Doc, I have this “sinus headaches” is probably a common symptom that patient present with in my clinic. Or at least that is what they believe they are suffering from….headaches resulting from inflamed or infected sinuses. That may be true to some extent but in actual fact, clinical studies have shown that only about 5-10% of the patients presenting with headaches have sinusitis. Acute sinusitis may cause headaches, the pattern of which will depend on the extent and the location of the sinuses involved. Chronic sinusitis rarely causes headaches. Acute sinusitis includes:
- Acute frontal sinusitis
- Acute maxillary sinusitis
- Acute ethmoid sinusitis
- Acute sphenoid sinusitis
Headaches are more commonly due to causes other than sinusitis. So why do patients believe that their headaches are due to sinuses? The reason may be that since the pain they experience is over the sinuses it must be due to something related to the sinuses. Furthermore non sinus related headaches may often be accompanied by nasal and eye symptoms such as nasal stuffiness or nasal blockage, running nose and tearing leading them to believe so. There are several causes for non-sinus related headaches. Some of these include:
- Atypical migraine
- Mid-facial Segment pain
- Tension headaches
- Cluster headaches
A large clinical study comprising of almost 3000 patients with headaches has shown that more than 85% of headaches may be migraine related. Clinical evaluation for “sinus headaches” will include:
- Detailed history which may provide clues to a working diagnosis.
- A nasal endoscopy to look for any sino-nasal pathology
- imaging studies such as CT scan of the sinuses.
If the nasal endoscopy and the CT scan of the sinuses are normal, the likely cause of headaches is non-sinus related with migraine topping the list.