Disease: Sinus Headache

    Sinus headache facts

    • 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 sinuses and leading to a sinus headache. Common causes of inflammation include allergies or colds.
    • 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.

    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.

    Picture of the sinuses.
    Picture of the sinus cavities.

    What is a sinus headache?

    If the lining of the ducts or tubes that connect the sinuses to the back of the nose becomes 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 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 inflammation (sinusitis) may be caused by a viral infection, much like a cold that causes swelling in the nose, the inflammation and decreased ability of the sinuses to drain may also be caused by an allergic reaction like hay fever. Inflammation, like anywhere else in the body, causes swelling and increased fluid production. In the sinuses, this decreases the ability of the sinuses to drain. The increased inflammatory fluid production (just like the weeping observed with a skin injury) combines with the decrease in drainage to cause the pain and pressure of a sinus headache.

    Nature does not like stagnant fluid, and 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 viral in nature. This is more likely 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.

    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. The part of the face in the area of the affected sinus can be tender to touch. 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.

    Symptoms with sinus infection

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

    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 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 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.

    The health care professional may consider imaging studies of the sinuses 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 also may be considered. Blood tests tend not to be helpful in making the diagnosis.

    What is the treatment for a sinus headache? Do home remedies work?

    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.

    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 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 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 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.

    For those whose sinus headaches that are due to allergies, inhaled nasal steroids are recommended unless there is a contraindication. This may be helpful along with nasal saline rinses in decreasing inflammation within the nasal passages to 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 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.

    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 as well decreased vision.
    • The brain, causing symptoms of meningitis or encephalitis.
    • The blood vessels that run near the sinuses can develop inflammation and blood clots. 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.

    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.

    What is a sinus headache?

    If the lining of the ducts or tubes that connect the sinuses to the back of the nose becomes 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 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 inflammation (sinusitis) may be caused by a viral infection, much like a cold that causes swelling in the nose, the inflammation and decreased ability of the sinuses to drain may also be caused by an allergic reaction like hay fever. Inflammation, like anywhere else in the body, causes swelling and increased fluid production. In the sinuses, this decreases the ability of the sinuses to drain. The increased inflammatory fluid production (just like the weeping observed with a skin injury) combines with the decrease in drainage to cause the pain and pressure of a sinus headache.

    Nature does not like stagnant fluid, and 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 viral in nature. This is more likely 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.

    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. The part of the face in the area of the affected sinus can be tender to touch. 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.

    Symptoms with sinus infection

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

    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 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 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.

    The health care professional may consider imaging studies of the sinuses 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 also may be considered. Blood tests tend not to be helpful in making the diagnosis.

    What is the treatment for a sinus headache? Do home remedies work?

    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.

    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 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 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 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.

    For those whose sinus headaches that are due to allergies, inhaled nasal steroids are recommended unless there is a contraindication. This may be helpful along with nasal saline rinses in decreasing inflammation within the nasal passages to 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 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.

    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 as well decreased vision.
    • The brain, causing symptoms of meningitis or encephalitis.
    • The blood vessels that run near the sinuses can develop inflammation and blood clots. 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.

    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.

    Source: http://www.rxlist.com

    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.

    The health care professional may consider imaging studies of the sinuses 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 also may be considered. Blood tests tend not to be helpful in making the diagnosis.

    Source: http://www.rxlist.com

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