How does sinusitis cause headache?

From the Guidelines

Sinusitis causes headaches primarily through inflammation and pressure buildup in the sinus cavities, which can be effectively managed with treatments such as decongestants, saline nasal irrigation, intranasal corticosteroids, and antibiotics if bacterial infection is present, as supported by the most recent evidence 1.

Mechanism of Headache

The mechanism by which sinusitis causes headaches involves the inflammation of the mucous membranes lining the sinus cavities, leading to swelling and blockage of normal drainage. This results in the accumulation of mucus, creating pressure within the confined sinus spaces that can directly stimulate pain-sensitive nerve endings. The location of the headache often corresponds to the affected sinus, with frontal sinusitis causing pain above the eyes and in the forehead, maxillary sinusitis causing pain in the cheeks, ethmoid sinusitis causing pain between and behind the eyes, and sphenoid sinusitis causing pain behind the eyes or at the top of the head.

Symptoms and Diagnosis

Symptoms of sinusitis include nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, headache, and cough, as outlined in the study by 1. The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. Acute bacterial sinusitis is suspected in patients whose upper respiratory tract infection has persisted beyond 10 to 14 days, with prominent symptoms including nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, headache, and cough.

Treatment and Management

Treating the underlying sinusitis with decongestants like pseudoephedrine, saline nasal irrigation, intranasal corticosteroids such as fluticasone, and antibiotics if bacterial infection is present will typically relieve the associated headache as the inflammation subsides and normal sinus drainage is restored, as recommended by 1. It is essential to note that the treatment approach may vary depending on the severity and duration of symptoms, as well as the presence of any underlying conditions or complications.

Key Points

• Sinusitis causes headaches through inflammation and pressure buildup in the sinus cavities.
• The location of the headache often corresponds to the affected sinus.
• Symptoms of sinusitis include nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, headache, and cough.
• Treatment involves decongestants, saline nasal irrigation, intranasal corticosteroids, and antibiotics if bacterial infection is present.
• The most recent evidence supports the use of these treatments to effectively manage sinusitis and relieve associated headaches, as outlined in the study by 1.

From the Research

Sinusitis and Headache

• Sinusitis is not a common cause of headache, with the majority of patients experiencing tension-type headache or migraine 2, 3.
• Acute sinusitis, particularly frontal sinusitis or sphenoiditis, can cause headache due to increased pressure and inflammation caused by pus trapped within the sinus cavity 2.
• Chronic sinusitis is not considered a usual cause of headache, unless it relapses into an acute stage 2, 3.
• The International Headache Society classification is robust in qualifying the term "sinus headache" and states that chronic sinusitis is not validated as a cause of headache and facial pain unless relapsing into an acute stage 2.

Diagnosis and Treatment

• Nasal endoscopy and imaging of the paranasal sinuses can help diagnose sinusitis and guide treatment 2, 4.
• Patients with acute sinusitis usually respond to antibiotics, while those with chronic sinusitis may require adjuvant therapies and surgery 2, 4.
• A systematic approach to differential diagnosis and a multidisciplinary approach are critical in providing optimal patient care for those with headache and rhinologic symptoms 5.

Common Misconceptions

• The idea that sinusitis can trigger migraine is misplaced, as the whole symptom complex is vascular and coexisting nasal congestion is due to vasodilation of the nasal mucosa 2.
• Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities and instead meet the IHS criteria for migraine or tension-type headache 3.