Sinus Headache
| M. Lee Williams, M.D. Assoc. Professor Emeritus Johns Hopkins Otolaryngology Author: The Sinusitis Help Book John Wiley and Sons, Inc. |
A persistent headache is too often blamed on a sinus infection when some other cause is responsible. In many instances, however, an accurate preliminary diagnosis of a sinus headache can be made by very careful questioning of the patient. In doing so it is important to remember that sinus headaches and sinus infections occur less often in the elderly and headaches after sixty are more likely due to something more serious. A sinus headache is a dull deep seated continuous pain with certain identifying characteristics and not a sharp, needle-like or throbbing pain.
Since the eight paranasal sinuses are paired four on each side of the head, any head pain caused by an infection in only one of them would be limited to one side of the head. However, an infected sinus will usually involve other sinuses nearby and this may tend to change the location of the head pain. When a sinus does become infected the pain is usually close to the involved sinus. The main exception to this is the sphenoid sinus located in the center of the skull, and when infected usually refers pain to the top or back of the head. Ethmoid and frontal sinus headaches are nearly always located in the medial brow area or the medial side of the orbit and just above the eye. The two maxillary sinuses located in the cheeks below the eye and above the teeth will usually, when infected, involve the ethmoid sinuses on that side, thereby referring pain to the brow and orbit as well as to the cheek, the back of the head and sometimes to an ear or tooth. One of the most striking things about a sinus headache is that it nearly always goes away during the night only to return the next morning and usually early if only an ethmoid sinus is involved and midmorning if only a frontal sinus is infected. Head pain from a frontal sinus infection characteristically begins mid-morning, increases toward the middle of the day and goes away in the evening, often referred to as “sun pain.” Whereas ethmoid sinus pain will begin early in the morning and usually disappear by midday, only to return in the evening. If the sinus head pain should persist throughout the night and become more intense, it could mean that the infection has extended beyond the confines of the boney sinus walls to involve the orbit, the central nervous system or the cavernous sinus, a blood lake behind the orbit, and to cause certain visual disturbances such as double vision, a high fever, elevated white count and other disturbing symptoms. Fortunately this rarely happens. Uncomplicated sinusitis usually causes little or no fever or even an elevated white count unless accompanied by a lung infection, bad sore throat or ear infection as seen more often in children.
A vacuum sinus headache may occur due to a sudden pressure change as in flying or diving with a blocked sinus and sometimes without any infection. This is usually very temporary unless there is a hemorrhage into the sinus wall or into the wall of the duct leading to the sinus and blocking the sinus air exchange and sinus drainage.
Since a sinus infection is the cause of a sinus headache it is important to confirm its presence with an examination as well as careful questioning. It would be important to know if the headache followed a plane flight, a head cold or flu and if the mucous drainage from the nose or any sputum coughed up is no longer clear but yellow, green or opaque white and therefore infected. Morning sore throats will often be noted from infected sinus discharge lodging in the throat overnight. Another important question is what makes the headache better or worse. Bending over, lifting, coughing, or straining will usually make a sinus head pain momentarily worse, whereas decongestant pills or nasal sprays and sleeping elevated will usually lessen the pain. Cold packs on the forehead may help momentarily but hot moist compresses to the forehead and cheeks will give a more sustained relief. It is also important to know how much relief was obtained with the usual pain medicines or if a much stronger medication was required and might therefore suggest seeking another cause for the headache. A good final question would be whether the patient has ever experienced this very same headache before, and if so whether it followed, a cold, flu or plane flight, how long it lasted, the color of the nasal discharge, the final diagnosis and what treatment seemed to work.
Asking sensible questions and obtaining thoughtful answers from an observant patient should hasten the diagnosis and treatment of a sinusitis headache.
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Thanks for this article. Right now I have exactly what’s described about the frontal sinusitis! I am completely fine (no pressure nor dull ache) when I just wake, but around 10-11AM it sets in, agonizing pressure and dull pain behind my left eye and temple, until around 4 or 5PM when it subsides. It’s been like this for about 3 days.
This is preceded by about 1.5 weeks of nasty cold and coughs (which are thankfully all but gone now).
Really hope it goes away in a couple more days! I’m using a combination of ibuprofen+pseudoephedrine, NeilMed nasal rinse, and doctor-prescribed Nasonex to really combat it.
I really liked how you addressed this particular and painful side of sinusitis. I think that it is not discussed often enough.
Thank you for the thoughtful and insightful post!
I am a sinus and nasal surgeon in New York City. I have found that many patients attribute any discomfort in the face or head to either sinus pain or migraines. It is important to consider the most common differential diagnoses because conservative treatment at home can frequently resolve the pain. TMJ or temporomandibular joint disorder can cause sharp or throbbing pain that can involve the cheeks, jaw and radiate to the temples and sides of the head (https://www.nycfacemd.com/temporomandibular-joint-disorder/). Dental pain in the upper jaw can feel like sinus pain. Tension headaches feel like a band across the forehead and can cause tightening of muscles all over the head and neck. Understanding where your pain is coming from and a trial of conservative treatment may bring relief.
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Jessie ~ here’s to your headache being gone!
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