| Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses can be seen with either acute or chronic stages of sinusitis. This pain is typically localized to the involved sinus and may worsen when the affected person bends over or when in the supine position.
Sinusitis is a condition consisting of infection or inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).
All forms of sinusitis may either result in, or be a part of, a generalized inflammation of the airway so other sinus headache symptoms such as cough may be associated with it.
There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. The ethmoid sinuses can also be further broken down into anterior and posterior.
Acute and chronic sinusitis may be accompanied by thick purulent nasal discharge (usually green in colour and with or without blood) and localized headache (toothache) are present and it is these sinus headache symptoms that can differentiate sinus related headache from other headache phenomena such as tension headaches and migraine headaches.
Recent studies suggest that up to 90% of "sinus headaches" are actually migraines. The confusion occurs in part because migraine involves activation of the trigeminal nerves which innervate both the sinus region and which surround the brain. Additionally, nasal congestion is a not uncommon result of migraine headaches, due to the autonomic nervous stimulation that can also result in tearing and a runny nose. A study found that patients with "sinus headache symptoms" respond to triptan migraine
medications, and state dissatisfaction with their treatment when they are treated with decongestants or antibiotics.
Bacterial and viral acute sinusitis are difficult to distinguish however, disease duration fewer than 7 days is considered as a viral whereas more than 7 days are considered as a bacterial sinusitis (usually 30% to 50% are bacterial sinusitis).
Over the counter (OTC) medication such as acetaminophen and ibuprofen can relieve some of the sinus headache symptoms associated with sinusitis, such as pressure, fatigue and pain.
The vast majority of cases of sinusitis are due to viral etiology and thus resolve without antibiotics. 60 to 90% of people do not experience resolution of symptoms with antibiotics. Antibiotics may not improve the long-term clinical outcome for sinusitis.
Nasal corticosteroids have not been found to be better than placebo either alone or in combination with antibiotics.
For chronic or recurring sinusitis and sinus headache symptoms, referral to an otolaryngologist may be advised for more specialist assessment and treatment, which may include nasal surgery. However, for most patients the surgical approach is not superior to appropriate medical treatment.
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