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Sinus Headache

What are the sinuses?

Sinuses of the face are cavities or spaces within the bones that help humidify air and secrete mucus to help with air filtration. Additionally, they contribute to the strength of the skull and its ability to resist trauma and allow more resonance in the voice.

The sinuses are often referred to as the paranasal sinuses because of their location and connection to the back of the nose. The sinuses develop as air sacs within the bones of the skull and are named by their location:

Frontal sinus: located above the eyes within the frontal bone of the skull

Maxillary sinus: located beneath the eyes under the cheekbones within the maxilla bone of the face

Ethmoid sinus: located in the ethmoid bone separating the eyes from the nose

Sphenoid sinus: located in the sphenoid bone at the base of the skull



What is a sinus headache?

Should the ducts that connect the sinuses to the back of the nose become inflamed, the ability of the sinuses to drain is decreased, and pressure builds within the affected sinus. There may also be associated swelling and inflammation of the lining of the sinuses, possibly resulting in increased mucus and fluid secretion. This increase in fluid and pressure causes the pain of a sinus headache. The term sinusitis is used to describe inflammation of the sinus (sinus + itis = inflammation).

What causes a sinus headache?

While a sinus infection (sinusitis) can be due to a viral infection much like a cold that causes swelling in the nose and decreases drainage of the sinuses, an allergic reaction (such as hay fever) may also begin the process of inflammation. As with any inflammation, there is swelling that in this case decreases the ability of the sinuses to drain and increased inflammatory fluid production (just like the weeping observed with a skin injury). The combination of more fluid and less drainage leads to the pain and pressure of a sinus headache.

Nature does not like stagnant fluid, and after a period of time bacteria and viruses can travel from the nasal cavities into the fluid and cause an infection. Less commonly, fungal infections may cause a sinus infection, and even more rarely, tumours can invade the sinus.
The maxillary sinus sits underneath the eye within the cheekbone. The upper teeth attach to the lower portion of this bone, and dental infections can travel up the root of the tooth and infect the sinus directly.

What are the symptoms of a sinus headache?

Pain is the primary symptom of a sinus headache, usually due to the increased pressure and decreased drainage from the affected sinus cavity. The pain of a sinus headache is often described as an increasing pressure sensation overlying the area with an associated tenderness to the touch. The pain occurs upon changing position of the head or when first getting up out of bed, which is due to the increased pressure within the sinus cavities.

Symptoms with sinus infection

- If an infection is present, there may be fever, chills, malaise (feeling poorly) or myalgias (achy muscles).

- Greenish-yellow nasal drainage may occur.

- Swollen lymph nodes (swollen glands) may occur in the neck if an infection is present, no different than the swelling of lymph nodes that accompanies acute pharyngitis (sore throat) or otitis media (ear infection).

Symptoms with sinus inflammation

If there is sinus inflammation without infection, the drainage may be clear.
If the maxillary sinus is inflamed, there may be pain felt in the upper teeth since the sinus is located in the bone where those teeth are located.

When should I seek medical care for a sinus headache?

Many people correctly self-diagnose sinusitis and treat themselves at home with fluids by mouth and breathing humidified air to loosen secretions and promote drainage. However, accessing medical care should be considered if a fever is present, there is swelling that can be felt in the face (perhaps signalling an abscess formation), or if the person exhibits a change in behaviour or thinking.

Medical care may be appropriate if the pain does not respond to over-the-counter pain medications such as ibuprofen or acetaminophen or if symptoms last longer than 10 to 14 days.

How is a sinus headache diagnosed?

It is important that the cause of the headache be diagnosed. Many patients who believe that they have sinus headaches may instead have migraine or tension headaches.
The health care practitioner will likely begin with a history of the symptoms to help come to the diagnosis. Contributing factors in the development of sinusitis and headache may include a recent cold or upper respiratory tract infection, history of smoking, environmental allergies to dust or moulds, as well as recent airplane travel, swimming or SCUBA diving, or other activities involving air pressure changes.

Physical examination may reveal tenderness to percussion, or tapping, over the affected sinus that reproduces the pain. Examination of the ears may reveal a serous otitis, or fluid levels behind the eardrum in the middle ear, that may suggest drainage problems in the face and sinuses. Examination of the nose may reveal swollen nasal passages and discharge.
The health care practitioner may want to consider imaging studies of the sinuses using a CT scan to look for fluid collections or thickening of the mucus membranes that line the sinus walls. Blood tests tend not to be helpful in making the diagnosis.

What is the treatment for a sinus headache?

The treatment goal for sinus headache is twofold. The first step is to decrease the inflammation within the sinuses and the help them drain. Once drainage occurs and the pressure is relieved, the pain should subside. The second aspect is to make the patient comfortable while the treating the underlying problem.

There are mechanical ways to help decrease congestion within the nasal passages. Drinking plenty of fluids will help with the general hydration in the body. Humidified air and salt water nasal spray will help with congestion as well. Neti pots are an alternative way to get humidity into the nasal passages and assist with drainage to prevent inflammation and infection.

Over-the-counter medications are available to help decrease inflammation within the sinuses and promote drainage. Brand name and generic drugs may be considered, but many contain pseudoephedrine (Sudafed), a medication that is related to adrenaline. People with pressure and other heart conditions should consult their health care practitioner or pharmacist before taking these medications.

Some nasal sprays, other than salt water sprays (Ocean Nasal Spray), may be used, but only for a short period of time because of side effects and complications. For example, Afrin nasal spray should be used for only three days in a row; otherwise, rebound inflammation may occur. With rebound inflammation, when the spray is stopped, the linings of the nasal passages may swell and potentially cause even more drainage complications.

For those whose sinus headaches are due to allergies, inhaled nasal steroids may be helpful in decreasing inflammation within the nasal passages to treat or prevent sinusitis.
If a bacterial infection is suspected, the health care practitioner may prescribe antibiotics to treat the infection while at the same time make suggestions to treat the underlying inflammation. If the inflammation does not resolve before the antibiotic course is complete, the bacterial infection may recur.

If the sinus headache persists, and repeated courses of treatment fail to relieve the sinusitis, surgery may be an option. Otolaryngologists (ear, nose, and throat surgeons) may be able to widen the openings that allow the sinuses to drain and decrease the risk that recurrent inflammation will obstruct the sinuses from draining.

What are the complications of a sinus headache?

Complications of a sinus infection (sinusitis) are rare; however, if left untreated a sinus infection may erode through the bony walls of the sinus and infect adjacent structures. These may include the orbit, causing pain, swelling, and redness of the eye including pain with any eye motion as well as the brain, causing symptoms of meningitis or encephalitis.

Infection may spread to the blood vessels that run near the sinuses cause inflammation and blood clots. The cavernous sinus is not truly a sinus, but instead, is a collection of small veins located near the sphenoid sinus that can potentially become infected and form blood clots.

Can a sinus headache be prevented?

Sinus headaches are due to inflammation of the sinuses and their ability to drain to the back of the nose. Avoiding smoke and other allergens may decrease the risk of developing sinusitis and the headache associated with it.

Similarly, avoiding colds and other respiratory infections may decrease the risk of sinus inflammation. This may include frequent hand washing and avoiding people who are ill.
Maintaining adequate hydration and keeping the air at home and work well humidified will allow the normal mucus that is produced in the sinuses to drain more easily.

What is the outlook (prognosis) for a sinus headache?

Most people with sinus headaches have short-lived temporary problems associated with colds or hay fever. They recover quickly, once the underlying condition resolves.

Certain people develop chronic sinus inflammation and more long-standing symptoms associated with their sinusitis. Once the underlying condition is identified, preventive measures may be available and future recurrences of the sinus headache may be minimized.

Sinus Headache At A Glance

Sinuses are air spaces that develop from the nasal passages that help with air humidification and mucus secretion.

Inflammation of the sinuses may decrease the ability for the mucus to drain, increasing pressure within the sinus, and leading to the sinus headache. Common causes include allergies or colds.

Diagnosis is often based on history and physical examination. Blood testing and X-rays are often not required.

Treatment is directed at decreasing the inflammation within the sinus passages, allowing them to drain, and decreasing the pressure that is the cause of the headache.