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Overview |
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Definition |
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An acute or subacute headache caused by sinus congestion and/or infection
results in dull, deep, or severe pain in the front of the head, localized over
the affected sinus. Found in patients with a previous history of upper
respiratory infection with residual nasal congestion and discharge. Allergies
that interfere with the body's protective mechanisms may precede the viral
infection. Symptoms worsen in cold, damp conditions. Pain is greater in the
morning and decreased by afternoon. Bending or leaning over worsens headache.
Sinus headache may be a symptom of sinusitis, a bacterial infection. Some
believe that true sinus headaches affect only 2% of the population; the rest who
believe they are experiencing sinus headache may instead have vascular headaches
(migraine, cluster). |
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Etiology |
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After an acute viral respiratory tract infection, the patient develops a
bacterial infection. Gram-negative rod or anaerobic microorganisms may worsen
infection.
- Streptococci
- Pneumococci
- Hemophilus influenzae
- Staphylococci
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Risk Factors |
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- Viral respiratory tract infections
- Sinusitis
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Signs and Symptoms |
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- Dull or severe frontal headache
- Previous upper respiratory infection
- Purulent nasal discharge; yellow or green rhinorrhea
- Fever
- Red, turgescent nasal passages
- Pain may be worse in mornings, better in afternoons
- Bending or leaning over increases pain
- Pain is worse in cold and damp weather
- Pain may be localized to one part of the
face
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Differential
Diagnosis |
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- Migraine, tension, or cluster headache
- Brain tumor or brain abscess
- Systemic disease or condition such as hypertension, allergy,
anemia
- Meningitis or meningeal irritation
- Sensitivity to vasoactive substances, nitrites, carbon
monoxide
- Seizure disorder
- Encephalitis
- Subdural hematoma
- Allergies
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Diagnosis |
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Physical Examination |
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Patient has history of upper respiratory infection and current swollen mucous
membranes, tenderness on compression over affected sinus, and evidence of nasal
obstruction. Eliminate vascular headaches masquerading as sinus headache:
Patient complains of general malaise and presents with mild to moderate fever
and apparent nasal congestion or discharge. |
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Laboratory Tests |
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- CBC
- Nasopharyngeal cultures
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Imaging |
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- CT scan if headache is recent and cause is not immediately clear,
especially if abnormal neurological signs are present
- X ray of sinuses,
transillumination
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Other Diagnostic
Procedures |
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Patient history and examination, with emphasis on upper respiratory symptoms
and previous infection. Patient history should note characteristics of headache,
timing, frequency, duration, and possible triggers.
- Try a migraine drug to see if it stops the
headache.
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Treatment Options |
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Treatment Strategy |
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Treatment should be directed at improving sinus drainage and eliminating
infection. Patients will appreciate pain relief. Inhaling steam or using a
vaporizer helps shrink mucous membrane blood vessels and improves
drainage. |
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Drug Therapies |
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- Nasal vasoconstrictor spray medications such as phenylephrine 0.25%
spray once every three hours are effective but must not be used longer than
seven days.
- Systemic vasoconstrictors such as pseudoephedrine 30 mg orally
(adult) every four to six hours may be helpful but are less reliable.
- Antibiotics for a minimum of 10 to 12 days. Ampicillin (2 g/day) or
amoxicillin (1.5 g/day), active against S. pneumoniae and H.
influenzae. Augmentin with beta-lactamase strains of influenzae. For
patients allergic to penicillin,
trimethoprim–sulfamethoxazole and cefaclor. Nasal
decongestants as supportive therapy.
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Complementary and Alternative
Therapies |
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Can be very helpful at minimizing the discomfort, treating the infection,
stimulating the immune system, clearing the congestion, and decreasing the
frequency of headaches/infections. A combination of physical medicine and herbal
or homeopathic treatment is often very effective. |
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Nutrition |
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- Use the same nutritional regimens as used in other treatments of
acute infection—vitamin C (1,000 mg tid), zinc (30 to
60 mg/day for acute phase only), beta-carotene (15,000 IU/day).
- Use bromelain (1,200 to 1,800 mcg, 250 to 500 mg) between
meals.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Wild indigo (Baptisia
tinctoria)—specific for upper respiratory and sinus
infections
- Eyebright (Euphrasia
officinalis)—stimulates drainage, warming and
soothing
- Licorice (Glycyrrhiza
glabra)—antiviral, soothing, especially with
exhaustion and/or heartburn, avoid with hypertension
- Coneflower (Echinacea)—stimulates the
immune system, antiviral
- Goldenseal (Hydrastis
canadensis)—antiviral, antibacterial, digestive
tonic
- A combination of all of the above herbs, equal parts, may be very
effective. Using dried herb—1 tbsp./cup water, 4 to 6
cups/day. Using tincture—equal parts of tincture, 60
drops every two to four hours.
- Jamaica dogwood (Piscidia piscipula) or St. John's wort
(Hypericum perforatum), in equal parts—may be
added for pain relief
- Garlic (Allium sativum) and ginger (Zingiber
officinale), as a tea—Use 2 to 3 cloves of garlic
and 2 to 3 slices of fresh ginger, steep 5 to 15 minutes and drink, breathing in
the steam. Stimulates immune system and drainage, prevents sinus problems from
extending into lungs.
- Essential oils may be used as a bath or as a steam. For a steam,
place 2 to 5 drops in a pot, bring to a simmer, and hold head over pot. For a
bath, add 5 to 10 drops of oil to the bath. Eucalyptus, lavender, and thyme are
specific for upper respiratory infections. Lavender and rosemary are also very
calming. All of these essential oils have antiseptic
properties.
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
The goal of homeopathic remedies for sinus problems is to encourage drainage;
patient should be advised that the resulting runny nose is helping to clear out
bacteria. Peptostrep, a German homeopathic remedy, works well to clear sinuses
and may be taken in 200X to 5X strength over the period of a
month.
- Arsenicum album for sinusitis with thin, watery, excoriating
discharge, especially with sneezing without any relief from the nasal stuffiness
and restlessness and/or anxiety.
- Kali bichromium for sinusitis with postnasal drip, especially
with ulcerations of the septum and weakness.
- Mercurius for raw, ulcerated nostrils with swelling, may have
bloody discharge and exhaustion.
- Pulsatilla for sinusitis with thick, bland discharges,
especially with weepiness, a lack of thirst, and wanting to be constantly
comforted/held
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Physical Medicine |
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- Alternating hot and cold compresses. Three minutes hot compress/cloth
across the sinus, alternating with 30 second cold compress. Repeat this cycle
three times for a single treatment. Treatment may be repeated from two to six
times/day. The hot compress brings blood, white blood cells, and therapeutic
agents (herbs or antibiotics) into the area. Heat is also analgesic. The cold
flushes the sinuses and relieves congestion, thereby relieving pain.
- Nasal lavage. Mix salt water to taste like tears. Rinse each nostril
by holding head over sink and letting water run from upper nostril to the lower
nostril. Keep nostrils lower than throat to prevent salt water draining into
back of throat. This shrinks membranes and increases drainage.
- Craniosacral therapy can be very effective at decreasing the
frequency of infections and headaches.
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Acupuncture |
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May be useful to stimulate immune system and increase
drainage. |
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Patient Monitoring |
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Use of nasal vasoconstriction sprays must be limited. Patients should be
instructed on proper use of this medicine and the importance of limiting the
time it is used.
Patient should return for treatment if a headache begins after exercise,
straining, coughing, sexual activity, or is accompanied by changes in mental
state or memory, confusion, or sleepiness. A sudden, severe headache may be
caused by hemorrhage or bleeding in the brain; or if accompanied by stiff neck
and fever, meningitis or meningoencephalitis. |
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Other
Considerations |
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Prevention |
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- At higher risk for sinusitis are smokers and people who are
repeatedly exposed to bacteria, such as school and health care workers, and
those who have allergies or deformities of the nose such as a deviated
septum.
- Avoid respiratory illnesses and infections.
- Treat respiratory illnesses promptly to prevent developing bacterial
infection.
- Patients should be advised not to use over-the-counter decongestant
nose drops or sprays that contain phenylephrine longer than three days because
they can lead to addiction.
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Complications/Sequelae |
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- If decongestant and antibiotic therapies are not effective, patient
may need surgery to remove infected material from sinus.
- Poorly controlled diabetic or immunocompromised patients are at risk
of developing potentially serious fungal
infections.
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Prognosis |
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Depending on severity of sinus infection, condition may take weeks to months
to resolve. When sinus infection is eliminated, sinus headaches are eliminated
also. |
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Pregnancy |
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Avoid medications or alternative remedies that are contraindicated during
pregnancy. |
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References |
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Berkow R. The Merck Manual. 15th ed. Rahway, NJ: Merck Sharp &
Dohme Research Laboratories; 1987.
Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil
preparations on neurophysiological and experimental algesimetric headache
parameters. Cephalalgia. 1994;14:228-234.
National Headache Foundation. Headache Topics: Sinus Headache. Accessed at
www.headaches.org/sheets/sinus.html on January 30, 1999.
Pryse-Phillips W. Guideline for the diagnosis and management of migraine in
clinical practice. Can Med Assoc J 1997; 156:1273-87.
University of Michigan Health System. Health Topics A to Z: Sinus Headaches.
Accessed at www.med.umich.edu/1libr/topics/hdache08.htm on January 30, 1999.
Walker L, Brown E. The Alternative Pharmacy: Break the Drug Cycle with
Safe Natural Treatment for 200 Everyday Ailments. Paramus, NJ: Prentice
Hall; 1998. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |