Sinus Headache

Giving the headache a specific name seems to make it more serious, and severe enough to warrant attention. It is usually not a doctor who has labeled the headaches as arising from the sinuses. More frequently it’s a self-diagnosis or the explanation of a well-meaning friend.

In medicine, there are two types of sinus that are important. The word sinus is Latin and means a hollow, bay or gulf.

One form of the sinus is a blind track leading from an epithelial surface, such as the skin or the mucous membrane lining some hollow organ, into the surrounding tissues. This can be congenital or acquired, usually arising from an abscess or pocket of pus that has burst through to the surface and continues to drain pus and prevents healing.

An abscess near the anus may burst through the wall of the anal canal and discharge into it. This fails to heal and leaves a blind track leading back to the space where the abscess was.

Another type of sinus in this category is the track leading from a small dimple in the cleft between the buttocks into the surrounding tissues. This is a pilonidal sinus and is subject to frequent bouts of infection.

Though neither of these types is the sinus we started out to talk about, we doctors use these terms when explaining to our patients what is wrong with them and it may be helpful for you to know that the term sinus has these extra meanings.

The nasal sinuses are air-containing cavities in the bones of the face and skull with small openings to the nose. Their lining is of the same tissue as that which lines the nose.

There is some doubt about the true function of these sinuses. They are thought to lighten the bones of the face and skull without reducing their strength. They may provide resonance for the voice, or they may be accessory olfactory or smelling organs like the nose that have been leftover in the evolutionary process.

The frontal sinuses lie in the frontal bones on either side above each eye, the ethmoidal sinuses in the ethmoidal bones behind the nose at the inner borders of the orbits in the eyes.

The antra or maxillary sinuses are in each maxilla, the bone that lies under the eye and forms the ridge of the cheek. These cavities become fully formed in children about the age of 12.

The main trouble that can arise from the sinuses is an infection, which usually spreads from the nose and may follow a cold or respiratory infection. In children, the sinuses may be infected as part of a tonsillitis or adenoidal infection. Occasionally they become infected when a person goes swimming in contaminated water.

With acute infection, the lining of the sinus is inflamed and swells. This may block the opening to the nose and prevent drainage when pus forms. There may be a fever and the patient is ill and toxic.

Pain is felt over the sinus, and the skin is tender if tapped with the finger. Pus may discharge through to the nose, and there will be the symptoms of the respiratory infection that caused the sinusitis.

If the infection is not treated or does not subside, it may spread to surrounding tissues. The bones can become infected and osteomyelitis results. If the coverings of the brain are involved this is a meningitis. If the infection penetrates these coverings, an abscess deep in the brain may result.

Antibiotics are usually necessary to control the infection, and measures to reduce the swelling and promote drainage are helpful. Decongestant drugs, by mouth or locally, reduce the swelling.

Pain and swelling may also be reduced by local heat from a hot water bottle, an infrared lamp, or by short wave diathermy. Inhaling steam, with or without menthol, is old fashioned but effective.

Chronic sinusitis is usually the result of an acute infection that does not settle down completely or recurrent mild infections. It may be associated with allergy, hay fever, or with nasal polyps, grape-like growths of the lining tissue.

A bend in the septum, the layer of bone and cartilage that separates the nostrils, can contribute to the chronic infection by preventing drainage.

Chronic sinusitis may cause dull headaches over the eyes or the cheeks, made worse when the person bends down.

It is usually associated with discharge through the nostrils or down the back of the throat, and the pain may be referred from the antrum to the teeth and lead to a dental investigation.

In some cases there are few localizing symptoms. Sinusitis may often be associated with chronic bronchitis.

X-rays will usually confirm the diagnosis in both acute and chronic infections. It may be necessary to open into the sinus and remove the pus.

This is more common in the maxillary sinuses, and antral washouts are a common operation for the ear, nose, and throat specialist.

In my experience, recurrent headaches are more likely to be migraine, or that variation of migraine known as cluster headache which affects men more than women.

Tension headaches can be felt in the back of the neck or in the forehead and are often mistakenly called sinus headaches by patients who do not understand their mechanism. Other people refer to “sinus” when their symptoms are due to hay fever.

So when you say, “I’ve got sinus again,” don’t be surprised if your doctor wants you to be more precise in explaining your symptoms. They might be unrelated to the sinuses.

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