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 patient’s 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.
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