Headache of a diagnosis: frontotemporal pain and inflammation associated with osteolysis

Lyndal J Tacon, Jonathon F Parkinson, Bernard J Hudson, Janice M Brewer, Nicholas S Little and Roderick J Clifton-Bligh
Med J Aust 2008; 189 (10): . || doi: 10.5694/j.1326-5377.2008.tb02190.x
Published online: 17 November 2008

A 62-year-old woman presented with left frontotemporal pain, scalp tenderness and raised levels of inflammatory markers. Temporal arteritis was considered likely, and symptoms resolved with prednisone therapy. This delayed diagnostic bone biopsy until a soft tissue abscess formed, and Pott's puffy tumour associated with Prevotella osteomyelitis of the frontal bone was diagnosed. This case highlights the value of early histopathological examination, and is a reminder of a condition seen frequently in the pre-antibiotic era.

A 62-year-old woman was referred with a 6-month history of spontaneous left frontotemporal scalp pain. Initially, the pain was associated with a soft swelling over the scalp and resolved within 6 weeks. It recurred 4 months later, without associated swelling, localised to the left frontal region and became progressively more severe, disturbing the patient’s sleep. She remained systemically well and had no history of fever, sinusitis, dental infection or diabetes mellitus.

  • Lyndal J Tacon1
  • Jonathon F Parkinson2
  • Bernard J Hudson3
  • Janice M Brewer4
  • Nicholas S Little5
  • Roderick J Clifton-Bligh6

  • Royal North Shore Hospital, Sydney, NSW.


Competing interests:

None identified.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.