Overdiagnosis of sinus headache

The sinus headache is usually dull, but more intense flare-ups can occur. Bending over and coughing commonly worsen the pain immediately.

There is research evidence indicating that headaches can be due to pressure on the nasal mucosa from anatomical variations, nasal polyps, or mucosal swelling.

The contact points may be, for example, between the septum and the inferior or middle turbinates, between the middle turbinate and the uncinate process, or between the middle turbinate and an ethmoidal bulla.

Diagnosis depends on visualizing these contacts by coronal sinus CT and by nasal endoscopy, and by temporarily alleviating the headache by application of a local anesthetic at the contact point.

Overdiagnosis of sinus headache

There have been innumerable patients receiving unsuccessful courses of antibiotic therapy and many patients operated on unsuccessfully for presumed sinusitis-related headaches.

Prescribing antibiotic therapy for headaches unaccompanied by such symptoms and before confirming the presence of sinusitis by coronal CT images and nasal endoscopy should generally be avoided.

Neurologists and headache specialists often see tension-type and migraine headaches, which are commonly felt in the region of the sinuses, misdiagnosed as sinus headaches by both patients and their physicians.

Patients not only assume that their headaches are from sinus problems, but treat themselves unsuccessfully for this with non-prescription sinus medications.

An absence of upper respiratory symptoms should make the physician consider non-sinus related headaches.