SINUS HEADACHES
WHAT ARE SINUS (RHINOGENIC) HEADACHES?
Headaches in the area of the forehead, facial bones, and cheeks or around the eyes are typically called sinus headaches. Some sinus headaches may occur in the back of the head. Sinus headache is a broad category. Some patients may feel that their head is full and not truly have a headache. In general patients with allergies or chronic sinusitis tend to have reduced resonance in their voice.
ARE ALL SINUS HEADACHES RELATED TO SINUSITIS OR SINUS/NASAL PROBLEMS?
Not necessarily. Many sinus headaches are not related to sinus problems and are more likely either migraines, tension headaches, cluster headaches, muscle tension headaches, dental pain, TMJ pain, or even mid-facial pain syndrome. Because there is an overlap between these conditions and sinus headaches, a CT scan of the sinuses and/or a nasal endoscopy is helpful in differentiating these headache syndromes from sinus headaches related to the nose and sinuses. It is important to remember that many of these headaches may be triggered by nasal or sinus problems. Migraine or migraine variants can be mistaken for sinus headaches and sinus headaches may be mistaken for migraines. It is important to distinguish between the two and a CT scan may be necessary or a nasal endoscopy to differentiate the two. Certainly, if treatment for these conditions is not working then sinusitis as a cause of headaches must be considered.
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CAN MY SINUS HEADACHES BE CURED?
Yes. If the headaches are due to chronic sinusitis or septal deviation or another sinus disease, then treatment of the sinus condition with medical therapy or surgery will alleviate the headaches. If medical therapy does not help, surgery in the form of balloon sinuplasty to open the sinuses or traditional functional endoscopic sinus surgery with or without septoplasty may be offered. However, if the headaches are not related to sinus disease, then other treatments are generally advised. Migraines often improve after sinus surgery or balloon sinuplasty and there seems to be a link between sinus inflammation and infections acting as triggers for migraine.
WHAT IF MY CT SCANS SHOW "MINIMAL SINUSITIS" AND I STILL HAVE SINUS HEADACHES?
This is a controversial area of sinus practice. There are situations such as contact points between the septum and turbinates or certain types of anomalies (concha bullosa, interfrontal air cells or Haller cells, septal deviation) in the CT scan that may predispose to recurrent sinusitis and headaches, particularly migraines or vacuum type of headaches. The science is not entirely clear on this. If medical therapy fails, surgery of these areas in a limited sinus surgery fashion may be very successful.
Balloon sinuplasty may also be effective in some of these carefully selected individuals. Our anecdotal experience suggests that in many patients that have chronic sinusitis and migraine-type headaches, endoscopic sinus surgery and balloon sinuplasty have been effective in improving migraine. In some patients with no obvious sinus disease or “minimal” sinus disease but with significant rhinogenic headaches, limited sinus surgery can be very effective even in the longer term. A number of scientific publications have shown that the degree of improvement of symptoms after endoscopic sinus surgery for those with “minimal” sinus disease on CT scan is about the same as those with more severe disease noted on CT scan. The decision for surgery in this group of individuals has to be taken very carefully.
