Which sinusitis causes pain on the sides of the head?

Which Sinus Infection Causes Pain on the Sides of the Head?

Sphenoid sinusitis is the primary sinus infection that causes pain on the sides of the head (temporal region), presenting as retro-orbital headache that radiates to the vertex and temples. 1

Understanding Sinus-Related Head Pain by Location

The location of your pain directly correlates with which sinus is infected:

Sphenoid Sinusitis (Sides/Temples of Head)

• Pain pattern: Permanent retro-orbital headache radiating to the vertex and temporal regions (sides of head) 1
• Characteristics: The pain's focus, intensity, and permanence may simulate intracranial hypertension 1
• Additional findings: Purulent discharge visible on the posterior pharyngeal wall 1
• Clinical significance: This is a serious infection requiring urgent treatment, often with fluoroquinolones (levofloxacin or moxifloxacin) rather than first-line antibiotics 1

Other Sinus Locations (For Comparison)

Maxillary sinusitis causes:

• Unilateral or bilateral infraorbital pain (below the eyes)
• Pain worsens when bending head forward
• Pulsatile quality, peaking in early evening and night 1

Frontal sinusitis causes:

• Supraorbital headache (above the eyes/forehead) 1

Fronto-ethmoidal sinusitis causes:

• Inner angle of eye filling
• Palpebral edema
• Retro-orbital headache 1

Critical Clinical Caveat

Most chronic facial pain and "sinus headaches" are NOT actually from sinusitis. Research shows that only 16-20% of patients with confirmed sinusitis on endoscopy actually report facial pain 2. The vast majority of patients presenting with temporal or frontal headaches have tension-type headache or migraine, not sinusitis 3, 2.

Red Flags Suggesting True Sphenoid Sinusitis:

• Unilateral symptoms
• Fever and purulent nasal discharge
• Recent viral upper respiratory infection
• Severe, persistent pain preventing sleep 1, 4
• Pain accompanied by endoscopic abnormalities 2

When It's Probably NOT Sinusitis:

• Bilateral, symmetrical temporal headaches (likely tension-type headache) 3
• Episodic unilateral headaches with nasal congestion (likely migraine with autonomic features) 3
• Chronic pain without fever or purulent discharge 3, 5
• Normal nasal endoscopy 2

Diagnostic Approach

Do not obtain imaging for diagnosis unless complications are suspected (proptosis, cranial nerve palsies, severe headache, facial swelling) 6, 7. The diagnosis is clinical, based on:

1. Duration >10 days of purulent nasal discharge
2. Unilateral facial pain/pressure
3. Fever >37.5°C
4. Location-specific pain pattern matching the affected sinus 1, 8

For suspected sphenoid sinusitis specifically, CT imaging may be warranted given the high complication risk and need for aggressive treatment 1.