Sinus and Headache

Sinus and Headache

Almost everyone can identify with the discomfort of ailing sinuses. A typical patient might present with pain behind his cheek bones, his nose, and above his eyes. It hurts more when he leans forward, and it really got bad on a plane flight last week. The pain goes up in altitude, and some relief coming down. He has greenish or yellow nasal mucus, post nasal drip, a decreased sense of smell, headaches behind his cheek bones and nose, maybe pain in the upper teeth, bad breath, and he coughs at night. On examination he has swollen mucus a membrane inside his nose and it hurts when the doctor taps the areas overlying the sinuses. A bright light held up to the sinus areas shows them to be dull due to interior inflammation. Maybe there’s a nasal polyp along with other findings. The diagnosis is clearly sinusitis. If these symptoms have been present less than four weeks, it is called acute sinusitis. If there are more than three episodes a year it is called chronic sinusitis.

Some people wonder why we have sinuses anyway. All they are is often a lot of trouble. Well, we don’t know exactly why there are sinuses. We do know that they lighten the front of the skull, assisting in holding the head upright. They act like a resonance chamber enriching the tone qualities of the voice. They warm and humidify nasal air, and insulate the dental roots and eyes from temperature changes. Finally they act like crumple shock absorbers when there is trauma to the face.

Sinusitis often follows a cold or viral infection. The sinuses are lined with the same mucosa as the inner nose. The nose and sinuses act as a unit when there is an infection or irritant. The distinct problem is they communicate with the nose through very small openings which can be blocked by mucus or inflammation. They have their own environment of stagnant mucus which is a great place for bacteria to grow. These bacteria cling to the mucous membranes of the sinuses and set up the cascade of inflammation which we perceive as pain, fullness, headaches, and the myriad of other symptoms described in our patient. The most common germs are Streptococcus, Moraxella and Hemophilus; the same bacteria which causes most bronchitis. It is no wonder that both conditions often eventually occur together. When infection goes on too long in the sinuses, there can be bacteria which don’t require oxygen, fungus infection, and even atypical TB germs. This is why it is important to treat sinus infections as early as possible with antibiotics. One characteristic of sinus infection is that they require longer treatment with antibiotics. Whereas a usual course of antibiotics might be 7 to 10 days, sinus infections might sometimes require 4 to 6 weeks of antibiotic therapy.

Children can get sinusitis, even though their sinuses have not fully developed. It can follow recent colds, allergy, or infection of the tonsils and adenoids. If a child has dark nasal discharge, cough, or persistent fever, the cause might be sinusitis. Children who attend daycare get sinusitis twice as often as those who don’t. Sinusitis can become chronic in children if not treated early when their immune systems are compromised by something like cystic fibrosis, leukemia, diabetes or HIV. Just like adults, children’s sinuses can become easily infected. The treatment of sinusitis is principally medical. In some severe cases endoscopic or classic surgery is required to correct the problem. Surgery usually punctures holes in the base of the sinus to get better drainage. This does have some negative outcomes. When your head is tilted the wrong way sometimes drainage spills forward out of the nose at the most opportunistic moment.

The first line of treatment is antibiotics, with emphasis on addressing the usual types of bacteria and giving them for an adequate length of time. Nasal corticosteroid sprays are used to reduce inflammation in the nasal passage. Less of the spray is systemically absorbed than when the corticosteroid is given orally. Antihistamines reduce the allergic component of production of histamine of the nasal reaction. The older antihistamines used to thicken and dry the nasal mucus, and are pretty much avoided now. Salt water or saline nasal sprays are available to moisturize and break up mucus. Some doctors recommend irrigation with a bulb syringe or a Water-Pik on low pressure to remove the mucus. Oral decongestants can be helpful, but are not wise in people with high blood pressure. Oral mucolytics such as guiafencin can be used to help the cough.

There are some other things to do which can help sinuses. Applying warm moist compresses to sinus areas or breathing steam three or four times daily can help relieve pressure. Acetaminophen or ibuprofen can be taken for pain and fever. It’s good to avoid smoke and air pollutants and wash your hands frequently. Drink plenty of fluids to thin out mucus secretions. It’s time to see the doctor if sinus symptoms last longer than about 3 days or return after you’ve completed a course of therapy. This is true if headaches are mild to severe and are not relieved by acetaminophen or ibuprofen. If there is fever along with the sinus symptoms it’s time to be checked. Complications can include acute sinusitis becoming chronic, infection of the facial bones, or bacteria entering the bloodstream (sepsis). One other consideration is that the bones between the sinuses are very thin, and infection can sometimes spread to the brain and develop a brain abscess. Infection can spread to the tissue around the eyes causing an emergency situation called orbital cellulitis especially in children.

John Drew Laurusonis M.D.
Doctors Medical Center