What can I do for terrible sinus headaches?

DEAR DOCTOR K:

I get terrible sinus headaches during allergy season. Antihistamines help, but not completely. What else can I try?

DEAR READER:

I see many patients during allergy season complaining of sinus headache pain. It occurs most often in the center of the face, the bridge of the nose and the cheeks. And it’s sometimes accompanied by nasal congestion and clear or opaque nasal discharge.

The sinuses are air-filled spaces in the bones of your head. They lie above, between and beneath your eyes, flanking your nose. Both the nose and sinuses are lined with a thin membrane that swells and produces mucus in response to irritation. Normally, the mucus from the sinuses drains through small openings called ostia. Ostia connect the sinuses to the nasal passages. (See the illustration below.)

 The Sinuses

Normally, mucus drains from the sinuses into the nasal passages through small openings, known as ostia. But these openings can become blocked from allergy or some other cause.

 

Allergies or other conditions that cause the nose or sinus membranes to become swollen can narrow or completely block the ostia, resulting in a sinus headache.

Treat an allergy-induced sinus headache with a combination of over-the-counter medications. First, as you’ve already been doing, take an antihistamine. This will block the action of histamine, a substance released during an allergic reaction. Histamine causes swelling of the lining of the sinuses and ostia and stimulates mucus production.

Then take guaifenesin (Mucinex is especially effective), which thins the mucus so that it drains more easily. Another option is a decongestant. This will reduce swelling and open up the nasal and sinus passages. Such medications, or a steam bath, will usually do the trick.

If you have yellow or green sinus discharge, you might have developed a bacterial infection of the sinuses. Bacteria live throughout our nose and sinuses. Normally they get drained out of the sinuses with the sinus mucus. But if a sinus is plugged up, the bacteria can start to multiply inside the sinus.

To treat a sinus infection, you’ll need an antibiotic and a decongestant, but no antihistamine. (Antihistamines dry out the mucus membranes and make drainage more difficult.) If a decongestant does not offer sufficient relief, ask your doctor about a steroid nasal spray.

Several of my patients with chronic sinus problems have asked me a simple question: “Why do we need sinuses, anyway? All they seem to do is cause trouble.” Just as with our appendix, about which we can ask the same question, the answer is we don’t know. There is a theory that sinuses in the skull add resonance to the sounds that more primitive animals make when they are mating or trying to scare off enemies. We just inherited them from the animals that preceded us on Earth. They certainly don’t help us mate or scare off enemies. At least, I don’t think so!