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 seem to 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 mislead people into thinking the nasal symptoms are 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.