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Sinus Headache: What the Otolaryngologist "Nose"
Howard L. Levine, M.D.
Posted: June 2005  
Headache & Pain 2005;16(1):9-14


Objective:   There is a widespread belief among patients that many headaches are "sinus headaches". However, the American Academy of Otolaryngology-Head and Neck Surgery Rhinology and Paranasal Sinus Committee has defined headache alone as a minor symptom of rhinosinusitis. Major diagnostic features of rhinosinusitis are facial pressure/pain, nasal congestion, nasal or postnasal drainage, hyposmia/anosmia, and cough (in children). This article focuses on how headache symptomatology may - or may not - be related to the sinuses.

Treatment:   If the headache is clearly sinus- or nasal-related, the otolaryngologist should treat it based on the cause. For rhinosinusitis, treatment may be medical or surgical. For contact-type headache, treatment may be a topical corticosteroid, decongestant therapy, or surgery. Turbinate dysfunction may be managed medically or surgically.

For the patient with purulent rhinosinusitis, thick secretions may obstruct the outflow channels of the sinuses. A mucolytic (such as guaifenesin) is used for the first several days to thin secretions and to promote drainage. Decongestants (such as pseudoepinephrine) are also used unless there is a medical contraindication (eg, hypertension or cardiac disease). Because many episodes of rhinosinusitis are initially viral, disease is self-limited: mucolytics and decongestants permit early resolution.

For the patient whose symptoms persist or worsen over 5 to 7 days -- or for the patient at risk because of other diseases such as asthma, chronic obstructive pulmonary disease, diabetes, or renal or immune compromise, antibiotic therapy may be considered at the onset of symptoms, in addition to symptomatic treatment. Typically, the medication used is high-dose amoxicillin, amoxicillin/clavulanate, or a fluoroquinolone.

Nasal and sinus surgery is generally indicated for patients with persistent rhinosinusitis that is unresponsive to medical management and for those who have nasal obstruction.

Summary:   If a patientís chief or only symptom is headache, he or she probably does not have sinus headache. Those persons who do have sinus headache have nasal sinus pathology, such as a deviated septum, vasomotor rhinitis, chronic sinusitis, or nasal/sinus polyps. Most patients who present with headache have mixed migraine and tension headache, tension headache or migraine alone, atypical facial pain, or cluster headache.