SINUS HEADACHE

Introduction:

Sinus headaches cause a dull, deep, throbbing pain in the front of your head and face. They are caused by an inflammation in your sinuses (air-filled cavities around your nose, eyes, and cheeks). Bending down or leaning over generally makes the pain worse, as does cold and damp weather. Sinus headaches often begin as soon as you get up in the morning, and may be better by afternoon. Sinus headaches can be difficult to diagnose, however, because symptoms are similar to tension headaches and migraines.

Signs and Symptoms:

Sinus headaches generally have these symptoms:

• Pressure like pain in one specific area of your face or head (for example, behind your eyes)
• Face is tender to the touch
• Pain is worse with sudden movements of the head and bending forward
• Worse pain in the morning (because mucus has been collecting and draining all night)
• Sudden temperature changes, like going out into the cold from a warm room, worsen the pain
• Headache often starts when you have a bad cold or just after

Other symptoms may be related to sinus inflammation (sinusitis):

• Postnasal drip with sore throat (pharyngitis)
• Yellow or green discharge from your nose
• Red and swollen nasal passages (nasal congestion)
• Mild to moderate fever
• General sense of not feeling well (malaise)
• Fatigue

Migraines can also feel worse when you bend forward and can be accompanied by nasal congestion. But a migraine is more likely to be made worse by noise or light, and to be accompanied by nausea.

Causes:

Sinus headaches can be caused by sinus congestion and inflammation (called sinusitis). Sinusitis, in turn, is caused by either a respiratory infection (such as a cold or flu) or allergies (like hay fever). Healthy sinuses allow mucus to drain and air to circulate throughout the nasal passages. When sinuses become inflamed, these areas get blocked and mucus cannot drain. When sinuses become blocked, they provide a place for bacteria, viruses, and fungus to live and grow rapidly. Although a cold is most often the culprit, sinusitis can be caused by anything that prevents the sinuses from draining.

Risk Factors:

• History of allergies (especially hay fever) or asthma
• Nasal polyps (swellings in the nasal passage), nasal bone spurs, nasal or facial tumor, deviated septum, or cleft palate
• Climbing or flying to high altitudes
• Frequent swimming and/or diving

Diagnosis:

Your doctor will ask questions in order to distinguish sinus headaches from migraines or tension headaches. If you have had a recent cold, allergy flare up, and/or symptoms of sinusitis, it will help your doctor make a definite diagnosis.

Your doctor will look in your nose to check for congestion and nasal discharge. He or she will also press on areas of your face to check for tenderness. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to look for sinus inflammation; if the light does not shine through, your sinuses may be congested.

If your doctor suspects chronic sinusitis, he or she may order imaging tests, including an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). If your doctor suspects allergies may be causing your sinusitis, he or she may suggest an allergy test. Sometimes, a referral to a specialist – known as an ear, nose and throat (ENT) doctor or an otolaryngologist – is necessary. This specialist may perform a nasal endoscopy using a fiber optic scope to look at your sinuses.

Treatment Approach:

The best way to avoid or get rid of a sinus headache is to treat the underlying sinus inflammation. Your doctor may prescribe antibiotics or corticosteroids. Lifestyle changes, such as using a humidifier or irrigating your nasal passages with salt water, may also help. Several dietary supplements and herbs may help prevent colds and flu or shorten their duration, or work together with antibiotics to treat your infection and support your immune system.

Lifestyle

Doing the following things can help reduce congestion in your sinuses:

• Using a humidifier
• Using a saline nasal spray
• Inhaling steam 2 - 4 times per day (for example, sitting in the bathroom with the shower running)
• Quickly treating allergic and asthma attacks

Other techniques that might help include:

• Stretches for the head and neck
• Relaxation techniques (see Mind/Body Medicine section)

Medications

Antibiotics — Your doctor may prescribe antibiotics if he or she suspects you have a bacterial infection. To treat acute sinusitis, you may take from 10 - 14 days of antibiotics. Treating chronic sinusitis may take longer, usually 3 - 4 weeks.

Nasal corticosteroids — These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose. They are most effective at reducing symptoms, although it can take from a few days to a week after you start using them to see improvement.

• Beclomethasone (Beconase)
• Fluticasone (Flonase)
• Mometasone (Nasonex)
• Triacinolone (Nasacort)

Antihistamines — Antihistamines are available in both oral and nasal spray forms, and as prescription drugs and over-the-counter remedies, to treat allergies. Over the counter antihistamines are short acting and can relieve mild to moderate symptoms. All work by blocking the release of histamine in your body.

• Over the counter antihistamines: Include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). These older antihistamines can cause sleepiness. Loratadine (Claritin), a newer antihistamine, does not cause drowsiness.
• Prescription antihistamines: These medications are longer-acting than over the counter antihistamines and are usually taken once a day. They include fexofenadine (Allegra) and cetrizine (Zyrtec).

Decongestants — Many over the counter and prescription decongestants are available in tablet or nasal spray form. They are often used with antihistamines.

• Oral and nasal decongestants: Include Sudafed, Actifed, Afrin, Neo-Synephrin. Some decongestants may contain pseudoephedrine, which can raise blood pressure. People with high blood pressure or enlarged prostate should not take drugs containing pseudoephedrine. Nasal decongestants can cause "rebound congestion," where the nasal passages swell. Avoid using nasal decongestants for more than 3 days in a row, unless specifically instructed by your doctor, and do not use them if you have emphysema or chronic bronchitis.

Triptans -- The majority of sinus headaches satisfy the critria of migraines. In one study, 82% of patients with sinus headaches had a significant response to triptans, a medication commonly used for migraines.

Surgery and Other Procedures

For chronic sinusitis that doesn' t respond to medication, your doctor may recommend endoscopic sinus surgery, which may be done to remove polyps or bone spurs. Enlarging the sinus opening is also sometimes recommended. A newer procedure called balloon rhinoplasty involves inserting a balloon inside the sinus cavity and then inflating it.

Surgical procedures for sinuses are performed by an ENT specialist.

Nutrition and Dietary Supplements

Several supplements may help prevent or treat sinus headaches, either by reducing sinus inflammation or by helping to ward off colds. (See Sinusitis for more details.) Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.

• Bromelain — Several studies suggest that bromelain, an enzyme derived from pineapples, may help reduce inflammation and swelling and relieve symptoms of sinusitis. However, not all studies show a benefit. Bromelain is often combined with quercetin a flavonoid (plant pigment responsible for the colors found in fruits and vegetables) that may act as an antihistamine. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood-thinners) should not take bromelain without talking to their doctor first. Taking bromelain with ACE inhibitors may cause a drop in blood pressure (hypotension).
• Quercetin — Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables. In test tubes, it inhibits the production and release of histamine, which causes allergy symptoms such as a runny nose and watery eyes. It' s often combined with bromelain, a supplement made from pineapples. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed. Some people may prefer water soluble forms of quercetin, such as hesperidin methyl chalcone (HMC) or quercetin chalcone.
• Probiotics (Lactobacillus) — Probiotics, or "friendly" bacteria, may be helpful if you are taking antibiotics for sinusitis. They may also reduce your chances of developing allergies.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.

As with supplements, there are many herbs that may help reduce your chances of getting a sinus headache by preventing or treating a cold, enhancing your immune function, or reducing sinus inflammation.

Sinupret (A proprietary formulation containing Sambucus nigra or European elder, Rumex acetosa or common sorrel, Primula veris or cowslip, Verbena officinalis or European vervain, Gentiana lutea or gentian) — In two studies, Sinupret was found to be more effective than placebo in relieving symptoms of sinusitis. The herbs it contains may work by thinning mucus and helping the sinuses to drain, and they may also help strengthen the immune system.

Although adequate research is lacking, other herbs that have been used traditionally to treat headaches include:

• Chinese skullcap (Scutellaria baicalensis)
• Devil's claw (Harpagophytum procumbens)
• Feverfew (Tanacetum parthenium)
• Willow bark (Salix spp.)

Homeopathy

One of the most common reasons people seek homeopathic care is to relieve chronic headaches. Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for sinus headaches based on their knowledge and clinical experience. In one study of homeopathy for sinusitis, more than 80% of the participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are remedies commonly prescribed for sinus congestion and headache:

• Arsenicum album — for throbbing, burning sinus pain that is relieved by lying upright in a cool room with open windows
• Belladonna — for throbbing headaches that come on suddenly and feel worse with motion and light; pain is partially relieved by pressure, standing, sitting, or leaning backwards
• Bryonia — for headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation
• Hepar sulphuricum — for headaches described as "a nail being driven between the eyes;" these types of headaches are often accompanied by thick, yellow nasal discharge; symptoms tend to worsen with movement and light touch of the scalp and improve with pressure
• Iris versicolor — for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting
• Kali bichromicum — for sinus headaches and congestion; pain often occurs between and behind the eyes; symptoms generally progress throughout the morning, worsen with cold and motion, and improve with warmth and pressure
• Mercurius — for raw, swollen nostrils; this remedy is most appropriate for individuals whose pain feels as though the head has been placed in a vise; pain may also extend to the teeth; symptoms tend to worsen at night and the individual may alternate between sweating and having the chills; nasal discharge may be bloody
• Natrum muriaticum — for headaches and congestion associated with allergies
• Pulsatilla — for headaches triggered by eating rich, fatty foods, particularly ice cream; pain may move around the head but tends to be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; symptoms tend to worsen at night and with coughing and blowing the nose; children often develop these symptoms while at school
• Silicea — for sinus pain that improves with pressure, head wraps, and warm compresses
• Spigelia — for stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up

Acupuncture

Although studies are few and have found conflicting results, some people may find that acupuncture helps relieve symptoms of sinusitis. An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances. Acupuncturists usually describe sinusitis as "dampness" which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy and/or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for this condition.

Chiropractic

Although no studies have examined using chiropractic to treat sinusitis, some practitioners suggest that it may decrease pain and improve sinus drainage for some people.

Mind/Body Medicine

For headaches in general, relaxation techniques can be helpful. That's especially true if the headaches are chronic and recurrent, as sinus headaches can be. You may want to try these techniques:

• Biofeedback to control muscle tension
• Learn to meditate, breathe deeply, or try other relaxation exercises, such as yoga or hypnotherapy
• Try giuded imagery techniques

Other Considerations:

If you are not better in a few weeks, your primary care physician may send you to see an ear, nose, and throat specialist for tests to find the cause of your sinus congestion.

Pregnancy

Sinus congestion often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use. Check with your doctor before using any herbs or supplements if you are pregnant or breastfeeding.

Warnings and Precautions

You should seek emergency medical attention if you experience the following:

• Sudden and severe headache that persists or increases in intensity over 24 hours
• A sudden, severe headache that you describe as "your worst ever," even if you are prone to headaches
• Chronic or severe headaches that begin after age 50
• Headaches accompanied by memory loss, confusion, loss of balance, change in speech or vision, or loss of strength in or numbness/tingling in any one of your limbs
• Headaches accompanied by fever, stiff neck, nausea and vomiting (may indicate meningitis)
• Severe headache localized to one eye, accompanied by redness of the eye (may indicate acute glaucoma)

Alternative Names:

Headache - sinus

• Reviewed last on: 9/30/2009
• Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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