Can sinusitis or its treatment cause headache or dizziness?

Can Sinusitis or Its Treatment Cause Headache or Dizziness?

Yes, sinusitis itself commonly causes headache, but dizziness is not a typical symptom of uncomplicated sinusitis. Headache is one of the prominent symptoms of acute bacterial sinusitis, while dizziness should prompt evaluation for complications or alternative diagnoses 1.

Headache as a Direct Symptom of Sinusitis

Acute Bacterial Sinusitis

• Headache is a prominent and well-recognized symptom of acute bacterial sinusitis, occurring alongside nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, and cough 1.
• The location of headache varies by affected sinus 1:
  • Maxillary sinusitis: Unilateral or bilateral infraorbital pain that increases when bending forward, often pulsatile and peaking in early evening and at night 1
  • Frontal sinusitis: Supraorbital headache 1
  • Sphenoid sinusitis: Permanent retro-orbital headache radiating to the vertex, with intensity that may simulate intracranial hypertension 1
  • Fronto-ethmoidal sinusitis: Retro-orbital headache 1

Chronic Sinusitis

• Chronic sinusitis symptoms are similar to acute sinusitis but more subtle 1.
• Headache attributed to chronic sinusitis may actually be a migraine equivalent rather than true sinus-related pain 1.
• The International Headache Society states that "chronic sinusitis is not validated as a cause of headache and facial pain unless relapsing into an acute stage" 2.

Fungal Sinusitis

• Fungus ball can cause nasal obstruction and headache as the mass impinges on surrounding structures 1.
• Invasive fungal sinusitis presents with fever, headache, epistaxis, and mental status changes in immunocompromised patients 1.

Important Diagnostic Pitfall: Migraine Misdiagnosed as Sinusitis

The vast majority of patients diagnosed with "sinus headache" actually have migraine or tension-type headache, not sinusitis 2, 3, 4.

• In one study, 81.5% of migraine patients were misdiagnosed as having sinusitis, with a mean diagnostic delay of 7.75 years 3.
• Among patients with a primary diagnosis of "sinus headache," the final diagnoses were migraine (68%), tension-type headache (27%), and actual chronic sinusitis (only 5%) 4.
• Autonomic symptoms accompanying migraine (nasal congestion, rhinorrhea) are due to vasodilation of nasal mucosa during the vascular event, not sinus infection 2.
• True sinus headache requires both clinical symptoms AND radiological evidence of acute bacterial rhinosinusitis 5.

Dizziness and Sinusitis

Dizziness is NOT listed as a typical symptom of uncomplicated sinusitis in any major guidelines 1.

When Dizziness Occurs with Sinusitis

If dizziness is present, consider:

• Intracranial complications: Meningitis, encephalitis, epidural/subdural empyema, brain abscess, or dural sinus thrombophlebitis 1.
• Mental status changes are a warning sign of invasive fungal sinusitis or intracranial extension 1.
• Altered consciousness suggests intracranial complications requiring immediate imaging and hospitalization 1.

Treatment-Related Considerations

Medications That May Cause Dizziness

While the evidence provided does not specifically address dizziness from sinusitis treatments, common medications used include:

• Antibiotics (amoxicillin-clavulanate, cephalosporins, fluoroquinolones) 1, 6, 7
• Decongestants (topical or systemic) 8, 7
• Intranasal corticosteroids 8, 7
• NSAIDs or acetaminophen for pain 8, 7

Critical Treatment Pitfalls

• Do not use topical decongestants beyond 3 days to prevent rhinitis medicamentosa (rebound congestion) 8.
• Avoid empiric antibiotics unless symptoms persist >10 days without improvement, severe symptoms last ≥3 consecutive days, or "double sickening" occurs 8, 7.
• Reassess at 3-5 days if no improvement; consider switching to broader-spectrum antibiotics 6, 7.

Red Flags Requiring Immediate Evaluation

Seek immediate medical attention if any of these occur 1, 7:

• Severe headache preventing sleep 1
• Altered consciousness or mental status changes 1
• Seizures, hemiparesis, or cranial nerve palsy 1
• Pott puffy tumor (frontal bone swelling) 1
• Periorbital edema, proptosis, ophthalmoplegia, or abnormal visual examination 1
• Meningeal signs 1

These symptoms indicate potential intracranial or orbital complications with significant morbidity and mortality risk, requiring hospitalization, imaging, and parenteral antibiotics 1.