From the Guidelines
Sinusitis headache pain typically presents as a deep, constant pressure or aching sensation concentrated in specific areas corresponding to the infected sinuses, and is often accompanied by other symptoms such as nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, and cough, as noted in the practice parameter update by the Journal of Allergy and Clinical Immunology 1. The pain is usually felt across the forehead (frontal sinuses), between or behind the eyes (ethmoid sinuses), in the cheeks (maxillary sinuses), or at the top of the head or between the eyes (sphenoid sinuses). Some key characteristics of sinusitis headaches include:
- Worsening when bending forward or lying down
- Most severe in the morning due to mucus accumulation during sleep
- Accompanied by other sinusitis symptoms including nasal congestion, thick yellow or green nasal discharge, post-nasal drip, reduced sense of smell, facial tenderness, and sometimes fever
- Intensifying with environmental changes like temperature shifts or when experiencing sudden head movements The underlying mechanism involves inflammation and pressure buildup in the sinus cavities due to blocked drainage pathways, which stimulates pain receptors in the sinus walls, as described in the study by the Journal of Allergy and Clinical Immunology 1. It's essential to differentiate sinusitis headaches from other types of headaches, such as migraines or tension headaches, which may have different pain distributions, triggers, and associated symptoms, and to consider the diagnosis of sinusitis based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests, as outlined in the practice parameter update 1.
From the Research
Headache Pain Pattern Sinusitis
- Headache attributed to rhinosinusitis is often over-diagnosed in patients who actually have primary headache disorders, most commonly migraine 2
- Failure to recognize and treat rhinosinusitis can have devastating consequences, and abnormalities of the sinuses may be treatable by surgical means, providing headache relief in selected patients 2
- The majority of patients presenting with sinus headache in the absence of significant acute inflammatory findings will be diagnosed with migraine, and the appropriate treatment is migraine-directed therapy 3
Diagnosis and Management
- A thorough neurologic and otolaryngologic evaluation is necessary to diagnose patients presenting with sinus headache 3
- Interdisciplinary otolaryngology-neurology efforts can result in a positive outcome for patients with sinus-headache pain 4
- Approximately 50% of patients may benefit from otolaryngic management, 50% may need neurological treatment, and 7% may require dental disease management 4
Treatment Options
- Migraine-directed therapy is the appropriate treatment for the majority of patients presenting with sinus headache 3
- Directed nasal surgery addressing endonasal contact points may be an option for a highly select group of patients 3
- Endoscopic sinus surgery (ESS) can be effective in patients receiving concurrent neurological intervention, but should be used judiciously 4