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Sinus headaches derive from infection or pressure in the paranasal sinuses. These include the maxillary sinus, frontal sinuses, ethmoid sinuses, and sphenoid sinuses. Sinus disease is very common -- on casual observation of the author, about 1/3 of the MRI scans of the head in Chicago show changes in the sinuses.

Symptoms:

Pain from the maxillary sinus is typically over the cheeks or in the teeth. Frontal sinus pain is usually over the eyes. Ethmoid and sphenoid sinusitus usually causes pain between the eyes. Sphenoid sinusitus can also radiate to the occiput. Nasal drainage and congestion are common. Pain does not correlate with sinus disease seen on X-ray (Shields et al. 2003), and sinus headaches are probably much less common than the general population thinks. Migraine accounts for far more headaches.

In Acute sinutitus, there is pus in the middle meatus, facial pain and pressure lasting less than 4 weeks. Fever or pain without other nasal symptoms does not constitute a diagnostic history in abscense of other nasal sinus symptoms.

Chronic sinusitus -- there is symptoms lasting more than 12 weeks.

Diagnosis

• Nasal endoscopy
• CT-sinus
• MRI

CT and MRI sinus abnormalities (usually meaningless) are found in the majority of the population. These include polyps, concha bullosa, septal deviation, etc. An "air-fluid" level is particularly telling as this generally means active sinus disease. CT scans of the sinus are much less expensive than MRI scans and also have the advantage over MRI that they show bone.

Migraine headaches are often misdiagnosed by patients themselves as sinus headaches. A recent study suggested that 88% of 2991 patients who had diagnosed themselves as having sinus headache, actually had migraine (Schreiber et al, 2004).

Medical treatment:

• Antibiotics
• Decongestants
• Antihistamines
• Nasal steroids

Surgical treatment

• Drainage
• Obliteration
• Opening of ostea with endoscope

References:

• Shields G, Seikaly H, LeBoeuf M, Guinto F, LeBoeuf H, Pincus T and Calhoun K (2003). "Correlation between facial pain or headache and computed tomography in rhinosinusitis in Canadian and U.S. subjects." Laryngoscope 113(6): 943-5.
• Schreiber CP and others. Prevalence of migraine in patients with a history of self-reported or physician diagnosed "Sinus" headache. Arch Int Med. 2004: 164: 1769-1772