Last week I received an e-mail from a friend who lives abroad and that I haven’t seen for a long time. Below is an excerpt.

“Recently I had a nasty virus/cold whatever. The reason I am telling you this is because I do not normally fall for advertised medication, but this time, even after taking a course of antibiotics I was getting unbearable headaches that woke me up at 4 every morning, splitting, throbbing…I was devastated until a friend brought me some Sudofed, which cleared it all out in about a week (but the headache stopped after the first day!)
I know you are mainly concerned with different types of headaches but it is quite puzzling that my doctor wouldn’t suggest taking/trying that, it was just a matter of clearing my sinuses…”

This combined with the fact that winter is a time for colds and flu prompted me to post some thoughts on sinus headaches.

Notwithstanding the above e-mail, the fact is that whereby many people believe that their head pain is due to sinus `infections`(and may even have been told this by their GP) the reality is they often have migraine with associated nasal congestion. That is to say the nasal congestion is the result of, rather than a cause of, the head pain.
It is also worth noting that on many occasions I have had patients in the clinic believing they have sinus headache when in fact there are suffering from some other type of head pain such as so-called `tension type` headache. In addition it is important to remember that dental problems may also refer pain into the sinuses.

Indeed you may also be surprised to hear that as yet research has failed to show a strong association between recurrent low grade sinus problems and frequent headaches. Nevertheless sinus headache does exist and what follows is a brief summary.

Maxillary- tends to give pain in cheek teeth or upper jaw
Ethmoid- tends to give pain between the eyes
Frontal- tends to give pain in the forehead
Sphenoid- tends to give pain on top of the head or generalised over the whole head

In typical cases pain associated with sinusitis is a dull, deep ache with feelings of fullness/congestion, made worse by bending forwards, coughing, sneezing and blowing the nose.The pain will often be worse in the morning, easing throughout the day. It may also interfere with sleep.

It is worth noting that Sinus headaches are more commonly found in association with the following;

1. Frequent illness(viral/ bacterial).
2. Allergies &/or sensitivities; usually inhalant-type (hayfever, dust etc) but also possibly others(for example food).
3. Overuse of decongestants.
4. Smoking.
5. Abnormal anatomy of the relevant parts of the Skull.
6. Presence of adenoids/polyps etc.
7. Coexisting emotional stress.
8. Any other condition that promotes inflammation and/or interferes with drainage from the sinuses.

Unfortunately there are few tests that will absolutely confirm, or alternatively rule out, the diagnosis of sinus headache. X-rays of the head/sinuses are of little value, MRI scans are more helpful and in extreme cases it may be necessary to investigate the sinuses with small cameras (a so-called endoscopy).
However, as with many other types of headache, diagnosis is usually based around the nature of the symptoms and the history of the patient and their head pain, rather than specific medical/laboratory tests.

Once sinus headache is suspected treatment will depend on the cause/causes; in essence resolving any infection, reducing swelling within, and improving drainage from, the sinuses. It is also vital to identify and dealing with any coexistent problems (such as allergies) which maybe contributing/maintaining problems within the sinuses.

An opinion from a headache specialist is therefore strongly recommended for accurate diagnosis and appropriate management/advice.

N.b. Interestingly frequent use of nasal decongestants very occasionally cause a type of headache which is characterised by very sudden attacks of severe head pain (and sometimes associated symptoms of dizziness, visual disturbance, and others) the medical name for this is Reversible Cerebral Vasoconstriction Syndrome and is one of the causes of so-called `thunderclap`headaches.
If you think you suffer from `thunderclap` type headaches you should ALWAYS consult your GP or headache specialist.


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