Sinusitis headache

Headaches caused by inflammation of the nose and sinuses (rhinosinusitis)

The nose is blocked. The nose is runny. The tissue contains watery discharge or thickened, viscous mucus. There is pressure around the eyes, in the upper jaw, and in the forehead. Head movements intensify the pain. You feel like you have a cold. Feverishness, a sore throat, a cough, and fatigue may accompany the symptoms. Bending the head forward worsens the pain.

These are symptoms that can correspond to sinusitis headache. The word "sinus" means bulge or cavity. It refers to inflammation of the nose and sinuses, which can be responsible for headaches in cases of acute infection. Scientifically, this headache is called "headache due to rhinosinusitis," or in short, "sinusitis headache." It is classified under code 11.5 in the International Classification of Headache Disorders (ICD-10) and under code G44.845 in the International Classification of Diseases (ICD-10).

In practice, sinusitis headaches are often confused with migraines or tension headaches. It is therefore very important to identify and accurately classify the headache in everyday life so that specific treatment can be initiated. The diagnostic criteria for headaches in rhinosinusitis are defined as follows:

A. Frontal headache accompanied by pain in one or more regions of the face, ears or teeth, and fulfilling criteria C and D

B. Acute rhinosinusitis or an acute exacerbation of chronic rhinosinusitis was clinically confirmed, by nasal endoscopy, CT or MRI imaging and/or laboratory tests

C. The headache and/or facial pain develop simultaneously with the onset of acute rhinosinusitis or the acute exacerbation of chronic rhinosinusitis

D. The headache and/or facial pain disappears within seven days after effective treatment or remission of the acute rhinosinusitis, or the acute exacerbation of the chronic rhinosinusitis

Clinical symptoms suggestive of inflammation of the nose or sinuses include, in particular, pus accumulation in the nasal cavity, nasal congestion, fever, reduced or complete loss of smell. Migraine and tension-type headaches can be mistaken for sinusitis headaches due to the similarity of pain location. A subgroup of patients who meet the criteria for migraine without aura also exhibit additional signs such as facial pain, nasal congestion, or triggering of attacks by weather changes. However, these patients do not have purulent nasal discharge or other signs of acute rhinosinusitis.

The most important distinguishing features are therefore signs of acute rhinosinusitis, such as purulent nasal discharge, sore throat, fever, and cough. Furthermore, sinus headaches are generally not accompanied by nausea or vomiting, nor are they aggravated by noise or light; thus, they do not have the typical accompanying symptoms of migraine attacks. With these characteristics, it should therefore be possible to differentiate sinus headaches from migraines or tension headaches in everyday life.

frequency

Rhinosinusitis is widespread. The diagnosis of "acute sinusitis" is made over 6 million times a year, and "chronic sinusitis" around 3 million times. It is a disease with a high and increasing incidence. Sinusitis is often accompanied by bronchitis, and vice versa.

causes

Rhinosinusitis can be caused by viral infections, allergies, bacterial infections, a weakened immune system, or structural changes in the nasal cavity. Local inflammation and changes in pressure within the nose and sinuses can cause headaches. The development of headaches is a well-established symptom of acute rhinosinusitis. In contrast, the development of headaches or facial pain in chronic sinusitis is not always clear, unless it is accompanied by an acute flare-up of sinusitis. Sinusitis can affect anyone. The likelihood of developing sinusitis may be increased by conditions such as asthma, nasal polyps, allergies (especially to house dust or pollen), a weakened immune system, or other illnesses.

If the symptoms persist for more than ten days, the headaches become very severe, the chosen self-medication does not provide sufficient relief, or a fever above 38° Celsius develops, medical treatment should be sought.

diagnosis

The primary focus is on assessing the symptoms of acute rhinosinusitis. The examination may reveal signs of tenderness in the frontal and maxillary sinus region. An endoscopic examination analyzes any narrowing of the nasal passages. Evidence of a bacterial or fungal infection can be obtained through mucosal swabs. In individual cases, imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be performed. Generally, the diagnosis does not require any additional diagnostic tests and can be made clinically.

Origin

In healthy sinuses, secretions and mucus are drained away, and air can circulate freely through the nasal passages. However, when the sinuses are acutely inflamed, these areas become narrowed and blocked, preventing secretions and mucus from draining. When this occurs, bacteria, viruses, and fungi can spread and multiply rapidly in the nasal mucus. Although acute viral infections are very often the cause of acute sinusitis, any condition that obstructs the drainage of secretions and mucus can lead to sinusitis.

Treatment

In cases of acute bacterial rhinosinusitis, a doctor may prescribe antibiotics. If the acute rhinosinusitis is caused by allergies, the doctor may initiate treatment with corticosteroid nasal sprays or tablets.

Acute headaches can also be treated with painkillers such as aspirin, paracetamol, or ibuprofen. Decongestant nasal drops and saline rinses can alleviate the symptoms.

Treatment for sinusitis should focus on thinning the mucus (secretolysis) and mobilizing it by reducing its viscosity (mucolysis), both to address the underlying cause and prevent chronic sinusitis. Additionally, activating ciliary movement should facilitate improved mucus drainage. Therefore, the cause of sinusitis headaches can be eliminated through secretolysis and mucolysis, as well as improved secretomotor function. The anti-inflammatory, antispasmodic, and antimicrobial effects of the therapy reduce mucosal inflammation and thus also address the underlying cause of the headaches.

prevention

To reduce the risk of acute rhinosinusitis, the following precautions should be taken to maintain the health of the sinus mucosa:

1. Wash your hands frequently: Washing your hands after frequent contact with many other people can help reduce acute sinus infections. An annual flu vaccination can also help prevent the occurrence of an acute flu infection.

2. Avoid irritating the sinus mucus: The most important rule: Don't smoke! You should also avoid environments where smoking is permitted. Ensure good air quality and ventilate frequently. Air pollution and dry air lead to swelling of the sinus mucosa and promote acute sinusitis.

3. Ensure adequate humidification: Adding moisture to the room air through humidification can be effective in preventing sinusitis. Excessively high room temperatures should be avoided.

Warning symptoms/precautions

If you experience the following headache symptoms, you should see a doctor:

– Headaches like never before: In the case of sudden and very severe headaches that are previously unknown, a doctor should be consulted immediately.

– Even if headaches have occurred repeatedly in the past, but unusually severe headaches suddenly occur, a doctor should also be consulted.

– For newly occurring headaches in people over the age of 50

– If headaches are accompanied by symptoms such as memory loss, concentration problems, balance disorders, dizziness, changes in speech, visual disturbances, weakness, etc., a doctor should be consulted.

– Headaches accompanied by fever, severe neck pain, neck stiffness, severe nausea and vomiting

– Headaches accompanied by red eyes, watery eyes and other symptoms.