Headache is a frequent symptom of sinusitis, and often the one that brings a patient to my office for treatment. Take, for example, my patient Larry, a company president who flew across the country at least once a week for business. He was plagued by frequent sinus headaches coincident with air flight. Despite long-term antibiotics, decongestants, and nasal sprays, he had persistent pain around the left side of his face and around his left eye. A CAT scan x-ray revealed a severe left-sided nasal septal deviation with narrow areas of sinus drainage and inflammation in the left maxillary sinus (cheek) and the left ethmoid sinus (around the eye). After surgery to correct the deviated septum and to widen his sinus openings, he was free of headaches.
There are some patients who, like Larry, have actual "sinus headaches" that respond favorably to treatment of the sinus disease. In fact, most patients who come to me with a history of headaches claim to have "sinus trouble." In reality, only a minority of these individuals actually has headaches that are nasal or sinus in origin. However, most patients with chronic sinus infections do have some degree of headache or facial pain, which must be addressed. It is important to try to differentiate if your headache is sinus in origin or due to another cause, since treatment for different types of headaches varies greatly. Any discussion of sinus disease would be incomplete without the common causes and treatments of headaches, and thus this article will explore both the sinus and the non-sinus headache.
The True Sinus Headache
An acute sinus infection may be accompanied by a headache. In these patients, a common cold or nasal allergy progresses to increasing congestion, fever, and pain in the area of the involved sinus. This headache increases in severity when coughing or bending over. The pain tends to be dull rather than piercing or knifelike. I often find that patients are not bothered by their nasal symptoms as much as by their headaches and facial pain.
As we have discussed earlier, adults have four pairs of sinuses. The frontal sinuses are located over the eyes, with pain presenting in the forehead when these sinuses are infected. Infection of the ethmoid sinuses, located in the deeper recesses of the nose rather than in the front of the face, causes pain between and behind the eyes. The deepest pair of sinuses, named the sphenoid sinuses, results in pain referred to the back of the head. This is a rare occurrence. The maxillary sinuses are located in the middle third of the face, below the eyes and to the side of the nose. These are the most frequently infected sinuses, with pain across the face or in the upper teeth on the affected side.
You should begin to suspect that you have an acute infection of the sinuses when a headache develops in the course of what seems to be only a cold. Acute sinusitis requires treatment by a physician, and usually includes an antibiotic and a decongestant.
Headache may also be a feature of chronic sinusitis. Usually characterized as a dull ache or feeling of fullness, this pressure starts after an individual is up and about in the morning, then lasts until late in the afternoon. It is triggered when congestion of the nasal lining results in contact between adjacent structures in the nose and sinuses. This leads to closing off of a normally patent sinus opening (ostium). When the opening to a sinus is blocked, the air within the sinus is absorbed and cannot be replaced because of the blockage. This results in a negative pressure within the sinus compared with the outside barometric pressure. This pressure, plus any accumulated secretions within the sinus, accounts for sinus headaches. Diagnosis usually requires examination and an x-ray study of the sinuses.
Many common things cause changes in air pressure, with resultant sinus swelling and possible headache. Going up and down in an airplane subjects you to quick changes in atmospheric pressure. This is why flying can lead to sinus (or even ear) trouble in the predisposed individual -- one who has an underlying anatomic narrowing. Even if you typically have no problems when flying, if you have an upper respiratory infection and decide to fly anyway, you may end up with a full-blown sinus infection because of the combination of nasal swelling from your cold and pressure changes in the airplane. Taking both an oral and a topical decongestant before takeoff may ameliorate this problem. Scuba diving, with its increased pressure underwater, can similarly lead to sinus swelling and infection.
Another common sinus headache patient I see is typified by Allen, a computer programmer who was debilitated whenever there was a drastic change in the weather. It reached the point where he was better at predicting the forecast than the local TV weatherman. While some might think Allen is crazy, this phenomenon actually has a scientific basis: With changes in atmospheric humidity, pressure changes within the sinuses can cause infection and headache.