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)
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.
- 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
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.
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.
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)
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.
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.
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)