We sat down with Christian Soneru, MD, Otolaryngologist at Tufts Medical Center, to learn more about the pressure sensation in the face and how to differentiate the causes and treatments.
If there is no such thing as a sinus headache, what causes pressure in the face?
A sinus headache is a term used by patients to describe a pressure sensation around the eyes, forehead and cheeks that worsens with bending over or lying down. Although these symptoms can be caused by sinusitis or inflammation of the lining of the sinuses, they can also be caused by tension or migraine headaches. In fact, a number of studies have shown that the majority of patients coming to see a doctor for "sinus headaches" end up being diagnosed with migraines. What makes it confusing is that migraine headaches can irritate the trigeminal nerve which has branches to the face. This irritation can lead to nasal congestion and a runny nose in the middle of a migraine headache.
How often is sinus pain caused by seasonal allergies? How would this be treated?
Seasonal allergies can cause sinus pressure, which is typically associated with nasal congestion, runny nose, sneezing, red or watery eyes and itching of the nose and eyes. Allergies are often caused by a trigger in the environment, such as the change of seasons or a pet. Avoiding the trigger can help control the symptoms. Several over-the-counter medications including oral antihistamines and intranasal steroid sprays can be very helpful at controlling the symptoms of seasonal allergies.
How will you know the cause of my sinus headache symptoms?
The pattern of symptoms can help differentiate if the sinus headache is caused by sinusitis or a migraine headache masquerading as a sinus infection. If the symptoms follow a cold and are associated with thick, cloudy nasal drainage, it is likely to be a sinus infection. If the sinus headache comes with nausea or a sensitivity to light or sound, it is more likely to be a migraine. In cases where it is difficult to tell, it may be useful to see an Otolaryngologist (or Ear, Nose and Throat doctor) who can look for evidence of inflammation in the sinuses. A simple in-office procedure called a nasal endoscopy looks at the sinus drainage pathways for evidence of inflammation. A CT scan can also be ordered to see if there is sinus inflammation. If the sinuses look healthy, then the sinus headache is unlikely to be caused by sinusitis.
When should I worry about sinus pressure?
If the sinus headache is severe and not responding to non-prescription pain medication, you should see a doctor. If the symptoms are mild to moderate and last more than 10 days or occur more than 15 days per month, you should also seek care.
What should I do if I think I have a sinus headache?
Over-the-counter pain medications, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, others) can help with the symptoms of sinus headaches but should not be taken regularly unless recommended by a provider. A nasal saline rinse can also be helpful at washing away mucus and irritants in the nose that cause symptoms.
