Sinus and nose-related headaches – Treatment

These include causes such as:
·    nose allergy,
·    a bent nasal septum blocking the sinus opening or in contact with the opposite nasal lining,
·    a narrowed sinus opening/s with a sinus infection and
·    an obstructed sinus with a negative sinus pressure
Sometimes possibly all of the above can be present in the same person at the same time. All of these conditions can stimulate and irritate the trigeminal nerve, which then generates the headache that we feel.

Treatment begins with the correct diagnosis. A full external and internal endoscopic examination of the nose should be undertaken. In instances when a sinus-related cause is suspected e.g. facial pains above, behind and below the eyes, and at the top of the head, a CT scan of the sinuses can exclude sinus disease. X-ray of the sinuses are traditionally undertaken but for a more comprehensive picture, CT scans provide a great deal more information as well as serve as the roadmap for sinus surgery should that be required.

Usually common things happen commonly, and by far the commonest nasal cause of a headache is inflammation of allergy or infection. If infection is seen, a simple course of antibiotics can be undertaken. Nasal allergy is easily treated also by avoiding the allergen e.g. house dust or pollen, saline nasal irrigation, topical nasal steroids and/or antihistamines. The reduction in the inflammation desensitizes the nasal lining as well as reduces the possibility of nasal lining contact and sinus obstruction.

Perhaps the next most likely cause for nasal irritation is when two opposing nasal linings touch one another forming a trigger point. This is likely to occur when the nasal septum is bent inside the nose. Often the patient would be aware of the bent septum as they are aware of a blocked nose, more on one side than the other although both may be equally blocked.

Sometimes a frank sinus infection is seen on endoscopy. Then antibiotic treatment with nasal decongestants also, would normally suffice, as sinus surgery is not the usual first line treatment modality. However in situations when the sinus condition becomes chronic without relenting or recurrent, then usually a more permanent solution to re-open the sinus drainage and re-vent the sinuses may be indicated. Nowadays, sinus surgery is extremely high tech, using endoscopes for minimally invasive surgery. Surgery is targeted at re-opening the natural openings of the sinuses. To make the surgery even less traumatic, when appropriate, the sinus openings can be re-dilated with inflatable balloons; this technique is known as balloon sinuplasty.

So to summarize, nose and sinus-related headaches are not altogether that uncommon especially today in our polluted modern world. It should be differentiated from all the other causes of headaches by its picture. Treatment of these headaches are usually very successful once the correct diagnosis has been established, as there is often a triggering point that fires off the nerve-endings of the trigeminal nerve that gives us these so-called Sluder’s headaches. You can almost imagine Dr. Sluder himself having a bad headache when he first described it too!




Reference: www.entific.com.hk/headache-remedy.html
The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Sinus and nose-related headaches – Why? & Causes

Headaches! We have all had them. There are many causes of headaches but this article relates to that arising from conditions that affect the nose and sinuses. Our nose is very sensitive. It has to be as it forms one of our earliest sense organ for finding food as well as arousing us to the presence of danger from predators or our changing environment. Many of us know the nose as an organ of smell (and therefore flavor) and this sensation comes from the olfactory nerve. The nose however has another nerve supply that provides us with the sensation of heat, cold, dry, humid and of course, pain. This sensation arises from the fifth nerve of our brain called the trigeminal nerve.

You all know this nerve, which innervates your face, eyes, nose, sinuses and teeth. It burns and gives you a headache if you do somersaults underwater in the swimming pool or take too much wasabi on your sushi. Your face burns from the inside and your eyes water. This is when your trigeminal nerve is being hyper-stimulated.

This same nerve is responsible for the headaches one can get from sino-nasal disease. If someone has nasal allergy, and especially if the septum (the bone inside your nose that separates the right from the left nostril) is bent, the lining of the nose expands considerably. When the hypersensitive linings touches one another, they can cause a localized headache at the top of the head, the temples or the back of the head. This kind of headache, or nerve pain, is known as Sluder’s neuralgia or Sluder’s headache.

Our sinuses are air-filled cavities inside our skull. These cavities have very narrow openings into the nose. Again, due to:

·             a nose allergy,

·             a bent septum blocking the sinus opening,

·             a narrowed sinus opening/s from recurrent infection

·             or all of the above in the same person at the same time,

the sinus opening/s become blocked. When this happens, a negative pressure is generated within the sinus and this can cause facial pains and headaches. If, on the other hand, there is a bacterial infection with pus formation, the pus will build up an intense pressure from within the sinus causing pain too. This change in pressure stimulates the nerve endings in the nose and sinuses, causing a sinus headache.

If only specific sinuses are affected like the frontal sinuses above the eyes, then a headache above and behind the eye may be felt.  Sinus headaches are peculiar in that the pain changes in intensity with position, being usually more painful when the head is lowered i.e. tying the shoelaces or picking something from the floor. Also the bony surface of the face just outside the inflamed sinus is painful to applied pressure from outside the face.

Naturally, as you now understand that sino-nasal inflammation can cause headaches, you will realize that any infection of the inside of the nose can do this too. Even when we are stressed, the nose lining inside swells up and this can manifest as a headache. Equally cancers of the nose, sinuses and nasopharynx can cause headaches as they stimulate the trigeminal nerve or block the sinus openings. Cancers are thankfully much, much less common than allergies. However in any case, any persistent or recurring headaches is best investigated for its cause and the correct treatment offered.

Reference: www.entific.com.hk/headache.html

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.