Diagnosing sinus headaches

In this video, we use the International Classification of Headache Disorders criteria to diagnose sinus headaches by differentiating sinus-related headaches from migraines. 

Robert Coni, DO EdS
Robert Coni, DO EdS
13th Sep 2020 • 3m read

Over 50% of patients who have migraine headaches also have nasal symptomatology. Unless the clinician assesses a patient for findings associated with migraines, a diagnosis of sinus headache may be made when a migraine is actually present. In this video, we use the International Classification of Headache Disorders criteria to diagnose sinus headaches by differentiating sinus-related headaches from migraines.

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Video transcript

There is a common belief among patients and some clinicians, that sinusitis is present and causing a headache whenever there is pain over the sinuses. One can define sinus headache as pain over the sinus region of the face, especially the maxillary area and the periorbital region. The pain can vary, and might even be pulsatile in nature.

Applying pressure over the sinuses may induce discomfort in sinus infection, and sinus headaches. Facial pain and pressure is typically thought of as one of the classic signs of sinusitis. However, it is only one of the major criteria. The major criteria include: purulence in the nasal cavity, facial pain, pressure, congestion or fullness, nasal obstruction, blockage or discharge hyposmia and anosmia, fever, ear pain and fullness.

The minor features include: headache, fatigue, halitosis, cough or dental pain. Two major criteria, or one major criteria and two minor criteria are needed to support a diagnosis. The most likely locations for sinusitis are within the maxillary and ethmoid sinuses. Sphenoid sinusitis is more difficult to diagnose, is more significant in terms of morbidity, and the symptoms are slightly different.

There is usually some abnormality on the CT scan, demonstrating mucosal thickening, clouding, sclerosis, and perhaps air fluid levels in the ethmoid sinuses. However, CT is not specific for bacterial sinusitis. The usual treatment for acute sinusitis is broad spectrum oral antibiotics for 10 to 14 days.

To treat the bacterial infection. Use local agents such as nasal decongestant sprays, which can reduce nasal tissue swelling, or oral decongestants. The spray should only be used for a few days to reduce rebound edema, and swelling. Surgical drainage may be necessary for refractory cases. Some primary headache syndromes of rhinorrhea-like symptoms.

A complaint of nasal congestion, as well as the patient noting improvement with sinus medication often leads to an incorrect diagnosis of sinus headache. More than 50% of patients who have migraine also have nasal symptomatology. The American Migraine Study II, demonstrated that 42% of patients with all the criteria of migraine had been previously diagnosed with sinus headaches.

Unless the clinician assesses the patient for findings associated with migraine, such as nausea, photophobia, phonophobia, laterality, throbbing pain, and aggravation with activity. The diagnosis of sinus headache may be made when migraine is actually present. Thus, to differentiate migraine, and sinus headaches, the clinician must assess using the international Headache Society International Classification of Headache Disorders criteria.