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Definition of True Sinus Headache Often Misunderstood

BY CHARLES BANKHEAD

Contributing Writer

LAKE BUENA VISTA, FLA. -(ECCC) Sinusitis rarely causes headache, and physicians should look elsewhere for the source of the pain, said Dr. Howard L. Levine on July 18 at an update course sponsored by the Diamond Headache Clinic Research and Education Foundation.

"When headache is the only symptom or is the major symptom, the major cause is almost never sinusitis," said Dr. Levine of the Cleveland Nasal-Sinus & Sleep Center. "That is the most important take-home message I can give you about the relationship between sinusitis and headache."

Dr. Levine cited several myths widely accepted as fact in the relationship between the two:

  • Sinus headaches are common
  • All pain in the face and forehead is "sinus"
  • A stuffy nose means a headache is caused by sinus
  • Headaches that coincide with a change in weather are caused by sinus
  • If over-the-counter sinus medications relieve a headache, the headache is caused by sinus
Dr. Levine explained that sinus pain often does not originate in a sinus but rather in the nasal turbinates. Infection, allergy, inflammation, irritants and other factors can cause the turbinates to swell, which causes pain that is inappropriately attributed to a sinus. Sinuses, in fact, are relatively insensitive to pain, said Dr. Levine.

According to the International Headache Society, to be considered an acute sinus headache, a headache must have characteristics such as purulent discharge and abnormal findings on plain-film x-ray or computed tomography.

The lack of key elements in the definition of sinusitis headache contributes to the confusion, misinformation, and myths surrounding sinus headache, said Dr. Levine. Terms such as "pain" and "pressure" have not been well defined, and the location of a sinus headache lacks specificity. The characteristics of frequency, severity, and other issues have also not been clearly described.

Rhinosinusitis also is frequently blamed for headaches, when in fact it rarely causes them. In most cases, rhinosinusitis involves a viral process and occasionally a bacterial infection. Facial pressure or pain often is a symptom of rhinosinusitis, but other symptoms are usually present, such as nasal congestion or discharge, fever, halitosis, dental pain, and cough.

“Facial pain does not constitute a suggestive history in the absence of other signs and symptoms,” said Dr. Levine.

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