Sinus Headaches: Symptoms, Causes, Risks, Diagnosis, Treatment and Prevention

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women suffering from Sinus Headaches

 

1Overview

A sinus headache is a term for rhinosinusitis, which is an inflammation of the paranasal sinuses and the nasal cavity. A sinus headache is a term that has confounded clinicians and researchers. More often than not, those who present with sinus headaches are actually experiencing migraines.

Rhinosinusitis can either be acute or chronic, depending on the duration. Acute rhinosinusitis is diagnosed when the pain surrounding the sinuses does not persist beyond four weeks. On theater hand, chronic rhinosinusitis is diagnosed if the symptoms last more than 12 weeks. Acute rhinosinusitis can also be classified according to its cause. It can be caused by viruses or bacteria and is thus known as viral rhinosinusitis or acute bacterial rhinosinusitis. Differentiating between the two is important because treating bacterial infections is different from treating viral infections.

Chronic rhinosinusitis is the same as acute rhinosinusitis, but the duration is longer. Between acute and chronic rhinosinusitis is subacute rhinosinusitis.

2Symptoms

Rhinosinusitis has symptoms that greatly overlap with that of other upper respiratory tract infections. The way that these two classes of diseases evolve is similar. However, there are three predictable patterns associated with rhinosinusitis. The first is that the symptoms are persistent. The patient may have nasal discharge or a cough, or both that lasts for 10 days or more. The nasal discharge and cough do not get better by 10 days. Viral upper respiratory tract infections typically do not last longer than 10 days. Therefore, when a patient does not improve after 10 days, this is usually a sign that he has rhinosinusitis.

Nasal discharge and cough may be accompanied by swelling around the eyes (periorbital edema), bad breath (halitosis), or low-grade fever. The nasal discharge may have varied in its characteristic from thin to thick.

The second pattern of presentation is that there is an onset of severe symptoms. Usually, the patient develops fever and purulent nasal discharge over a period of 3-4 days. The third presentation is characterized by worsening of symptoms. Initially, patients will experience feeling better, but then they get worse again within 10 days of the disease. The worsening of symptoms is accompanied by the start of a new fever, congestion, and more nasal discharge.

In addition to these, the patient may feel facial pain or pressure, especially in cases of chronic rhinosinusitis. The inside of the nose may become red and swollen. Facial tenderness over the jaw and nose can also be a sign. Occasionally, patients may have to swell around the eyes of changes in skin color below the eyelids. 

3Causes

Rhinosinusitis is primarily an inflammatory disease, which is why there are many ways that it manifests itself. There are two major types, one with nasal polyps (an outgrowth of the mucosal lining) and one without nasal polyps. With regard to how the disease develops, there are three main elements that need to be understood. One is the narrow opening of the sinuses, another is the inability of the cilia, or small hairs in the nose, to function, and the third is the thick sinus secretions.

The narrow opening of the sinuses predisposes it to blockage or obstruction. Nasal obstruction may result to the swelling of the mucosa, as well as the mechanical obstruction of the nasal passageways. The most frequent and most important causes of nasal obstruction are viral upper respiratory tract infections and inflammation due to allergic reactions. When there is a blockage in the sinuses, the pressure inside the sinus cavity increases. Since space is closed, oxygen cannot enter. This is an ideal place for various types of bacteria to grow. Bacteria can enter the sinuses by nose blowing or sniffing.

If the obstruction in the nose continues, the lining of the nose secretes more mucus, which results in the accumulation of fluids in the sinuses.

The inability of cilia in the nose to move mucus along also contributes to the disease. When a person has a cold, the cilia do not function correctly. Therefore, materials inside the nose are not able to exit.

Thick sinus secretions then allow bacteria to grow. Bacteria may cover the inside of the sinuses, forming a thin film. Usually, the bacteria found in these films are resistant to antibiotics.

The three most common types of bacteria to cause rhinosinusitis are Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhal. Of these three, H. influenza causes the most number of sinus infections.

4Risk Factors

There are various risk factors that predispose people to develop rhinosinusitis. One of these is anatomic variations. For instance, when the midline of the nose, or the septum, is deviated more than 3 mm, chronic rhinosinusitis can develop.

Smoking and exposure to tobacco smoke are also risk factors.

Age is another risk factor. Rhinosinusitis is more common in young children. All infants are vulnerable to infections before the immune system has fully developed. Infants may have colds every 1-2 months. Young children are also susceptible to colds and may have 8-12 colds per years. In addition, infants and children have small nasal and sinus passages. This makes the more vulnerable to upper respiratory tract infections. Ear infections in children, such as infections of the middle ear (otitis media), are associated with rhinosinusitis.

The elderly are also at risk for rhinosinusitis. The nasal passages of elderly persons tend to dry out with age. In addition to this, there are changes in the anatomy of the nose that cause airflow changes. For instance, elderly people usually have weak supporting cartilages that change the airflow. Their gag reflexes are also impaired, and their immune system is weaker.

People with asthma or allergies are also at an increased risk for rhinosinusitis. The risk for rhinosinusitis is increased in patients who have severe asthma. Aside from these, sensitivity to aspirin has also been identified as a risk factor.

5Diagnosis

Since the signs and symptoms of rhinosinusitis are similar to those of upper respiratory tract infections, the challenge for clinicians is to identify patients who will benefit from antibacterial agents. Usually, physicians will ask for the patient’s complete history, including exposure to other people who have rhinosinusitis, exposure to smoke, and previous episodes of rhinosinusitis.

If the clinician is still unsure of the diagnosis, he or she can request for imaging studies. CT scans or MRIs are useful for these instances. CT scans are especially recommended for patients who are suspected of having chronic rhinosinusitis. Nasal endoscopy can also be performed by a doctor. During nasal endoscopy, a small probe with a camera is guided into the nose to view the upper respiratory tract. In addition, samples of the mucous secretions can also be cultured in the laboratory to determine the type of bacteria that caused the infection.

6Treatment

Nasal sprays can provide temporary relief for patients with rhinosinusitis. Nasal sprays usually contain oxymetazoline. However, they should not be used for longer than the recommended period because the rhinosinusitis can return, known as rebound rhinosinusitis. However, the vast majority of rhinosinusitis cases are caused by viruses. In most instances, viruses are self-limiting and will resolve on their own.

If symptoms do not improve within 10 days, antibiotics can be taken. Antibiotics are not recommended for those who only have mild to moderate illnesses during the first week of infection because they come with a list of unpleasant side effects. They are also costly and taking antibiotics unless recommended will contribute to antibiotic resistance.

For bacterial rhinosinusitis, the recommended treatment of choice is amoxicillin-clavulanate, since most bacteria today are already immune to amoxicillin. A short course of antibiotics is often recommended. Short courses last from 3-7 days. These short courses seem to be just as effective as antibiotics taken for a longer period of time, up to 14 days.

Children who have rhinosinusitis, however, should be treated with antibiotics from 10 days to 2 weeks.

For cases where acute rhinosinusitis is not yet confirmed, nasal corticosteroids are recommended. In case the patient does not benefit from medications, surgery may be the best treatment option. Medications should only be taken under the advice of a doctor.

One type of surgery is called maxillary antral washout, which involves making a small hole in the sinus and using a salt solution to flush out the mucus. Functional sinus surgery is another option because it reduces tissue disruption and has lower complications following surgery.

7Prevention

Treat stuffiness of the nose caused by allergies and colds right away. This can help prevent bacterial infections for occurring. Avoid contact with people who are sick. People who have upper respiratory tract infections should also be avoided. Regular hand washing is also recommended to prevent the virus or bacteria from reaching the nose. People should also refrain from smoking or be exposed to tobacco smoke. Smoke irritates the sinuses and causes inflammation of the nose and sinuses. Asthmatics should also treat their illnesses promptly. Dry air should also be avoided, as this predisposes to rhinosinusitis. Lastly, remaining hydrated is essential for preventing rhinosinusitis.