Pressure across forehead

[Dor57]

I can't really call this symptom a headache. I would call it more of a "throbbing pressure on my forehead." I am presently 59 years old and from 2006 to early 2010 received Botox injections about twice a year for frown lines. Following my last injections in Feb 2010, I noticed a nagging slight headache in the area of the injection sites. This was replaced with a feeling of pressure across my forehead a week or so later. This feeling persisted and is still present to this day. (I haven't had any more injections!)  The feeling is present all of the time and at times it just feels "tight" and other times it throbs somewhat. I can get it to feel better by consciously relaxing my forehead muscles. The uncomfortableness is relieved by Ibuprofen. I haven't really noticed any pattern to this. Some days I wake up with no pressure and it increases as the day goes on. Other times I wake up with it. If I push on the affected area, I feel somewhat increasing pressure and it hurts more. I had a sinus X-ray which showed clear sinuses. I really think it is somehow related to the Botox, but am wondering if you have any other thoughts. Also, what do you suggest I do?

[Shiv Kumar, MD]

Dear Dor57,

From the features of headache you have described to me, it looks like you are suffering from Tension type headache (TTH).

In this type of headache typically pain is like a tightness around the head or a feeling of squeezing or pressure on their head. It usually occurs on both sides of your head, and often spreads down your neck, or seems to come from your neck. Sometimes it is just on one side. The pain is usually moderate or mild, but sometimes it may be severe. It usually comes on during the day, and gets worse as the day goes on. Some people don't like bright lights or loud noises, and don't feel like eating much when they have a TTH.

However Botox does not cause headaches. It is actually used as a treatment for chronic migraine and tension type headache.

Your condition can be treated with pain killers like Paracetamol, Ibuprofen and Aspirin. However these should not be used too often as they may cause the development of medication-overuse headache.

Amitriptyline is the medicine most commonly used to treat chronic tension-type headaches. This is not a painkiller. It is an antidepressant medicine and you have to take it every day with the aim of preventing headaches. It should be taken for 4-6 months. If you don't respond to this you can also consider Botox for headache. Please meet your GP to discuss if these treatments would be right for you. You may also consider getting a CT scan to rule out other causes of headache.

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Shiva Kumar R.