What’s the best way to treat sinus headaches?

DEAR DOCTOR K:

I’ve had terrible allergies this year, and they have caused repeated, severe sinus headaches. What’s the best way to treat sinus headaches?

DEAR READER:

The sinuses are air-filled spaces 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, known as ostia, into the nose. The stuff you blow out when your nose is congested is usually mucus produced by the membranes that are in your sinuses and in your nose.

Any condition that causes the nose or sinus membranes to become swollen can narrow or completely block the ostia. This results in a sinus headache. (I’ve put an illustration of this at the end of this post.)

Sinus headaches can occur in three situations:

  • when the membranes become inflamed;
  • when fluid builds up in the sinuses and can’t drain out through the nose;
  • when pressure in the sinuses is lower than the environmental air pressure.

Allergies are a major sinus irritant. Viral infections or exposure to secondhand smoke, perfume or other inhaled chemicals also can cause a sinus headache. Whatever the cause, sinus headache pain is most often felt in the center of the face, the bridge of the nose and the cheeks.

People with allergies are especially susceptible to sinus headaches. To treat your sinus headache, start with an over-the-counter (OTC) antihistamine. Histamine is a substance released during an allergic reaction; it causes swelling of the mucous membranes and mucus production. Antihistamines block the action of histamine.

Some antihistamines (both OTC and prescription) have bothersome side effects. They can make you drowsy, slow your reaction time and impair your judgment. Older, “first-generation” antihistamines are more likely to cause such effects.

Newer, “second-generation” antihistamines have fewer side effects. They are less likely to cause drowsiness and nasal dryness than the older ones, but still can cause these symptoms in some people. These non-sedating medicines include loratadine (Claritin, others) and fexofenadine (Allegra). They are available over the counter. Desloratadine (Clarinex) and azelastine (Astelin nasal spray) are available by prescription.

Corticosteroid nasal sprays reduce swelling and mucus in the nasal passageway. They also relieve nasal symptoms. These sprays require a doctor’s prescription.

Guaifenesin is another ingredient to look for. It thins the mucus so that it drains more easily. (Mucinex is especially effective.)

Decongestants also reduce swelling and open up the nasal and sinus passages. A steam bath can sometimes also do the trick.

Sometimes sinus inflammation and congestion can trigger migraine headaches in people prone to getting them. There are several distinctive features of many migraine headaches. They often begin on one side of the head; are located behind the eye or in the temple; are pounding or throbbing, rather than steady; are accompanied by nausea; are accompanied by changes in vision (blurring, black spots, flashes of light). Different medicines are needed to prevent migraines.

Sinus infection (sinusitis)

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Normally, mucus drains from the sinuses into the nasal passages through small openings, known as ostia. But these openings can become blocked from allergy, viral infection, or some other cause. This congestion can lead to a bacterial sinus infection, which is often accompanied by yellow or green nasal discharge, a bad taste in the mouth, and sometimes fever.