Sinus infections (and allergy) and headaches are very common medical problems that people often experience on a regular basis. Because they’re both very common problems, they are often believed to have a simple cause and effect relationship. The term “Sinus headache” is a frequent complaint used by both patients and doctors, but research and evidence and patient experience reveals that accurate diagnosis and treatments are typically much more complicated.
There is no accurate clinical definition or diagnostic codes that exist for the classic sinus headache (which is actually referred to as a “rhinogenic headache” by ENT specialists). The term usually is applied when patients have pain and pressure on both sides of the face, including the cheeks, forehead and around the eyes. This type of pain may very well be due to sinus (and allergy) problems, but it’s also common with forms of migraine and tension headaches. Multiple research studies show patients with presumed sinus (and allergy) headaches eventually get treated successfully for a migraine disorder. To make it even less clear, many migraine disorders also cause sinus (and allergy) symptoms like nasal stuffiness! Ok, how can we figure this out?
In my experience, to be diagnosed accurately with sinus (rhinogenic) headaches, the patient will also experience other sinus symptoms such as: nasal congestion or obstruction, post nasal drip and cough, halitosis (a foul taste or odor of the breath), or a reduced or absent sense of smell. The headaches typically coincide with these other sinus symptoms as well (meaning, headaches rarely present without the other sinus symptoms). Moreover, the headache is improved or resolved once treated with sinus (and allergy) medications. Now, on the contrary, these headaches in the absence of the other sinus symptoms are usually not caused by sinuses but are more likely from an underlying migraine or tension variant headache disorder.
However, just to cloud the picture even more, there is another disorder that causes these headaches in the absence of sinus symptoms; they are known as Rhinogenic contact point headaches. This occurs when two apposing surfaces in the sinus/nasal cavities touch (make contact) with each other. When the two sites make contact, the sensory nerves malfunction and cause pain and headaches. Causes are usually a septal deviation or spur (from a previous nasal trauma) or an abnormality in growth during sinus development. So to recap, headaches with sinus symptoms, or headaches without sinus symptoms, may or may not be caused from your sinuses….simple (I hope you picked up on the sarcasm!)!
Now that you’re completely confused, let’s try to help figure this out:
1. If you have the typical sinus headache pain and pressure that is accompanied by other sinus (and allergy) symptoms, then your headaches are likely caused by your sinuses and specific sinus therapies from an ENT specialist will help.
2. If you have the typical sinus headache and pain and pressure but is not accompanied with the other sinus symptoms, then you more likely have a migraine or tension variant disorder or the rhinogenic contact point headache. How can you make a determination? A thorough ENT exam, including an in-office sinus/nasal endoscopy and possibly a dedicated sinus CT scan, is the best method to make an accurate diagnosis.
Classic sinus headaches are usually not as simple to accurately diagnose or treat as we all would hope. However, you don’t have to live with this chronic pain. Precise diagnosis and treatments are available and most patients have very successful outcomes. Find your local ENT specialist to see if your sinuses are the true problem behind these headaches so you can start feeling better.
