How is a sinus headache diagnosed?
It is important that the cause of the headache be diagnosed. Many patients who believe that they have sinus headaches may instead have migraine or tension headaches.The health care practitioner will likely begin with a history of the symptoms to help come to the diagnosis. Contributing factors in the development of sinusitis and headache may include a recent cold or upper respiratory tract infection, history of smoking, environmental allergies to dust or molds, as well as recent airplane travel, swimming or SCUBA diving, or other activities involving air pressure changes.
Physical examination may reveal tenderness to percussion, or tapping, over the affected sinus that reproduces the pain. Examination of the ears may reveal a serous otitis, or fluid levels behind the eardrum in the middle ear, that may suggest drainage problems in the face and sinuses. Examination of the nose may reveal swollen nasal passages and discharge.
The health care practitioner may want to consider imaging studies of the sinuses using a CT scan to look for fluid collections or thickening of the mucus membranes that line the sinus walls. Blood tests tend not to be helpful in making the diagnosis.
What is the treatment for a sinus headache?
The treatment goal for sinus headache is twofold. The first step is to decrease the inflammation within the sinuses and the help them drain. Once drainage occurs and the pressure is relieved, the pain should subside. The second aspect is to make the patient comfortable while the treating the underlying problem.There are mechanical ways to help decrease congestion within the nasal passages. Drinking plenty of fluids will help with the general hydration in the body. Humidified air and salt water nasal spray will help with congestion as well. Neti pots are an alternative way to get humidity into the nasal passages and assist with drainage to prevent inflammation and infection.
Over-the-counter medications are available to help decrease inflammation within the sinuses and promote drainage. Brand name and generic drugs may be considered, but many contain pseudoephedrine (Sudafed), a medication that is related to adrenaline. People with high blood pressure and other heart conditions should consult their health care practitioner or pharmacist before taking these medications.
Some nasal sprays, other than salt water sprays (Ocean NasalSpray), may be used, but only for a short period of time because of side effects and complications. For example, Afrin nasal spray should be used for only three days in a row; otherwise, rebound inflammation may occur. With rebound inflammation, when the spray is stopped, the linings of the nasal passages may swell and potentially cause even more drainage complications.
For those whose sinus headaches are due to allergies, inhaled nasal steroids may be helpful in decreasing inflammation within the nasal passages to treat or prevent sinusitis.
If a bacterial infection is suspected, the health care practitioner may prescribe antibiotics to treat the infection while at the same time make suggestions to treat the underlying inflammation. If the inflammation does not resolve before the antibiotic course is complete, the bacterial infection may recur.
If the sinus headache persists, and repeated courses of treatment fail to relieve the sinusitis, surgery may be an option. Otolaryngologists (ear, nose, and throat surgeons) may be able to widen the openings that allow the sinuses to drain and decrease the risk that recurrent inflammation will obstruct the sinuses from draining.
