SINUS HEADACHES
One of the most frustrating symptoms patients consult us for is face
pain. We see many such patients because of the popular notion of
'sinus' headache. Headaches caused by sinus disease are so rare that
they are the least likely cause of headache. Those rare headaches
caused by sinus disease are mild, and are almost always associated with
unmistakable changes in secretions, massive swellings and losses
of sensation over the face.
The sinuses are in no way affected by tapping on the face or forehead.
Unusual facial tenderness has nothing to do with the nose or sinuses.
The advertising programs of the cough and cold industry have done the
public a great disservice by exaggerating for sales purposes the
probability of sinus disease as a cause of headache.
People who suffer from frequent severe headaches usually will be
found to have a mixed headache syndrome. The 'mix' includes muscle
tension and contraction, causing a 'charlie horse of the muscles of the
face, head and neck. This component produces most of the
tenderness patients often believe points to the sinuses.
A second major element is tempero-mandibular joint syndrome (TMJ) from
clenching the teeth in severe pain. This contributes to the
tenderness and headaches on the side of the head.
The most important element of the mix is the vascular headache. These
intense headaches arise in the blood vessels in the brain. They
can be located anywhere on the head...even the face or teeth! They are
often accompanied by nausea, and are relieved by sleep. They can be
triggered by several foods, hormonal fluctuations, and, some are
convinced, certain weather conditions. Vascular headaches seemto be
caused by abnormalities in brain chemistry. There is a strong inherited
element. They are the major cause of severe headache misery.
Migraine headaches are just one example of this kind of headache. They
occasionally cause nasal swelling and wetness..which misled people into
thinking the nasal symptoms were pointing to the cause, rather than an
effect.
In some headache sufferers, the nasal swelling causes a crowding and
pinching in the nose, which is experienced as face pain..adding to the
misery. Occasionally this component can be reduced or eliminated by
septum or sinus surgery.
The detailed diagnosis and management of this complex problem falls
within the view of the specialties of neurology, internal medicine, and
family medicine. Often a headache management team is required to
bring them under control.