Sinus Headache

• Sinuses in the face are air spaces that develop from the nasal passages and help with air humidification and mucus secretion.
• Inflammation of the sinuses may decrease the ability of the mucus to drain, increasing pressure within the sinuses, which can cause 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;
  • runny or stuffy nose;
  • post-nasal drip; and
  • persistent cough.
• Acute sinusitis typically lasts less than eight weeks or occurs no more than three times per year.
• Chronic or recurring sinusitis lasts longer than eight weeks or occurs more than four times per year.
• 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.

The picture shows the four types of sinuses.

Sinuses of the face are cavities or spaces within the bones that help humidify the 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, which 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.

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.

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, 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.

• 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 head positions or when first getting up out of bed, again because of increased pressure within the sinus cavities.

• If there is an infection, fever, chills, feeling poorly, or achy muscles occur.
• Opaque or greenish-yellow nasal drainage.
• Postnasal drainage, in which secretions drip down to the back of the throat. This can cause a cough and sometimes people have signs like 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).

Signs and symptoms of sinus inflammation

• If there is no infection, ear 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.

• Acute sinusitis typically lasts less than eight weeks or occurs no more than three times per year with each episode lasting no longer than 10 days. Medications are generally effective against acute sinusitis. Successful treatment counteracts damage done to the mucous lining of the sinuses and surrounding bone of the skull.
• Chronic or recurring sinusitis lasts longer than eight weeks or occurs more than four times per year, with symptoms usually lasting more than 20 days.

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 healthcare 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 serous otitis or fluid levels behind the eardrum in the middle ear, which 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 doctor considers imaging studies of the sinuses, it is to confirm the diagnosis and look for fluid collections or thickening of the mucus membranes that line the sinus walls. A 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 headaches.

Usually, a sinus headache can be cured with treatment, which can be two-fold.

• First, sinus inflammation is treated to help them drain. Once the sinuses are drained and the pressure is relieved, the pain should subside.
• Next, relief of headache pain, and other signs and symptoms.

Natural and home remedies that can be used at home to help decrease congestion include:

• Drink plenty of fluids to help keep the body hydrated.
• Use a humidifier 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 infections using tap water in the Neti-pot.

OTC cold medications are available to help decrease inflammation within the sinuses and promote drainage.

• Brand names and generic drugs may be considered, but many contain pseudoephedrine (Sudafed), a medication that is related to adrenaline.
• People with high blood pressure, heart conditions, or are pregnant, should consult their doctor 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 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.

Headaches from allergies can be relieved with a prescription for nasal steroid 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 healthcare 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 drainage, nasal obstruction, facial pain, or pressure.
• 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.

• 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.

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 the spread of the infection include:

• The orbit (eye socket), causes 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 causes symptoms of meningitis or encephalitis.

The blood vessels that run near the sinuses can develop inflammation and blood may clot (thrombus).

• Cavernous sinus thrombosis is 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.

Most primary healthcare 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.

• 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.

Sinus headaches are due to inflammation of the sinuses and their ability to drain to the back of the nose.

• Avoid smoking, secondhand smoke, and other allergens because they may decrease the risk of developing sinusitis and a sinus headache. Smoking reduces the ability of the sinuses to clear mucous and fluid.
• Avoid colds and other respiratory infections because it may decrease the risk of sinus inflammation, for example, frequent hand washing, and avoiding people who are sick.
• Flying is not recommended if you have a cold, sinus infection, or an upper respiratory infection because of the pressure changes in the face that occur with flying.
• 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 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.