What are the treatment options for pain on the right side of the forehead?

Treatment of Right-Sided Forehead Pain

Start with ibuprofen 400 mg or acetaminophen 1000 mg for acute relief, as this presentation most likely represents either tension-type headache or migraine, both of which respond to these first-line agents. 1

Initial Diagnostic Approach

Before initiating treatment, briefly assess for red flags that would require urgent evaluation:

• Age ≥40 years with new-onset headache warrants neuroimaging to exclude secondary causes 2
• Thunderclap onset (instantly peaking pain) mandates immediate CT to exclude subarachnoid hemorrhage 2
• Exertional onset requires urgent workup including non-contrast head CT within 6 hours 2
• Neurological deficits, neck stiffness, or altered consciousness necessitate emergency evaluation 2, 3

If none of these red flags are present, proceed with treatment based on headache characteristics.

Acute Treatment Algorithm

For Tension-Type Headache Features

If the pain is described as pressing, tightening, or band-like (even if unilateral), with mild-to-moderate intensity and no nausea or photophobia:

• Ibuprofen 400 mg every 4-6 hours as first-line therapy 1, 4
• Acetaminophen 1000 mg as alternative 1
• Maximum ibuprofen dose is 3200 mg daily; do not exceed this limit 4
• Avoid using analgesics more than twice weekly to prevent medication-overuse headache 1, 5

For Migraine Features

If the pain is throbbing, moderate-to-severe, with nausea, photophobia, or phonophobia (even if unilateral on the right forehead):

First-line options:

• Aspirin-acetaminophen-caffeine combination (strong recommendation) 1
• Ibuprofen 400 mg or naproxen 1

If inadequate response to NSAIDs:

• Triptans: sumatriptan, rizatriptan, eletriptan, or zolmitriptan (strong recommendation) 1
  • These eliminate pain in 20-30% of patients by 2 hours 6
  • Avoid in patients with cardiovascular disease due to vasoconstrictive properties 6
  • Transient flushing, tightness, or tingling occurs in 25% of patients 6

Newer alternatives if triptans contraindicated:

• Rimegepant or ubrogepant (gepants) eliminate headache in 20% at 2 hours with nausea/dry mouth in 1-4% 1, 6

Clinical Clue: "Pointing Forehead" Sign

Patients who point to the right side of their forehead when describing pain are significantly more likely to have migraine (especially if unilateral and severe), which should guide you toward migraine-specific therapy rather than simple analgesics 7

Preventive Therapy Considerations

If headaches occur more than twice weekly, preventive therapy should be considered to avoid medication-overuse headache:

For chronic tension-type pattern:

• Amitriptyline is the most evidence-based preventive agent 1, 8

For migraine pattern:

• Multiple options including antihypertensives, antiepileptics, or CGRP monoclonal antibodies reduce migraine frequency by 1-3 days per month 6

Common Pitfalls to Avoid

• Never assume unilateral forehead pain is benign without proper history - cluster headache presents with severe unilateral pain but includes ipsilateral autonomic symptoms (tearing, nasal congestion, ptosis) lasting 15-180 minutes 1
• Do not use opioids or butalbital combinations routinely - these increase risk of chronic daily headache despite short-term efficacy 8
• Limit acute medication use to <2 days per week to prevent medication-overuse headache 5
• Do not order neuroimaging for typical primary headache patterns without red flags, as this does not change management 1, 3

Adjunctive Non-Pharmacologic Measures

• Physical therapy for tension-type, migraine, or cervicogenic patterns 1
• Aerobic exercise or progressive strength training for prevention 1
• Consider behavioral interventions (biofeedback, cognitive therapy) though evidence is limited 1, 8