Sinus Headache
Mark E. Reiber, MD, FACS, FAAOA
Headache is one of the most common complaints of patients seeking care for allergy and sinus problems. Pain may be frontal, mid-face, temporal, or in the back of the head pain. Generally, patients have tried over the counter medications without success only to turn to prescription antibiotics and antihistamines with the same result. Desperate for relief and convinced the pain is due to an allergy or sinus condition, they present to me for help.
Facial pain and headache (FP &HA) is a complex subject requiring a professional evaluation with a detailed history, examination and diagnostic testing. The following information is for general education and should not be used to make conclusions in a specific patient.
Do allergies cause headaches?
One of the most famous headache experts in the U.S. said, on a national talk show, allergies do not cause headaches. In my fifteen years of experience, many patients have reported their headaches diminished or resolved with appropriate allergy management. There clearly is some relationship between the two, but allergy is only one of several factors causing headaches. The role of allergies in headaches is probably much less than most people believe.
Why do allergy medications not relieve my headaches?
The obvious reason is the “diagnosis is incorrect”. One study by The Headache Care Center found that over 97% of self reported “sinus headaches” were migraines.
A second reason may be you are using medications incorrectly. All allergy medications are not alike and are not effective for all symptoms. Most are preventative meaning they more effective at blocking symptoms before they begin. With proper selection, combination, and usage, allergy management can be very effective for headaches.
What are the best allergy medications for decreasing headache frequency?
My experience is that oral antihistamines are not very effective. They work for “wet” symptoms of allergy (runny nose, watery eyes, hives and sneezing) but not pressure and pain.
I believe a combination of nasal steroid spray and leukotriene inhibitor, used daily, is the best for allergy headaches. Occassionaly, a topical antihistamine spray provides relief. Patients responding to these medications may consider testing and immunotherapy for more long term results.
More information about the classes and specific allergy medications is found in the article entitled “Allergy Medications”.
My nose is congested and my eyes and nose waters with my headaches, so isn’t that sinus related?
These are common migraine symptoms and are a major reason for misdiagnosis. During a migraine, the sympathetic and parasympathetic nervous system become “activated” causing secretions and blood flow increases with obstruction.
I have nausea from all the post-nasal drainage, so my problem is sinus infection, isn't it?
A good physical examination and occasionally X-Rays may help answer this question but, migraine is more likely the cause. My experience is nausea from sinus drainage is rare.
If it is not “sinus” what causes my headaches?
Well, this can be a very complicated. Migraines take many different forms and are not always one sided headache with nausea and other neurologic symptoms. There are other pain syndromes such as cluster headaches and facial neuralgias. Pain in the chewing muscles and the jaw joint (TMJ syndromes) is very common and causes temporal headaches and/ or ear, face and neck pain. Dental infections may cause one sided mid-face pain. Medications and other more systemic conditions may also cause headaches and hormonal abnormalities may cause cyclical headaches in women.
Why do my headaches keep coming back after over the counter medications wear off?
This is a very common problem. Daily use of pain relievers such as acetaminophen and ibuprofen, and stimulants including caffeine, may lead to rebound headaches. Headache specialists recommend stopping all such medication as an initial intervention.
How do I know where to turn for help with my headaches?
If your headaches and facial pain is persistent and recurring, turn to a healthcare professional who understands the subject well. This may be your primary care physician, a neurologist, or an otolaryngologist with allergy expertise.