Neurologic Diseases: Sinus Headache

Introduction

Sinus headache is a relatively common type of headache.

As the name implies it is the sinus problem that gives rise to headache. Sinuses are the air filled cavities in the skull bones and they are located on the front aspect (anterior aspect) of the skull bone and accordingly this type of headache is essentially felt in the front area of the head (forehead and/or face areas). Not all headaches that present in the forehead or face area are due to sinuses but when sinus problems present with headache then the symptoms are essentially confined to the above mentioned areas.

The most common sinus condition that is associated with this headache is sinusitis. Sinusitis is the infection and/or inflammation of the sinuses. Sinus infection is a common condition and most of the pathogens are bacteria or viruses. Among the bacteria pneumococcal and H influenza are the usual organisms.

How does the patient present?

The following are the usual symptoms;

• Headache
• Fever
• Congestion/stuffy feeling
• Nasal secretions
• Post nasal drip etc

If bacterial infection is present the color of the nasal secretion (phlegm) may be yellowish or greenish.

More on Sinus-Headache

So this type of headache may be associated with sinusitis manifestations. This usually helps in differentiating this type of headache from other common headache conditions like migraine, tension headache etc.

But some patients have minor sinus symptoms especially the chronic sinusitis patients. Many of these patients have some chronic allergy of the sinuses. Since sinus symptoms are mild sometimes it is difficult to differentiate from migraine or other headaches.

The following features generally help in differentiating sinus type headache from migraine type;

• Typical sinusitis symptoms
• Tenderness over the sinus
• Headache distributed more in the face and forehead areas
• Absence of light or sound bothering much (presence favors migraine)
• Absence of aura and/or premonitory symptoms like seeing lights, stars, blind spots (presence favors migraine)
• Investigations are suggestive of sinusitis

Diagnosis

If diagnosis cannot be made clinically or if surgical interventions are considered then an imaging study like x-ray or CT or MRI of the sinuses is obtained.

Treatment

The migraine headache medications like Triptan group of agents (e.g. Sumatriptan or Imitrex) are generally not helpful for this headache. This type of headache is generally treated with NSAIDs (non steroidal anti-inflammatory drugs) like Naproxen, Ibuprofen etc. They can cause gastrointestinal bleed and many other side effects.

If infection is present then a course of antibiotics necessary. Antibiotics like azithromycin, amoxicillin with clavulanate, ampicillin, ofloxacin are some of the choices.

Decongestants like antihistaminics are not to be used routinely as they may cause thickening of sinus secretions and difficult to expel.

If allergic sinusitis is causing the sinus headache then avoidance of the allergies as much as possible, anti-allergy shots, steroid preparations, preventive agents like sodium chromoglycate etc are some options.

This type of headache is commonly treated by a neurologist or ENT dr, or a family doctor.



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