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).

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

• Viral respiratory tract infections
• Sinusitis

• 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

• 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

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.

• CBC
• Nasopharyngeal cultures

• CT scan if headache is recent and cause is not immediately clear, especially if abnormal neurological signs are present
• X ray of sinuses, transillumination

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.

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.

• 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.

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.

• 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.

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.

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

• 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.

May be useful to stimulate immune system and increase drainage.

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.

• 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.

• 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.

Depending on severity of sinus infection, condition may take weeks to months to resolve. When sinus infection is eliminated, sinus headaches are eliminated also.

Avoid medications or alternative remedies that are contraindicated during pregnancy.

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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.

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