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The Medical Minute: Sinus headache? Maybe not.

You may want to sit down while reading this. A common perception is about to be shattered.

There is no such thing as a sinus headache.

That phrase we’ve all bandied about when our head is pounding is really a misnomer, according to Dr. John McGinn, an otolaryngologist at Penn State Health Milton S. Hershey Medical Center.

If you have a head cold, and you feel like a balloon has been inflated inside your face for more than a week, what you’re most likely dealing with is a bacterial sinus infection. The temporary but seemingly unrelenting facial/head pressure is a symptom of that, but often a minor one in comparison to nasal complaints, such as congestion, runny nose or loss of sense of smell.

“We acknowledge that some patients do experience a mild degree of head discomfort when they are actively in the midst of a sinus infection, but it is not a predominant symptom,” McGinn said. However, there is a common perception that when patients are suffering with dominant pain in their face that they see that as a “sinus problem as opposed to a headache.”

An important distinction 

When a patient raises the concern about “sinus headaches” to McGinn, he likes to highlight that the head isn’t just where the hairline is or where a hat rests.

“The half-lighthearted thing I try to explain to patients is, you know, your face is part of your head, too,” McGinn said. “So, pain in your face is a headache, just as it is if the pain is in the top of your head or the back of your head.”

This isn’t about semantics. It’s about proper treatment. If patients are dealing with facial pressure and pain consistently, if there are days in which they are wiped out by that pressure and have no other nasal symptoms, they are not suffering through a sinus headache, like many believe.

They almost certainly are dealing with something else, maybe migraines, and should treat the pain accordingly, McGinn said.

“With most of the people I talk to who say ‘I have sinus headache issues,’ they are talking about chronic, recurrent, frequent or even severe headaches, things that are affecting their quality of life and their day-to-day functioning,” McGinn said. “And that is almost never actually related to their sinuses. That’s the big point of this misconception.”

OK, so what do I do about it?

As an otolaryngologist ― commonly referred to as an ear, nose and throat doctor ― McGinn said when he examines a patient complaining of sinus headaches, he’ll usually order a computed tomography (CT) scan to determine the connection, if any, to the sinuses. If that test is normal, he’ll refer the patients to a neurologist, someone who can determine the cause and type of headaches.

“There are a couple of good studies that have looked at patients who are coming in with this concern that they suffer with sinus headaches, whether they were self-diagnosed or were referred by a physician or provider,” he said. “And 85% of those patients ended up having migraine headaches as their explanation.”

The studies found the remaining 15% had myriad other issues, including different varieties of non-migraine headaches or potential nerve inflammation, McGinn said.

Finding out the root cause is key because it allows doctors to be able to treat the symptoms properly both immediately and long-term.

Patients with “sinus headaches” are sometimes prescribed antibiotics by primary care doctors and providers, and ultimately, the head pain goes away, so the patients believe the medicine worked. It may simply have been a coincidence – headaches dissipate on their own, McGinn says – and when the pain returns, more antibiotics are sought out, although the medicine doesn’t target what causes the headaches.

McGinn said, “If everyone keeps thinking this is a sinus problem and if they keep getting put on medications that we use for sinus problems, it’s not going to make it better.”

The bottom line is doctors want their patients to be healthy and symptom-free. McGinn knows he may startle some when he shatters the sinus headache myth, but it’s with the purpose of finding a solution to improve their lives.

“I try to have a positive spin on it when they see me and I’m kind of changing their world by telling them I don’t think their sinuses are the problem,” he said. “I’m giving them hope. I understand that the reason you are seeing me today is that you’ve been unsuccessful in managing this symptom. Now, we’re getting you on the right track.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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