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Sinus headaches
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/sinus-headaches/DS00647
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Definition
Sinus headaches are headaches that may accompany sinusitis, a condition in which the membranes lining your sinuses become swollen and inflamed. You may feel pressure around your eyes, cheeks and forehead. Perhaps your head throbs. Although these can indicate sinus headaches, don't jump to conclusions. Many people who assume they have sinus headaches actually have migraines or tension headaches.
When sinus headaches caused by sinusitis do occur, proper diagnosis and treatment are the keys to relief.
Symptoms
Sinus headache signs and symptoms may include:
- Pain, pressure and fullness in your cheeks, brow or forehead
- Pain may worsen when bending forward or lying down
- Yellow-green or blood-tinged nasal discharge
- Sore throat
- Fever
- Cough
- Fatigue
- Achy feeling in your upper teeth
Sinus headache or migraine?
It's important to note that it's possible to confuse migraines and sinus headaches. This is because the signs and symptoms of the two types of headaches overlap. Studies have shown that 90 percent of those with "sinus headaches" actually have migraines.
As with sinus headaches, migraine pain often gets worse when you bend forward, and migraines can be accompanied by various nasal signs and symptoms — including congestion, facial pressure and a clear, watery nasal discharge.
Sinus headaches, however, usually aren't associated with nausea or vomiting, or aggravated by noise or bright light — all common features of migraines.
When to see a doctor
Consult your doctor if:
- Your symptoms last longer than 10 days
- You have a severe headache, and over-the-counter pain medicine doesn't help
- You have a fever greater than 100.5 F (38 C)
Causes
Sinus headaches accompany sinusitis, a condition in which the membranes lining your sinuses become swollen and inflamed. Sinusitis can be caused by colds, bacterial or fungal infections, an impaired immune system, or structural problems in the nasal cavity. The resulting pressure changes in the sinuses can trigger headaches.
Risk factors
Sinusitis can affect anyone. You may be more likely to develop chronic sinusitis if you have:
- Asthma
- Nasal growths (polyps)
- Allergies to dust, mold or pollen
- A weak immune system
- A condition that affects the way mucus moves within your respiratory system, such as cystic fibrosis
- Exposure to cigarette smoke, first- or secondhand
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to an ear, nose and throat doctor (otolaryngologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restricting your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For sinus headaches, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Are there other possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first experience your headache?
- Has your headache been continuous or occasional?
- Has anyone in your immediate family experienced migraines?
- What, if anything, seems to improve your headaches?
- What, if anything, appears to worsen your headaches?
Tests and diagnosis
The cause of headaches can be difficult to determine. The doctor will ask questions about your headaches and do a physical exam. Be sure to mention if you've had a recent cold, if you have allergies and if you smoke. These factors may precipitate or contribute to acute sinusitis.
Your doctor may perform one of these tests to determine if you have sinusitis:
- Nasal endoscopy. Tender sinuses may be one sign of sinusitis. The doctor may use a thin tube with a light (endoscope) to examine your nasal passages.
- Mucus testing. He or she may also test mucus samples from inside your nose for evidence of a bacterial or fungal infection.
- Imaging tests. Examples include CT or MRI scans. 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. With MRIs, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.
Treatments and drugs
If you're diagnosed with sinusitis, your doctor may recommend:
- Antibiotics. Be sure to finish the entire course of medication you're prescribed — even if your signs and symptoms disappear before all the pills or capsules are gone. This is the only way to eradicate the germs causing the infection.
- Corticosteroid nasal sprays or pills. Your doctor may prescribe this medication if your sinusitis is related to inflammation or allergies.
- Over-the-counter medications. As the sinus infection clears up, the sinus headaches should disappear. In the meantime, over-the-counter pain relievers, decongestants and saline nasal spray might help you feel better. Use these products only as directed. It may help to drink plenty of fluids as well.
- Surgical correction. If a structural problem in your nasal cavity is contributing to sinusitis or sinus headaches, surgical correction may be recommended.
Prevention
To reduce the risk of sinusitis, keep your sinuses healthy.
- Wash your hands often. Soap and water can help you avoid the upper respiratory infections that can lead to sinusitis. You may want to ask your doctor about a yearly flu vaccine as well.
- Avoid irritants. Avoid cigarette, cigar and pipe smoke. These and other air pollutants can cause your sinus membranes to swell.
- Use a humidifier. Adding moisture to dry indoor air can help prevent sinusitis — but don't overdo it. High indoor humidity can promote mold and dust mite growth in your home. Be sure the humidifier is clean and kept free of mold.
- Bajwa ZH, et al. Headache symptoms other than migraine. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2009.
- Hwang PH, et al. Acute sinusitis and rhinosinusitis in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2009.
- Sinus headaches. American Academy of Otolaryngology — Head and Surgery. http://www.entnet.org/HealthInformation/sinusHeadache.cfm. Accessed Dec. 17, 2009.
- Sinus infection (sinusitis). Centers for Disease Control and Prevention. http://www.cdc.gov/getsmart/antibiotic-use/URI/sinus-infection.html. Accessed Dec. 17, 2009.
- Sinusitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch091/ch091g.html?qt=sinus headache&alt=sh. Accessed Dec. 16, 2009.
- Sinus headache. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_Sheets/Sinus_Headache. Accessed Dec. 17, 2009.
- Headache and sinus disease. American Rhinologic Society. http://www.american-rhinologic.org/patientinfo.headache.phtml. Accessed Dec. 17, 2009.
- Swanson JW (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 23, 2009.
- Schreiber CP, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Archives of Internal Medicine. 2004;164:1769.
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