclical patterns. The pain is so severe that individuals often feel restless during an attack. This headache is accompanied by distinct autonomic symptoms on the same side as the pain. Unlike migraines, the pain in a cluster headache almost always remains on the same side during a single cluster period.
Pain Radiating from the Neck and Back of the Head
Pain originating in the neck or the base of the skull and moving upward into the head is characteristic of a cervicogenic headache. This secondary headache is a symptom of an underlying structural issue in the cervical spine. The source of the pain is often dysfunction in the upper cervical vertebrae, discs, or soft tissues.
The pain is often one-sided, starting at the back of the head and radiating to the front, sometimes settling behind the eye or in the temple. Movement of the neck or sustained awkward postures, such as prolonged screen time, can trigger or worsen the pain. This referred pain is transmitted from neck structures to the head via shared nerve pathways.
While tension headaches can involve the back of the head due to muscle tightness, a cervicogenic headache is tied to a verifiable disorder of the neck anatomy. The pain is steady and non-throbbing, and individuals often experience restricted range of motion or stiffness in the neck. Addressing the underlying structural or muscular issue in the neck is the most effective treatment for this radiating head pain.
When Headache Location Signals an Emergency
While most headaches are benign, certain symptoms signal a medical emergency requiring immediate attention, regardless of location. The most alarming symptom is the “thunderclap” headache, defined as severe pain reaching maximum intensity within 60 seconds. This sudden, explosive onset can signal a subarachnoid hemorrhage (bleeding around the brain).
A headache accompanied by new neurological deficits also warrants urgent evaluation. These deficits include weakness or numbness on one side of the body, slurred speech, confusion, or a sudden change in vision. Any new headache following a head injury must be checked immediately to rule out internal bleeding or concussion.
Other red flags include a headache paired with a fever and a stiff neck, suggesting meningitis (an infection of the membranes surrounding the brain and spinal cord). New headaches starting in individuals over 50, or a pattern of pain that worsens significantly over days or weeks, also require prompt medical assessment. The urgency is based on the speed of onset and the presence of accompanying symptoms suggesting a serious underlying condition.