About Sinus Headaches

A sinus headache occurs because your sinuses are congested with mucus. The sinuses are hollow spaces in the bones of your face. They connect with the nose through small openings. Like the nose, they are lined with membranes that make mucus. Mucus drains through the small openings to the nose.

Causes of a Sinus Headache
If you have a cold or allergies, the openings of your sinuses may be blocked by excess mucus or a swelling of the tissue that lines the sinuses. When drainage of mucus from the sinuses is blocked, the sinuses become congested. They may become infected with bacteria, a virus, or even fungus. The infection can make the sinuses even more clogged. The pressure caused by swelling and congestion causes sinus headaches.

About Stress/Tension Headaches

Headache is a complex problem with many possible causes other than just the sinuses. The head itself may be the source of pain. An example is tension headache: Most people describe a tension headache as a constant dull, achy feeling on both sides of the head. Some people with tension headaches also have a tight feeling in their head or neck muscles. Tension headaches usually begin slowly and gradually. They often start in the middle of the day.

Another name for this type of headache is "stress headache." When people say they have a stress headache, they usually mean they have a tension headache. Tension headaches may be mild or severe. Sometimes they hurt more than migraine headaches.

Migraines and Other Headaches

Many primary headaches, particularly migraine or cluster, may closely resemble sinus headache. Migraine and sinus headaches may even coexist in many cases. Sinus headaches are usually more generalized than migraines, but it is often difficult to tell them apart, particularly if headache is the only symptom of sinusitis. A migraine can last for hours or days and may cause intense pain. You may also feel sick to your stomach or have eye problems.

The following symptoms suggest a migraine rather than a sinus headache:

• The headache is recurrent.  
• You feel nauseated, and light bothers you.
• It has a significant impact on daily activities. 
• The headache does not get worse over time.

Neuralgia (Nerve-Related Pain)

In some cases, headache that persists after successful treatment of chronic sinusitis may be due to neuralgia (nerve-related pain) in the face. This condition requires specific drugs, such as tricyclic antidepressants or carbamazepine. Trials using such agents may identify patients with neuralgia and help avoid unnecessary invasive treatments for chronic sinusitis.

Other conditions that can mimic sinusitis:

• Dental problems
• A foreign object in the nasal passage
• Temporal arteritis
• Persistent upper respiratory tract infections
• Chronic fatigue syndrome or fibromyalgia
• Temporomandibular disorders (problems in the joints and muscles of the jaw hinges)
• Vasomotor rhinitis, a condition in which the nasal passages become congested in response to irritants or stress (this often occurs in pregnant women).