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Howard Levine, M.D.
Mt. Sinai Nasal-Sinus Center, Cleveland, OH
Headache is a common complaint that is often associated with sinusitis. However, the true cause for a headache may be difficult to determine because headaches have many causes. The United States Center for Disease Control reports that sinusitis affects over 30 million people and is the most common chronic disease in this country. Thus, many sinus sufferers will also suffer headaches. While headaches and sinusitis are common problems sometimes headaches occur with sinusitis and sometimes they do not.
Typically, a nasal and/or sinus problem will have congestion and stuffiness, often with nasal drainage. If an infection is present there will be discolored, thick drainage in the front of the nose and down the back of the throat. If a headache is present, it is usually a pressure sensation varying in intensity from almost non-existent to somewhat severe.
Generally, a sinus headache will be located over the sinuses, (forehead, corners of the eye, and cheek areas). On occasion, the pain will be felt behind the eyes, in the back of the neck, or may extend into the upper teeth. Head movement usually worsens this headache.
The true cause for headache may be difficult to determine...
sometimes headaches occur with sinusitis and sometimes not.
Non-sinus headaches may give these same symptoms thus making it difficult to determine if the headache is truly from a sinus problem. For example, tension headaches will occur in the forehead and neck; migraine headaches often occur in and around the eyes.
It is unusual for a person with a sinus or nasal problem to only have a headache. A sinus headache is nearly always accompanied by nasal stuffiness, congestion, obstruction, or drainage. When headache is the only symptom, it is rarely sinus related.
The main cause of nasal and sinus headaches is the nasal turbinates - nasal structures that swell and contract throughout the day giving the feeling of nasal congestion and occasionally pressure. Worsened by irritants such as perfume, cigarette smoke or allergens, the internal swelling causes facial pressure. When the turbinates swell, not only is the breathing passage blocked, but also normal sinus draining passages are blocked creating a "back-up" situation.
Drainage remains "trapped" in the sinus cavity causing the pain and pressure you feel over the sinuses. It may also cause an infection.
Oral decongestants (i.e. pseudoephedrine) or a nasal spray (i.e. neosynephrine, oxymetazoline) will often give relief. However, these sprays should not be used for more than a few days since they can cause even more congestion when their effect wears off.
Caution is needed when using decongestant pills, especially is a person has a history of heart disease or high blood pressure. These adrenaline-like medications can cause a rapid heart rate or increased blood pressure.
If over the counter medical management for nasal congestion is not effective, a physician may choose to prescribe a steroid nasal spray.
If medical management fails or cannot be tolerated, surgery to reduce the turbinates is extremely successful.
Another cause for a sinus headache is the common cold, which may seem to be a sinus infection. If over-the-counter cold remedies fail and the symptoms continue beyond several days or if there are other debilitating medical problems, a physician should be called.
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