Location helps clinicians in making a provisional diagnosis. History taking is one of the most important things for neurological disorders. Data regarding the location of a headache are very more informative. Let’s see how we can come to a provisional diagnosis based on location.
A) Hemicranial Headache:
Migraine headache is unilateral in two-thirds of attacks. Often it is associated with nausea, vomiting, interfering with routine activities, and sensitivity to light, sound, and smells.
B) Localised forehead, maxilla, or orbit:
The forehead is the anterior aspect of our face above the eyes. Pathology of the paranasal sinuses, teeth, eyes induces a less sharply localized pain, usually in the region of the forehead or maxilla or around the eyes.
Inflammation of an extracranial artery such as the superficial temporal artery causes pain localized to the site of the vessel i.e in the temporal region. The temporal region is part of the skull around the ears. Its involvement is quite common in Giant cell arteritis. In giant cell arteritis, inflammation causes a narrowing or blockage of the blood vessels, resulting in interruption of blood flow.
Brain tumors also can cause frontotemporal region pain.
C) Occipital and neck region:
The occipital region is part of the skull above the neck. Brain tumor in the posterior fossa causes pain in the occipital region.
It can be also caused by a distinct entity occipital neuralgia where typically, the pain begins in the neck and then spreads upward in the occipital region.
D) Near vertex or midline top of the head:
The vertex is the midline bony landmark at the most superior part of the skull bone
Headaches localized to the vertex or biparietal regions are infrequent and should raise the suspicion of sphenoid or ethmoid sinus disease or thrombosis of the superior sagittal venous sinus.
D) Referred pain:
Localization, however, is not often accurate and may also be confusing sometimes.
Pain in the frontal regions may be caused by diverse pathologies and mechanisms like raised intracranial pressure.
Similarly, ear pain may signify disease of the ear itself, but as often it is referred from the throat, cervical muscles, spine, or structures in the posterior fossa.