Sinus headaches cause a dull, deep, or severe pain in the front of your head and face. They are caused by an inflammation in the passages behind the cheeks, nose, and eyes. Bending down or leaning over generally makes the pain worse, as does cold and damp weather. Sinus headaches are often worse in the morning, and better by afternoon.

Sinus headaches are generally described by the following characteristics:

• Dull or severe presure-like pain in one specific area of the face or head (for example, behind the eyes)
• Facial tenderness to touch
• Pain aggravated by sudden movements of the head and bending forward
• Worse pain in the morning because mucus has been collecting and draining all night
• Sudden temperature changes, like going out into the cold from a warm room, also worsen the pain
• Headache often starts when you have a bad cold or just after

Other symptoms that may be present related to sinus inflammation (sinusitis):

• Postnasal drip with sore throat (pharyngitis)
• Yellow or green discharge from your nose
• Red and swollen nasal passages (nasal congestion)
• Mild to moderate fever
• General sense of not feeling well (malaise)
• Fatigue

Sinus headaches are caused by sinus congestion and inflammation (called sinusitis). Sinusitis, in turn, is caused by either a respiratory infection (such as a cold) or allergies (like hay fever, also called allergic rhinitis). The sinuses are air-filled spaces lined with mucous membranes surrounding the forehead, cheeks and eyes. Healthy sinuses allow mucus to drain and air to circulate throughout the nasal passages. When sinuses become inflamed, these areas get blocked and mucus cannot drain. This lack of proper sinus drainage can lead to infection.

Sinus headaches can also result from changes in atmospheric pressure (for example, from swimming or climbing to high altitudes)

• History of allergies (especially hay fever) or asthma
• Disease or an abnormal structure in the sinus area; for example, nasal polyps (swellings in the nasal passage), nasal bone spurs (projections of bone in the nose), nasal or facial tumor, deviated septum, or cleft palate
• Climbing or flying to high altitudes
• Frequent swimming and/or diving

When you see your health care provider, he or she will take a detailed history in order to distinguish sinus headaches from headaches of other causes, such as migraines or tension. Making this distinction is not always easy or straightforward. If your headache symptoms are characterized by the description in the section entitled Signs and Symptoms above, that helps the doctor make the diagnosis. Also, if you have had a recent cold, allergy flare-up, and/or symptoms of sinusitis, that also helps make a definite diagnosis.

On physical exam, the doctor will look in your nose to check for evidence of congestion and nasal discharge. He or she will also press on areas of your face to check for tenderness. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to look for sinus inflammation; if the light does not shine through, this suggests congestion.

If the diagnosis is still not clear, your doctor may consider xrays, a CT scan, or an MRI to look for the cause of your headache. If the headache is a sinus-type, then these tests should show inflammation.

The best way to avoid or get rid of a sinus headache is to treat the underlying sinus inflammation and, if present, clear any infection by using antibiotics (see Medications). Treating the inflammation involves anything from using a humidifier (see section entitled Lifestyle) to taking medicines to surgically drain of the mucous in the sinuses. Relaxation techniques (see Mind/Body Medicine) may be helpful for headaches in general. More specifically for sinus headaches, acupuncture and homeopathic remedies help many people prone to sinus congestion and its symptoms.

The following measures can reduce congestion in your sinuses:

• Use of a humidifier
• Saline nasal spray
• Inhaling steam 2 to 4 times per day (for example, sitting in the bathroom with the shower running)

Additional measures that tend to help relieve all types of headaches or help you prevent them include:

• Stretches for the head and neck
• Relaxation techniques (see Mind/Body Medicine section)

Decongestants—are used to reduce inflammation and relieve sinus symptoms; these come in nasal (for example, oxymetazoline, pheylephrine, and xylometazoline) or oral (namely, pseudoephedrine, phenylpropanolamine) forms. The problem with nasal sprays is that they can promote dependency and "rebound" congestion (congestion that worsens if the spray is used for a prolonged period of time); therefore, nasal decongestants should not be used for longer than 3 to 5 days in a row, unless specifically instructed by your doctor. Also, decongestants can cause constriction of blood vessels and, therefore, should not be used if you have heart disease, high blood pressure, migraines, or Raynaud's disease; you should also not use decongestants if you have difficulty urinating (for example, from an enlarged prostate), have emphysema, or take certain medications such as antidepressants.

Nasal steroid spray— decrease inflammation, especially if you have allergies or a structural problem contributing to the inflammation (like a nasal polyp). Examples of this group of medications includes beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone.

Antibiotics are prescribed if a bacterial infection is present or suspected. There are many different antibiotics that your doctor may consider when treating a sinus infection.

Surgery may be necessary if your sinus headaches are related to structural problems such as a deviated septum or nasal polyps. Even when such structural problems are present, medication and other less invasive alternatives are tried before surgery is recommended. This is because of the potential risks associated with surgery and because surgery is not always successful for getting rid of your symptoms even if the structural problem has been fixed.

Surgical procedures for sinuses are performed by an Ear, Nose, and Throat (ENT) specialist, also called an otolaryngologist.

There are several supplements (see bulleted list below) that may help prevent or treat sinus headaches because they either diminish sinus inflammation or help to ward of colds which, in turn, makes it less likely for you to get sinusitis. See our monograph on Sinusitis for more details regarding the use of these supplements for this condition. Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

• Bromelain and Quercetin
• Lactobacillus and other probiotics ("friendly" bacteria)
• N-acetylcysteine, a modified form of cysteine
• Vitamin C
• Zinc

The use of herbs is a time-honored approach to strengthen the body and treat disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Like supplements, there are many different herbs that may help reduce your chances of getting a sinus headache by preventing or treating a cold, enhancing your immune function, or reducing sinus inflammation:

• Barberry (Berberis vulgaris)
• Goldenseal (Hydrastis canadensis); although, barberry is preferable because goldenseal is endangered
• Echinacea (Echinacea angustifolia/E. pallida/E. purpurea)
• Ephedra (Ephedra sinica); because of some serious risks associated with this herb, it should only be used under the guidance of a trained health professional
• Eucalyptus (Eucalyptus globulus)

Although adequate research is lacking, other herbs that have been used traditionally to treat headaches include:

• Chinese skullcap (Scuterllaria baicalensis) - can reduce inflammation associated with allergies such as hay fever (allergic rhinitis); also, skullcap (Scutellaria lateriflora), a close relative of Chinese skullcap, is used by herbalists for headaches, particularly tension headaches
• Devil's claw (Harpagophytum procumbens) - has pain relieving and anti-inflammatory properties
• Feverfew (Tanacetum parthenium), a member of the sunflower family, has been used for centuries in European folk medicine as a remedy for headaches and fever; in present day, this is mainly used to treat migraine headaches, which has been studied scientifically
• Ginkgo (Ginkgo biloba) - early evidence suggesting that ginkgo may help prevent symptoms, like headaches associated with change in altitude
• Jamaica dogwood (Piscidia erythrina/Piscidia piscipula) - according to animal studies, this herb relieves pain, reduces inflammation, lowers fever, and alleviates cough; Jamaica dogwood is a potent herb and should be used only under the guidance of a qualified healthcare professional
• Lavender (Lavandula angustifolia) - used by aromatherapists as a tonic in inhalation therapy to treat headaches
• Linden (Tilia cordata/platypus ) flowers - used for colds, cough, fever, infections, and headache (particularly migraine)
• Willow bark (Salix spp.) - Willow bark's most important medicinal qualities are its ability to ease pain (for example, from headaches) and reduce inflammation

One of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. In general, there have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for sinus headaches based on their knowledge and clinical experience. In one study of homeopathy for sinusitis, more than 80% of the 119 participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks without antibiotics or other medications.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are remedies commonly prescribed for sinus congestion and headache:

• Arsenicum album — for throbbing, burning sinus pain that is relieved by lying upright in a cool room with open windows
• Belladonna — for throbbing headaches that come on suddenly and feel worse with motion and light; pain is partially relieved by pressure, standing, sitting, or leaning backwards
• Bryonia — for headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation
• Hepar sulphuricum — for headaches described as "a nail being driven between the eyes;" these types of headaches are often accompanied by thick, yellow nasal discharge; symptoms tend to worsen with movement and light touch of the scalp and improve with pressure
• Iris versicolor — for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting
• Kali bichromicum — for sinus headaches and congestion; pain often occurs between and behind the eyes; symptoms generally progress throughout the morning, worsen with cold and motion, and improve with warmth and pressure
• Mercurius — for raw, swollen nostrils; this remedy is most appropriate for individuals whose pain feels as though the head has been placed in a vise; pain may also extend to the teeth; symptoms tend to worsen at night and the individual may alternate between sweating and having the chills; nasal discharge may be bloody
• Natrum muriaticum — for headaches and congestion associated with allergies
• Pulsatilla — for headaches triggered by eating rich, fatty foods, particularly ice cream; pain may move around the head but tends to be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; symptoms tend to worsen at night and with coughing and blowing the nose; children often develop these symptoms while at school
• Silicea — for sinus pain that improves with pressure, head wraps, and warm compresses
• Spigelia — for stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up 

The National Institutes of Health recommends acupuncture as a treatment for headache. While few studies have investigated whether acupuncture is effective specifically for sinus headache, this condition is often successfully treated by acupuncturists. An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances.

Practitioners often describe sinus headache as a "dampness" which creates inflammation and fluid retention in the mucus membranes. This dampness can be cleared by strengthening the spleen meridian. In addition to needling, acupuncturists may use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points). Those with special training may also recommend herbal therapy.

Although no studies have examined the effectiveness of chiropractic for sinus headaches, some practitioners suggest that manipulations by a well-trained chiropractor may decrease pain and improve sinus drainage in certain individuals.

For headaches in general, relaxation techniques such as meditation and biofeedback can be helpful, particularly if the headaches are chronic and recurrent, as can be the case with sinus headaches.

If you are not better in a few weeks, your primary care physician may send you to see an ENT specialist for tests to find the cause of your sinus congestion.

Sinus congestion often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use. Please check the monographs on individual herbs and drugs discussed in this article to know which are safe and which are not. Also, check with your obstetrician before using any herbs or supplements.

Be sure to contact your physician if you experience a new headache or any change in the quality of your previous headaches. For example, if the pain is more severe or your usual measures to relieve your headache are not working, call your doctor immediately. Another reason to notify your physician right away is if you have a new fever and/or a particularly stiff neck along with the headache; this may indicate meningitis, a potential complication from sinusitis.

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