If you've ever been sick with a cold, struggled through a stuffy nose and found yourself dealing with a throbbing headache on top of it all, you're not alone.
Sinusitis—inflammation of the sinuses—and headaches can be closely connected. Sinusitis can be caused by irritants or organisms you breathe in: viruses, bacteria, fungus, mold, smoke, urban pollution, allergens and even perfumes. The resulting inflammation can cause obstructions in the sinus and nasal passageways and subsequent pressure changes, which can feel just like a headache.
“You end up with pressure gradients which causes something kind of like when you go on an airplane and you can equalize your ears and it hurts. The pressure is actually pulling on the membranes," says Jordan S. Josephson, M.D., FACS, an ear, nose and throat doctor at Lenox Hill Hospital in New York City and author of Sinus Relief Now.
The anatomy of a sinus headache
Sinus pain is also complex, owing to the structure of the sinuses themselves.
The sinuses are essentially air-filled pockets in the bone structure of the face and skull whose primary function is to produce mucus that protects the nasal passages from pollutants and keeps them moisturized.
Depending on where inflammation and infection take place, pain can manifest differently.
If the frontal sinus—located in the forehead—is obstructed, the pain is associated with what is typically described as a headache. Obstruction of the maxillary sinus, found behind both cheeks, causes pain that manifests more like dental or cheek pain. The ethmoid sinuses, between the eyes, can cause pain in and around eyes. Obstruction of the sphenoid sinus, behind the nose, can cause pain in the neck or top of the head.
“You can have multiple areas blocked and that will give you headaches in various areas at the same time," says Josephson.
Symptoms and signs
These different manifestations of symptoms can make a sinus headache hard to diagnose, as well. Like other forms of headaches, a sinus headache has some typical symptoms, although they may not be as obvious as, say, the sensitivity to light and sound of a migraine.
A sinus headache can show up with a cluster of other symptoms including ear and nose congestion, tinnitus, decreased sense of smell and taste and thick phlegm.
“If you're complaining about all those things and then you're complaining about headaches, there's a fairly good chance that those headaches could be, especially if they are in the forehead or around your eyes or behind your eyes or in your cheeks, due to sinus problems," says Josephson.
But that's not always the case, and without some of these signature symptoms, a sinus headache may feel like or mimic other kinds of headache.
Sinus headaches can even provoke things like migraines. If you are prone to migraines, it's not uncommon for a flare up of sinusitis to cause both a headache and a subsequent migraine.
Diagnosis is key
Sinus headaches can usually be treated in a similar manner to traditional headaches.
“Whether it's a neurologic headache or a sinus headache, there are inflammatory components that are causing it. Taking anti-inflammatory agents will help both kinds of headaches," explains Josephson.
But, if you're suffering from some form of chronic headache or sinus pain that hasn't been diagnosed, it's important to see a professional.
“Sometimes they are hard to tell. You have to take a whole history and try to find out what's really causing the headache."
In some cases, surgery—specifically known as endoscopic sinus surgery—is used to treat chronic sinusitis, although this is typically only considered when other forms of treatment have been attempted. The goal of endoscopic sinus surgery is to help improve drainage by widening the natural pathways. The result is less infection, inflammation and obstruction.
“The good news is that [if you] have sinus headaches, there is a good chance that [you] can get [it] resolved," adds Josephson.