“I can’t get rid of this sinus headache”
“The pressure in my sinuses is constant”
“My sinuses hurt so much it gives me a migraine”
Sound familiar? For many people, unfortunately, it will. Facial pain, pressure, and headache are common symptoms that can cause a great deal of distress, often leading to repeat doctor visits and a significant decrease in quality of life. Facial pain is often assumed to be due to sinusitis (inflammation and infection of the air-containing spaces in the face), and patients are frequently treated with multiple courses of antibiotics and steroids as well as medicated nasal sprays and other allergy medications. Unfortunately, it is common for facial discomfort to continue or return despite these treatments, and as a result many suffering patients will seek help from an otolaryngologist (medical specialist in ear, nose, and throat problems).
Sinusitis can certainly cause facial pain and pressure, and for some patients an ENT specialist may recommend additional treatments such as sinus surgery to help control symptoms. In many cases, however, patients are surprised to find out that their sinuses are healthy. Then why do they hurt? As it turns out, many other medical problems can cause facial pain and pressure that are frequently attributed to sinusitis. The list is long, but commonly includes headache disorders such as migraine or tension, problems with the jaw joint (temporomandibular joint disorder), and musculoskeletal tightness in muscles used for chewing and moving the neck. Studies have shown that of the four major symptoms of sinusitis (facial pain, nasal drainage, congestion, and loss of smell), pain is the least accurate at predicting the presence of sinusitis on CT scan or nasal endoscopy. Furthermore, researchers have found that a vast majority of patients with “sinus headache” respond to medications for migraine.
It is important for frustrated patients to realize that although their facial pain, pressure, and headache are very real, the source of these symptoms may be quite different than expected. For many, the key to improvement may not be another round of antibiotics, but instead a consultation with a neurologist, dentist, physical therapist, or other affiliated healthcare professional, in order to work on the root cause of the problem.