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Sinus Headache

Definition

Sinus headache refers to head and facial pain associated with inflammation of the sinuses (called sinusitis). The sinuses are hollow cavities in the skull that have openings into the nose. Colds and allergies cause inflammation of the nasal passages and can lead to sinusitis. Sinus headache is a symptom of sinusitis.
Sinus Headache: Areas of Pain
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Causes

Allergies and viral upper respiratory infections increase nasal secretions and cause tissue lining the nasal passages to swell. This results in nasal congestion and stuffiness. The nasal passages become blocked and normal drainage cannot occur. Secretions that are trapped in the sinuses may become infected with bacteria or, rarely, fungus. The swollen tissue or infection may create pain and pressure.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for sinus headache include:
  • Allergies
  • Asthma
  • Persistent cold or upper respiratory infection
  • Ear infections
  • Nasal polyps
  • Tooth abscess or infection
  • Enlarged tonsils or adenoids
  • Nasal deformities, such as a deviated septum
  • Cystic fibrosis
  • Problems with immunity
  • Prior sinus surgery
  • Facial injuries that block sinus passages
  • Traveling in an airplane if you have an upper respiratory infection
  • Swimming in dirty water

Symptoms

Symptoms of sinus headache may include:
  • Pain and tenderness behind the forehead, cheeks, and around the eyes and ears
  • Pain in the upper teeth
  • Pain ranging from mild to severe
  • Pain that is more intense first thing in the morning
  • Pain that may worsen when you bend over
  • Headache occurring with other symptoms of sinusitis, including:
    • Nasal stuffiness and congestion
    • Thick nasal drainage
    • Postnasal drip
    • Fever
    • Fatigue
    • Stuffy ears
    • Sore throat
    • Cough
    • Puffiness around the eyes

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Your nasal secretions may be tested for allergies and infection.
If you suffer from chronic sinusitis, tests may include:
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
  • Nasal endoscopy—uses a thin, lighted tube to look inside your nose and possibly take samples of drainage to be tested

Treatment

Sinus headache treatment aims to:
  • Open the nasal passages
  • Treat any infection
  • Allow sinus cavities to drain
Treatment may include:

Medications

Medications may include:
  • Pain relievers
  • Decongestants to open clogged nasal passages, which allows the sinuses to drain—Do not use longer or more often than directed. Overuse of decongestant nose sprays may increase swelling and make your symptoms worse.
  • Steroid nose spray to reduce inflammation
  • Drugs that thin secretions
  • Antibiotics—only if a bacterial infection has developed

Self-care during the Headache

Self-care includes:
  • Breathe warm, moist air. Try inhaling steam.
  • Try a mist of saline nasal spray to moisten the nasal passages and help remove crusty secretions. A saline spray can be used up to six times per day.
  • Ask your doctor for directions on how to perform nasal irrigation that you can do at home.
  • Do not smoke. If you smoke, quit.
  • Avoid second-hand smoke and polluted air.

Surgery

Surgery is usually not required. Patients with a structural abnormality or chronic sinusitis that does not respond to medications may benefit from surgery. The doctor may perform one of several procedures to clean out your sinus cavities.
If you are diagnosed with a sinus headache, follow your doctor's instructions.

Prevention

The following strategies may reduce the risk of getting a sinus headache:
  • Avoid exposure to anything that triggers allergy or sinus symptoms.
  • Seek medical treatment for allergies.
  • Wash your hands frequently to avoid colds.
  • Seek treatment for a persistent cold before sinusitis sets in.
  • Avoid alcoholic drinks. Alcohol can cause swelling of nasal and sinus tissues.
  • Check with your doctor about using a decongestant before air travel.

RESOURCES

American Academy of Otolaryngology - Head and Neck Surgery http://www.entnet.org

Asthma and Allergy Foundation of America http://www.aafa.org

CANADIAN RESOURCES

Allergy Asthma Information Association http://aaia.ca

Calgary Allergy Network http://www.calgaryallergy.ca

References

Cady RK, Dodick DW, et al. Sinus headache: a neurology, otolaryngology, allergy, and primary care consensus on diagnosis and treatment. Mayo Clinic Proc. 2005;80:908-816.

Dambro M, Griffith J. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2006.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. Philadelphia, PA: WB Saunders Co; 1999.

Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2000.

National Headache Foundation website. Available at: http://www.headaches.org. Accessed July 9, 2009.

Sinus headache. American Academy of Otolaryngology website. Available at: http://www.entnet.org/HealthInformation/sinusHeadache.cfm. Accessed July 9, 2009.

Sinus headaches. American Rhinologic Society website. Available at: http://www.american-rhinologic.org. Accessed July 9, 2009.

Sinus problems. Asthma and Allergy Foundation of America website. Available at: http://www.aafa.org. Updated 2005. Accessed July 9, 2009.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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