What is sinus headache

Sinus headaches are an uncommon type of headache caused by inflamed sinuses (sinusitis). They are felt as a dull, throbbing pain in the upper face.

However, many people who assume they have headaches from sinusitis, including many who have received such a diagnosis, actually have migraines or tension headaches.

It’s important to see your doctor if you have any type of bad headache that you cannot control with over-the-counter medicine, particularly if it lasts a week or more, so you can get a proper diagnosis and treatment.

What is sinusitis

Sinusitis is a common condition in which the lining of the sinuses (hollow spaces in the bones of your face) becomes inflamed. The sinuses are small, air-filled cavities behind your cheekbones and forehead. Sinusitis is  usually caused by a viral infection and your body will normally overcome the cause of inflammation within two and a half weeks without the need for medical treatment.

Sinusitis is a common symptom after colds and the flu. If you have sinusitis, your symptoms will usually get worse after five days, or will last for more than 10 days. In some cases, there is an infection in the sinuses caused by bacteria.

The mucus produced by your sinuses usually drains into your nose through small channels. In sinusitis, these channels become blocked because the sinus linings are inflamed (swollen).

Figure 1. Sinusitis

See your doctor if:

• Your headache symptoms are severe or getting worse
• Your headache symptoms haven’t started to improve after around 7-10 days
• You have frequent episodes of sinusitis.
• Your headache symptoms require frequent over-the-counter pain medicine
• You have a severe headache, and over-the-counter pain medicine doesn’t help
• You miss school or work because of frequent headaches or the headaches interfere with your daily life

Your doctor may prescribe medicines including regular pain relief, a saline nasal spray or a nasal decongestant. In some cases, your doctor may decide to give you inhaled steroids or an antibiotic. If you often get sinusitis, it could be due to an allergy so they may refer you to an ear, nose and throat (ENT) specialist.

Tell your doctor if you develop bleeding from the nose, a stiff neck, swelling, or problems with your vision.

Causes of acute sinusitis

Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, a bacterial infection develops.

An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed.

It’s not clear exactly what causes sinusitis to become chronic (long-lasting), but it has been associated with:

• allergies and related conditions, including allergic rhinitis, asthma and hay fever
• nasal polyps (growths inside the nose)
• smoking
• a weakened immune system

Making sure underlying conditions such as allergies and asthma are well controlled may improve the symptoms of chronic sinusitis.

Risk factors of acute sinusitis

You may be at increased risk of getting sinusitis if you have:

• Hay fever or another allergic condition that affects your sinuses
• A nasal passage abnormality, such as a deviated nasal septum, nasal polyps or tumors
• A medical condition such as cystic fibrosis or an immune system disorder such as HIV/AIDS

Complications of acute sinusitis

Acute sinusitis complications are uncommon. If they occur, they might include:

• Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis lasts longer than 12 weeks.
• Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
• Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
• Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
• Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Prevention of acute sinusitis

Take these steps to help reduce your risk of getting acute sinusitis:

• Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.
• Manage your allergies. Work with your doctor to keep symptoms under control.
• Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.
• Use a humidifier. If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

Diagnosis of acute sinusitis

Your doctor will feel for tenderness in your nose and face and look inside your nose.

Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:

• Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
• Imaging studies. A CT scan or MRI can show details of your sinuses and nasal area. While not recommended for uncomplicated acute sinusitis, imaging studies might help identify abnormalities or suspected complications.
• Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as a bacterial infection.
• Allergy testing. If your doctor suspects that allergies have triggered your acute sinusitis, he or she will recommend an allergy skin test. A skin test is safe and quick, and can help pinpoint the allergen that’s responsible for your nasal flare-ups.

Treatment of acute sinusitis

Most cases of acute sinusitis, those caused by a viral infection, resolve on their own. Self-care techniques are usually all you need to ease symptoms.

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

• Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
• Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
• Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Use nasal decongestants for only a few days. Otherwise they may cause the return of more severe congestion (rebound congestion).
• Over-the-counter (OTC) pain relievers, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Antibiotics

Antibiotics usually aren’t needed to treat acute sinusitis. Even if your acute sinusitis is bacterial, it may clear up without treatment.

Your doctor might wait and watch to see if your bacterial acute sinusitis worsens. However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body’s reaction to specific allergens may help treat your symptoms.

Home remedies for acute sinusitis

These self-help steps can help relieve sinusitis symptoms:

• Rest. This will help your body fight infection and speed recovery.
• Drink fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose.
• Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
• Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
• Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses. If you make your own rinse, use water that’s contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water and leave open to air-dry.
• Sleep with your head elevated. This will help your sinuses drain, reducing congestion.

Cleaning inside your nose

You can clean the inside of your nose using either a home-made salt water solution or a solution made with sachets of ingredients bought from a pharmacy.

To make the solution at home, mix a teaspoon of salt and a teaspoon of bicarbonate of soda into a pint of boiled water that has been left to cool. To rinse your nose:

• wash and dry your hands
• stand over a sink, cup the palm of one hand and pour a small amount of the solution into it
• sniff the water into one nostril at a time

Repeat these steps until your nose feels more comfortable (you may not need to use all of the solution). You should make a fresh solution each day. Don’t re-use a solution made the day before.

Special devices you can use instead of your hand are also available for pharmacies. If you choose to use one of these, make sure you follow the manufacturer’s instructions about using and cleaning it.

Surgery

If your symptoms don’t improve despite trying the treatments mentioned above, a type of surgery called functional endoscopic sinus surgery (FESS) may be recommended. This is a procedure to improve the drainage of mucus from your sinuses.

Functional endoscopic sinus surgery (FESS) is usually carried out under general anesthetic. During the procedure, the surgeon will insert an endoscope into your nose. This is a thin tube with a lens at one end that magnifies the inside of your nose. It will allow the surgeon to see the opening of your sinuses and insert small surgical instruments.

The surgeon will then either:

• remove any tissues, such as nasal polyps (growths), that are blocking the affected sinus
• inflate a tiny balloon in the drainage passages from your sinuses to widen them, before the balloon is deflated and removed (this is known as a balloon catheter dilation)

Potential side effects and risks of these procedures include temporary discomfort and crusting inside the nose, bleeding from the nose and infection. Make sure you discuss the risks with your surgeon beforehand.

Sinusitis or migraine?

Migraines and headaches from sinusitis are easy to confuse because the signs and symptoms of the two types of headaches often overlap.

Both sinusitis and migraine headache pain often gets worse when you bend forward. Migraine can also be accompanied by various nasal signs and symptoms — including congestion, facial pressure and a clear, watery nasal discharge. In fact, studies have shown that approximately 90 percent of people who see a doctor for sinus headaches are found to have migraines instead.

Sinusitis, however, usually isn’t associated with nausea or vomiting or aggravated by noise or bright light — all common features of migraines.

Sinusitis usually occurs after a viral upper respiratory infection or cold and includes thick, discolored nasal mucus, decreased sense of smell, and pain in one cheek or upper teeth.

Sinus headache causes

The sinuses are small air spaces in the skull, found behind the nose, eyes and cheeks. They open out into the nose, allowing mucus to drain and air to circulate normally.

When the lining of the nose and upper airways becomes infected – for example, with a cold – the infection can spread to the sinuses and cause them to become swollen. The small opening from the sinuses to the nose can become blocked, which leads to a build-up of pressure inside the sinuses. This is known as sinusitis.

For some people with sinusitis, the pressure builds up to such an extent that it causes pain, or a sinus headache.

You may feel stuffy and congested for a while, but it normally gets better once the cold goes away.

Sinusitis and sinus headaches can last much longer. This usually only happens if bacteria infect the trapped mucus, or your sinuses repeatedly swell up because of an allergy.

Sinus headaches are usually associated with migraines or other forms of headaches.

Risk factors for sinus headache

Sinus headaches can affect anyone but may be more likely if you have:

• A previous history of migraines or headaches
• A family history of migraines or headaches
• Hormonal changes associated with headaches.

Prevention of Sinus headaches

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of headaches. One or more of these suggestions may be helpful for you:

• Avoid triggers. If certain foods or odors seem to have triggered your headaches in the past, avoid them. Your doctor may recommend you reduce your caffeine and alcohol intake and avoid tobacco. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.

• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent headaches. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in headaches, and regular exercise can help you maintain a healthy weight or lose weight.
• Reduce the effects of estrogen. If you’re a woman who has headaches and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the appropriate alternatives or dosages for you.

Sinus headache symptoms

A sinus headache is a constant, throbbing pain felt in the face (around the eyes, cheeks and forehead), usually only on one side. It tends to be at its worst first thing in the morning and may get better by the afternoon.

The pain may get worse when you move your head, strain or bend down, and when you experience extreme changes in temperature (such as going from a warm room into freezing air outside). It can also spread to your teeth, upper jaw and other parts of your head.

Your face may feel swollen and tender to the touch, and you will also have other symptoms of sinusitis, such as green or yellow mucus discharge from your nose and a high temperature (fever).

Signs and symptoms of sinus headaches — regardless of cause — may include:

• Pain, pressure and fullness in your cheeks, brow or forehead
• Worsening pain if you bend forward or lie down
• Stuffy nose
• Fatigue
• Achy feeling in your upper teeth

The symptoms of a sinus headache can be very similar to those of a migraine and tension-type headache, so it can sometimes be hard to tell which you have, but sinus headaches occur with other sinusitis symptoms, such as fever and nasal discharge.

• Generally, if you have facial pain or a headache, but no other symptoms of sinusitis, you’re more likely to have a migraine or tension-type headache.

Signs and symptoms of sinusitis

Sinusitis usually occurs after an upper respiratory tract infection, such as a cold. If you have a persistent cold and develop the symptoms below, you may have sinusitis.

Symptoms of sinusitis include:

• a green or yellow discharge from your nose
• a blocked nose
• pain and tenderness around your cheeks, eyes or forehead
• a sinus headache
• a high temperature (fever) of 38° C (100.4° F) or more
• toothache
• a reduced sense of smell
• bad breath (halitosis)

Children with sinusitis may be irritable, breathe through their mouth, and have difficulty feeding. Their speech may also sound nasal (as though they have a stuffy cold).

The symptoms of sinusitis often clear up within a few weeks (acute sinusitis), although occasionally they can last three months or more (chronic sinusitis).

Diagnosis of sinus headache

The cause of headaches can be difficult to determine. The doctor will question you about your headaches and do a physical exam.

Your doctor may perform imaging tests to help determine the cause of your headache, including:

• CT scan. CT scans use a computer to create cross-sectional images of your brain and head (including your sinuses) by combining images from an X-ray unit that rotates around your body.
• Magnetic resonance imaging (MRI). With MRIs, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

How to get rid of a sinus headache

Most people who assume they have sinusitis actually have migraines or tension-type headaches.

Migraines and chronic or recurrent headaches may be treated with prescription medication that is either taken every day to reduce or prevent headaches or taken at the onset of a headache to prevent it from getting worse.

To treat these types of headaches, your doctor may recommend:

• Over-the-counter pain relievers. Migraines and other types of headaches may be treated with over-the-counter medications, such as acetaminophen (Tylenol, others), naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB).
• Triptans. Many people with migraine attacks use triptans to relieve pain. Triptans work by promoting constriction of blood vessels and blocking pain pathways in the brain. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Some triptans are available as nasal sprays and injections, in addition to tablets. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved to be more effective in relieving migraine symptoms than either medication on its own.
• Ergots. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are less effective than triptans. Ergots seem most effective in those whose pain lasts for more than 72 hours. Ergotamine may cause worsened nausea and vomiting related to your migraines and other side effects, and it may also lead to medication-overuse headaches. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It’s available as a nasal spray and in injection form. This medication may cause fewer side effects than ergotamine and is less likely to lead to medication-overuse headaches.
• Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro).
• Glucocorticoids (dexamethasone). A glucocorticoid may be used in conjunction with other medications to improve pain relief. Because of the risk of steroid toxicity, glucocorticoids shouldn’t be used frequently.

Home remedies for sinus headache

If you have mild symptoms, you may be able to treat them at home by:

• resting and drinking plenty of fluids
• taking over-the-counter painkillers, such as paracetamol or ibuprofen
• using over-the-counter decongestant nasal sprays or drops to help unblock your nose – although these shouldn’t be used for more than a week at a time
• holding a warm flannel to your affected sinuses for a few minutes, and repeating this several times a day
• flushing the inside of your nose with a saline nasal spray or solution available from your pharmacist – this can help to reduce swelling in the sinuses by cleaning out mucus, bacteria and any allergy-causing particles.