Facial Pain, Pressure, “Sinus” Headache

Diagnosis

Chronic pressure and/or pain in the cheeks, around or behind the eyes.  Often described as a “sinus” headache without other symptoms of acute sinusitis.  May be unilateral or bilateral.

Underlying problem

Turbinate swelling, an abnormally enlarged middle turbinate bone (concha bullosa) and/or a deviated nasal septum.  The swollen or enlarged turbinates press against the septum or lateral nasal wall to cause pain and pressure.  A septal deviation can be impacted into an inferior or middle turbinate to cause pain and pressure.  A more appropriate term is a nasal headache if no evidence of sinusitis is found.

Treatment

Medical treatment is focused on decreasing nasal turbinate swelling with decongestants or nasal steroid sprays.  I symptom relief is not achieved after an appropriate trial of medical therapy, referral and/or imaging studies should be obtained to rule out chronic sinusitis, tumors and anatomic deformities.

Many patients will have already tried oral or spray decongestants with variable success.  Overuse of nasal decongestant sprays is common in patients with “sinus” headaches and should be avoided.  Oral decongestants often work well for patients with occasional symptoms.

Patients with chronic “sinus” headaches may obtain symptom relief when treated with nasal steroid sprays.

Surgical correction of a deviated septum that is impacted against the lower or middle turbinate often but not always relieves nasal headaches and facial pain if the pain is located on the side of the deformity.  Surgery can also correct an abnormally enlarged middle turbinate bone (concho bullosa), which will often relieve facial pain and nasal headaches.  The results of surgery to alleviate facial pain and headache are not always predictable, but an estimate of success can be attained by performing a topical anesthesia test.

Case:  Sinus Headaches

Anne Marie, a 28 year old actress, complained of persistent, severe “sinus” headaches, yet sinus x-rays were negative.  Oral decongestants sometimes helped; antihistamines were ineffective.  She had previously used a nasal steroid spray for 2 weeks with no relief and the spray had caused her nose to become dry and crusted on the anterior septum.  Her headaches were crippling, and she was crying in the office during our visit.

Examination revealed a markedly congested nose with swollen nasal turbinates as well as a deviated nasal septum impacting into the inferior turbinate.  It was not clear if the nasal turbinate congestion, the deviated septum, or both were responsible for her headaches.

Anne Marie was instructed to try the nasal steroid spray again, this time applying a small amount of petroleum jelly to the anterior septum and aiming the spray lightly away from the septum.  She was instructed to use the spray for 6 weeks before assessing results.  She somewhat reluctantly agreed to this treatment plan.  At her follow-up appointment 6 weeks later, she reported complete relief of her “sinus” headaches.  She continues to use the steroid spray and has no problems with intranasal dryness.  She stated that using the nasal steroid spray had “changed her life.”  At this time, she does not feel that she needs to have the nasal septum straightened.

© Copyright 1997-2011 Dr. Gerard O’Halloran and GB Resources.  All Rights Reserved.

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Dr. Gerard O’Halloran specializes in nose and sinus problems.  Trained at Mayo Medical School, Dr. O’Halloran is an Ear, Nose and Throat Physician.

He sees patients at the FamilyHealth Medical Clinic in Lakeville. The Lakeville clinic is convenient for residents of Lakeville, Rosemount, Burnsville, Eagan, Bloomington, Edina, Minneapolis and surrounding communities.  Please call (952) 469-0500 to schedule an appointment in Lakeville.

Dr. O’Halloran also sees patients at the O’Halloran Clinic in Faribault.  The O’Halloran Clinic is convenient for residents of Faribault, Owatonna, Waseca and surrounding  communities.  Please call (507) 333-5499 to schedule an appointment in Faribault.

While there are many people who suffer from allergies, a new survey by the Asthma and Allergy Foundation of America suggests that many people might be wrong when complaining about allergies.  They should be complaining about sinusitis, an inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

The survey, released May 17, 2011, “finds that many Americans who self-diagnose themselves with nasal allergies or sinusitis have difficulty differentiating between symptoms of the two conditions. As a result, they may be misdiagnosing themselves and potentially suffering from a more severe form of the condition known as chronic sinusitis. According to the survey … a significant percentage of those suffering from symptoms are skipping a visit to their doctor and diagnosing themselves even when their symptoms are severe. As a result, patients may often be confusing sinus infection symptoms with allergy symptoms, and not getting optimal care for their condition.

“The symptoms of sinusitis are similar to allergies, and sometimes allergies can lead to sinusitis, so it’s no surprise to learn that patients are confused,” says Mike Tringale, vice president of external affairs at AAFA. “However, there is a key difference between allergies and chronic sinusitis. If you have allergy-like symptoms that last longer than 12 weeks or symptoms that occur more than three times per year, with symptoms usually lasting more than 20 days despite treatment attempts, you may have chronic sinusitis and should see your doctor for a correct diagnosis and the right medical solution.”

It is estimated that 7 million Americans suffer from chronic sinusitis, resulting in nearly 32 million cases reported by healthcare providers each year according to the CDC, making it one of the most common health problems in the United States. As this month (May) marks the peak of spring allergy season, it’s important that those suffering from persistent allergies get a proper diagnosis since almost half (47%) of the respondents to the AAFA survey admit to self-diagnosing when they have symptoms.  But close to two in five (39%) respondents think it’s difficult to differentiate between symptoms, and, as a result, over half (51%) have misdiagnosed themselves with allergies when it actually turned out to be sinusitis.

Dr. Stacey Silvers of Beth Israel Hospital in New York City says she is not surprised to learn that close to one in four (23%) respondents typically experience more than three sinus infections a year, meaning that they may actually have chronic sinusitis, while nearly one half (48%) of sinusitis sufferers have not been told about chronic sinusitis by a medical professional.

“Chronic sinusitis has been under-diagnosed for many years for a variety of reasons,” said Dr. Silvers.  ”However, since many patients are confused about which medications to take and more than 50 percent of patients do not respond adequately to medications, it’s import that they consult with an Ear, Nose and Throat (ENT) physician to get the most appropriate treatment to alleviate long-term suffering.”

A few of the key findings included:

• Over half (51%) of sufferers have misdiagnosed themselves as having allergies when it actually turned out to be sinusitis.

• Close to one in four (23%) respondents typically experience this condition more than three times a year, which means that they may actually have chronic sinusitis.

• What’s more, nearly half (49%) of sinusitis sufferers have never seen an ENT about their sinusitis.

See more on the survey at the Asthma and Allergy Foundation of America.

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Dr. O’Halloran, an Ear, Nose and Throat Physician, specializes in treating nose and sinus problems.  Trained at the Mayo Clinic, appointments with Dr. O’Halloran can be made at these two locations:

1.) O’Halloran Clinic in Faribault: Patients from Faribault, Owatonna, Waseca and surrounding areas can make an appointment to see Dr. O’Halloran at the O’Halloran Clinic in Faribault.  Please call (507) 333-5499 to schedule an appointment.

2.) FamilyHealth Medical Clinic in Lakeville: Patients from Lakeville, Burnsville, Minneapolis, St. Paul, Eagan, Eden Prairie, Rosemount, Edina, Savage, Shakopee, Bloomington and surrounding areas can make an appointment to see Dr. O’Halloran at FamilyHealth Medical Clinic in Lakeville.  Please call (952) 469-0500 to schedule an appointment in Lakeville.

INTERESTING FACT:  THE NASAL CYCLE

80% of the population has a nasal cycle.  The turbinates on one side of the nose are alternately more swollen than those on the other side.  This turbinate congestion changes sides every 4 – 8 hours.

Most patients are not aware of this cycle because there is an open breathing passage on the non-congested side and a partially open breathing passage on the congested side.  If a patient complains of alternating nasal congestion (notices the nasal cycle), it often means that the turbinates are chronically enlarged from vasomotor rhinitis or chronic allergic rhinitis or that the nasal septum is deviated.

Chronic turbinate enlargement and/or a deviated septum narrow the nasal airway.  When cyclic enlargement of the nasal turbinates on one side of the nose occurs in a patient with an already narrowed nasal airway, the nasal passage on the congested side may become nearly completely obstructed and therefore noticeable to the patient.

Book excerpt republished with permission of author and publisher.  © 1997 – 2011 Dr. Gerard O’Halloran & GB Resources.  The Nose in 60 Minutes has sold over 30,000 units.

Dr. O’Halloran, an Ear, Nose and Throat Doctor, specializes in treating nose and sinus problems, children’s ENT problems, and adult sleep apnea and snoring.  Patients from Faribault, Owatonna, Waseca and surrounding areas can make an appointment to see Dr. O’Halloran at the O’Halloran Clinic in Faribault.  Please call (507) 333-5499 to schedule an appointment.  Patients from Lakeville, Burnsville, Minneapolis, St. Paul, Eagan, Eden Prairie, Rosemount, Edina, Savage, Bloomington and surrounding areas can make an appointment to see Dr. O’Halloran at FamilyHealth Medical Clinic in Lakeville.  Please call (952) 469-0500 to schedule an appointment in Lakeville.

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Dr. O’Halloran’s, a Mayo-trained  ENT Doctor, specializes in nose & sinus problems, children’s ear nose & throat problems, adult sleep apnea & snoring, skin cancers of the head, face & neck and facial cosmetic procedures.

FamilyHealth Medical Clinic—Lakeville is located at the intersection of County Road 70 and Jacquard Avenue, just south of Lakeville South High School.  The address is 9974 214th Street West, Lakeville, MN 55044.  Please call (952) 469-0500 to schedule an appointment.

An Otolaryngologist is known by many other names including:  ear nose throat doctor, ear nose & throat physician, ENT specialist, doctor ears nose and throat, and surgeon ear nose throat.

Otolaryngologists are medical doctors who are required in the United States to complete 5 years of surgical residency training.  The medical disorders treated by an Otolaryngologist include:  chronic ear infection, sinusitis, snoring and sleep apnea, hearing loss, allergies and hay fever, swallowing disorders, nosebleeds, hoarseness, dizziness, and head and neck cancer.  Otolaryngologists are also trained in facial plastic surgery.

So, if you want to impress friends and family after a visit to Dr. O’Halloran, don’t just say you visited an ear, nose and throat doctor; drop a 7-syllable word on them and say you visited a Otolaryngologist.

“• Dr. Gerard O’Halloran will open his new clinic at 1645 Lyndale Ave. N. (just south of the Faribault Garden Center) on January 27.

• The clinic will specialize in ear, nose and throat care in addition to facial plastic surgery.”

To read the complete story, go to Faribault.com