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What causes a sinus headache?

Satish Govindaraj, MD
Ear, Nose & Throat (Otolaryngology)
Sinus headaches are caused by pressure. In this video, Satish Govindaraj, MD, director of endoscopic skull base surgery at The Mount Sinai Medical Center, explains how congestion plays a role.
Sinus headache can occur in three circumstances: when the inner membrane becomes inflamed, when fluid builds up in the sinuses and can't drain out through the nose, or when pressure in the sinuses is lower than environmental air pressure (sometimes called barometric pressure because it is measured by an instrument known as a barometer). Whatever the cause, sinus headache pain is most often felt in the center of the face, the bridge of the nose, and the cheeks. It may also occur behind the eyes or the center of the forehead and be accompanied by nasal congestion and clear or opaque nasal discharge.

Any condition that causes the nose or sinus membranes to become swollen can narrow or completely block the ostia—resulting in a sinus headache.

Inflammation of the nose and sinus membranes, known as rhinosinusitis, is usually triggered by allergy or viral infection. Less often, rhinosinusitis is caused by exposure to secondhand smoke, perfume, or other inhaled chemicals.

Sometimes, particularly when the inflammation is sufficient to block drainage from the sinuses, bacteria that normally live in the sinuses take advantage of the situation, producing a bacterial infection. A bacterial sinus infection not only causes head pain, but also often produces foul-smelling, yellow-green discharge, coughed up from the back of the throat, that can leave a bad taste in the mouth. A bacterial infection can also cause fever, and, at its worst, chills and uncontrollable shaking.

Air pressure inside the sinuses also contributes to sinus headache. Typically, the air pressure inside the sinuses is the same as the pressure in the nose and in the air around you. But blockage of the ostia can result in unusually low air pressure inside the sinuses due to absorption of air, which produces sinus pain.

Sinus headaches are common and occur when there is an active sinus infection (sinusitis). The symptoms include nasal congestion, and stuffiness, runny nose, sneezing, watery eyes, facial pressure and headaches. Headache is commonly located in the face or forehead and may be throbbing in quality. However these headaches should not be confused with migraines. If you have a history of sinus headaches, which tend to linger after the sinusitis has been treated you should discuss this with your doctor.

Any allergic reaction or even a tumor in the sinuses can produce swelling and blockage of the sinuses, causing the headache pain you feel. Although not all pain in the sinus area is directly related to sinus disease, some of the most common causes of pain include:

Obstruction - When the cilia in the nasal passages become damaged or do not work effectively, the mucus builds up causing an obstruction. This obstruction of the sinuses and impacted mucus results in decreased oxygen in your sinus cavities. When the ostia in the sinus is blocked, the pressure in your sinus cavity increases, leading to the pain that you feel.

Inflammation - Sometimes sinus pain is due to extreme swelling of the membranes against a deviated nasal septum or nerve area. Or, if you suffer sinus pain while in cold air, you may have a wide nose where the bones don't come together. When the roof of your nose is open, cold air strikes the membranes directly, resulting in excruciating pain.

Referred pain - Sometimes, what you may think is a "sinus headache" is really "referred" pain from the neck. This is because of the hookup of the nerves causing painful stimuli to radiate to the front area above your eyes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.