Sinus Headache

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Sinus headaches cause head and facial pain.

Sinus headache facts

  • Sinuses in the face are air the spaces that develop from the nasal passages and help with air humidification and mucus secretion.
  • Inflammation of the sinuses may decrease the ability for the mucus to drain, increasing pressure within the sinuses and leading to a sinus headache. Common causes of inflammation include allergies, infections, or colds.
  • Symptoms of a sinus headache include pain in the face that may worsen with bending down or straining;
  • pain that radiates to the forehead, temple or cheek;
  • Diagnosis of sinus headache is often based on history and physical examination. Blood testing and X-rays are usually 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. Antibiotics may not always be necessary.
  • Home remedies to treat sinus symptoms are directed at helping the sinuses drain to help relieve pressure and inflammation. These include drinking plenty of fluid to remain hydrated, humidification of air, warm compresses to the face, and over-the-counter (OTC) pain medications.

Quick GuideSinus Infection (Sinusitis) Symptoms & Treatment

Sinus Infection (Sinusitis) Symptoms & Treatment

Sinus Infection and Headache Symptoms

Sinus infection is characterized by an infection of the lining tissues of the sinuses within the skull. Early signs and symptoms of a sinus infection include:

  • Pain or pressure over the involved area
  • Facial tenderness and swelling
  • Stuffy nose
  • Nasal congestion
  • Earache
  • Pain in the jaw
Sinus cavities provide air filtration and contribute to the strength of the skull.

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. The sinus cavities also allow more resonance to be added to 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

While infants do have sinuses, they are very poorly developed. The maxillary sinuses cannot be seen on an X-ray until 1 to 2 years of age, and the frontal sinuses are not seen until age 5 or 6.

What is a sinus headache?

If the linings of the ducts or tubes that connect the sinuses to the back of the nose become inflamed, the sinuses may not be able to drain normally, and pressure may build up within the blocked sinus. There may also be associated swelling and inflammation of the lining of the sinuses, resulting in increased mucus and fluid secretion. This increase in fluid combined with the inability to drain increases pressure within the sinus cavity, causing the pain of a sinus headache. The term sinusitis is used to describe inflammation of the sinus.

Picture of the sinus cavities.
Picture of the sinus cavities
Sinus headache symptoms include excess mucus, swelling and pain in the sinuses.

What causes a sinus headache?

While a sinus inflammation (sinusitis) may be caused by a viral infection and causes swelling in the nose (inflammation). This inflammation and decreased ability of the sinuses to drain also may be caused by an allergic reaction such as hay fever. The inflammation causes swelling and increased fluid production. In the sinuses, this decreases the ability of the sinuses to drain. This increased inflammatory fluid production and the decrease in drainage causes the pain and pressure of a sinus headache.

After a period of time bacteria and viruses may travel from the nasal cavities into the stagnant fluid within the sinus cavity and cause an infection. Most sinus infections are due to viruses. Viruses are the more likely cause if symptoms have been present for less than a week and are not getting worse. Bacterial infections typically will follow the initial period of inflammation from a viral infection or other significant sinus blockage. Less commonly, fungal infections may cause a sinus infection, and even more rarely, tumors 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.

Because there is almost always nasal inflammation associated with sinus inflammation, the illness is now often referred to as rhinosinusitis.

What are the symptoms of a sinus headache?

Pain and pressure are the primary symptoms of a sinus headache, usually due to the increased inflammation and decreased drainage from the affected sinus cavity. The pain of a sinus headache is often described as an increasing pressure sensation overlying the sinus that is blocked. This may be the cheek area (maxillary), the forehead (frontal area), or both. The part of the face in the area of the affected sinus can be tender to touch and reddened. Swelling also may occur. The pain can increase with changing position of the head, or when first getting up out of bed, again because of increased pressure within the sinus cavities.

Sinus inflammation can result with or without an infection.

Symptoms with sinus infection

  • If an infection is present, there may be fever, chills, malaise (feeling poorly), or myalgias (achy muscles).
  • Opaque or greenish-yellow nasal drainage may occur.
  • There may be postnasal drainage, in which secretions drip down to the back of the throat. This can cause a cough and patients sometimes complain about coughing up yellow sputum. However, they may actually be coughing up the drainage that has dripped down from the sinuses instead of coughing up phlegm from the lungs.
  • Swollen lymph nodes (swollen glands) may occur in the neck if an infection is present, which is no different than the swelling of lymph nodes that accompanies an acute sore throat (pharyngitis) or ear infection (otitis media).

Symptoms with sinus inflammation

  • If there is sinus inflammation without infection, the drainage may be clear.
  • If the maxillary sinus is inflamed, pain may also be felt in the upper teeth since the sinus is located within the bone that holds those teeth.
  • Pain also may radiate to the temples, back of the neck, or top of the head.

What kind of a doctor treats sinus headache?

Most primary health-care professionals, including those who practice family medicine, pediatrics, and internal medicine, can care for routine sinus infections. Often patients will seek care at a walk-in clinic or Urgent Care Center. If complications arise, otolaryngologists (ear, nose and throat specialists) are often consulted to discuss the potential need for surgery and drainage of a sinus. On the rare occasion when fungal infections of the sinus are present, an infectious disease specialist may be consulted.

If sinus headache symptoms last more than 10 days, seek medical care.

When should I seek medical care for a sinus headache?

Many people correctly self-diagnose sinusitis and treat themselves at home. Drinking plenty of fluids and humidifying the air is often enough to open the nasal passages and allow the sinuses to drain. This home treatment also may loosen secretions that are already present and promote drainage.

However, medical care may be needed if a fever is present, if there is swelling that can be felt in the face (perhaps signaling an abscess formation), or if the person exhibits a change in behavior or thinking.

Seeking medical care may also be appropriate if the pain does not respond to over-the-counter (OTC) pain medications such as ibuprofen (Advil, Motrin, Nuprin, and others) or acetaminophen (Tylenol and others) or if symptoms last longer than 10 to 14 days.

X-rays and CT scans are used to diagnose sinus problems.

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 professional will likely begin by taking 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 molds, as well as recent airplane travel, swimming or SCUBA diving, or other activities involving air pressure changes within the facial sinuses.

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. Evaluation of the mouth and teeth may find a source of infection, and the back of the throat may be examined for signs of postnasal drainage.

Routine X-rays of the face are not recommended to make the diagnosis of sinusitis or sinus infection. If the health-care professional considers imaging studies of the sinuses it is to confirm the diagnosis, and to look for fluid collections or thickening of the mucus membranes that line the sinus walls. Limited CT scan of the sinuses is often recommended. Plain X-rays of the sinuses may sometimes be considered. Blood tests tend not to be helpful in making the diagnosis of the cause of sinus headache.

Rinsing of the sinuses may help relieve sinus pain and sinus pressure.

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 to 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 treating the underlying problem.

What home remedies help soothe the symptoms of a sinus headache?

There are remedies that can be used at home to help decrease congestion within the nasal passages, and include:

Drinking plenty of fluids to help keep the body hydrated.

Using humidified air and a salt water nasal spray to help with congestion

Neti pots are an alternative way to get humidity into the nasal passages and assist with drainage to prevent inflammation and infection. Remember to read the instructions and use distilled or properly boiled water. Deaths have been caused by using tap water in the Neti-pot.

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There are many OTC sinus medications available.

What over-the-counter (OTC) medications treat a sinus headache?

OTC cold 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 high blood pressure, or who have heart conditions or are pregnant, should consult their health-care professional or pharmacist to assess their safety before taking these medications.

Some decongestant 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 and similar nasal sprays should be used for no more than 3 days in a row; otherwise, rebound inflammation may occur. With rebound inflammation, when the spray medication is stopped, the linings of the nasal passages may swell and potentially cause even more drainage complications.

Doctors may prescribe prescription medications for sinus headache symptoms.

What prescription medications treat a sinus headache?

Headaches from canallergies can be relieved with a prescription for nasal steroids sprays unless there is a contraindication. This may be helpful along with nasal saline rinses to decrease inflammation within the nasal passages and treat or prevent sinusitis.

If a bacterial infection is suspected, the health-care professional may prescribe antibiotics to treat the infection and at the same time make suggestions to treat the underlying inflammation. To establish the diagnosis of acute bacterial rhinosinusitis and the need for antibiotics, your doctor should confirm that symptoms of acute rhinosinusitis have been present for 10 days or are worsening. Symptoms should include pus-like (purulent) nasal frainage, nasal obstruction, facial pain or pressure. If the inflammation does not resolve before the antibiotic course is complete, the bacterial infection may recur.

Quick GuideSinus Infection (Sinusitis) Symptoms & Treatment

Sinus Infection (Sinusitis) Symptoms & Treatment
Sinus surgery may be required for patients with recurrent sinus infections.

What about surgery for sinus headache?

If the sinus headache persists, and repeated courses of treatment fail to relieve the sinusitis, surgery may be an option. Otorhinolaryngologists (ear, nose, and throat [ENT] surgeons) may be able to widen the openings that allow the sinuses to drain and decrease the risk of recurrent inflammation that may 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 in the face. Two potential areas for spread of the infection include:

  • The orbit (eye socket), causing pain, swelling, and redness of the eyelid and skin surrounding the orbit. There can also be pain with any eye motion. Decreased vision may develop.
  • The brain, causing symptoms of meningitis or encephalitis.
  • The blood vessels that run near the sinuses can develop inflammation and blood may clot (thrombus). Cavernous sinus thrombosis describes the inflammation and clotting of the cavernous sinus, a collection of small veins located near the sphenoid sinus, that can potentially become infected and form blood clots.
Breathing humidified air allows the normal mucus that is produced in the sinuses to drain more easily.

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 smoking and secondhand smoke and other allergens may decrease the risk of developing sinusitis and the headache associated with it. Smoking reduces the ability of the sinuses to clear mucous and fluid.

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. Because of the pressure changes in the face that occur with flying, it is not necessarily recommended when a patient is ill with an upper respiratory tract infection or cold.

Maintaining adequate hydration and breathing humidified air at home and work will allow the normal mucus that is produced in the sinuses to drain more easily.

Sinus headaches either resolve on their own, or when the underlying cause is treated.

What is the prognosis for a sinus headache?

Sinus headaches are 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. If the headache symptoms are not associated with inflammation of the sinuses, the underlying cause (such as a migraine headache) needs to be adequately addressed to relieve symptoms.

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Reviewed on 10/30/2015
References
REFERENCE:

Rakel, D. and R. E. Rakel. Textbook of Family Medicine,98th ed. Saunders, 2015.

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