Sinus Headaches

Few of us today can forbear cocking an eyebrow when the term "sinus headache" comes up. As Joseph and Renner2 state "To the American public one of the most standard forms of headache is 'sinus headache'. Though there is indeed pain associated with some sinus disease, the magnitude and incidence of sinus headache has been oversold to the public...". Many authors would agree with this. For example, in the Raskin and Appenzeller monograph,3 which gives as its mission the presentation of "thorough reviews of those headache disorders most commonly encountered by physicians rather than an encyclopedic coverage of the subject", "sinus headache" is not mentioned. In Lance's text,4 the subject of "sinus headache" is dealt with as follows: "vasomotor rhinitis is said to give rise to a mid-frontal headache. The author is rather skeptical of this statement since vasomotor rhinitis is a common disorder and affects many people without causing headache. It does, of course, predispose to sinusiris, which causes headache in the stage of active inflammation or when the ostium of a particular sinus is obstructed. Rhinologic causes of headache and facial pain are discussed by Ryan and Kern who comment that chronic sinusitis rarely causes facial pain. In my own experience, most patients who complain of recurrent 'sinus headache' are suffering from one of the varieties of migraine". Birt,5 writing as an otolaryngologist, states that "Otolaryngologists see scores of patients with vague discomfort in the forehead, between the eyes and across the nose and cheeks. The patient invariably ascribes his symptoms to sinus disease and is surprised to find out that they are uninfected... in fact, chronic sinusitis is not particularly common and many of these patients will probably have muscle tension headaches". Sinus headache gets scant mention in the volume on headache in the new series of the Handbook of Clinical Neurology; Hock-aday6 in her chapter on "Headache in children" writes "Acute sinusiris is usually self-evident and accompanying local pain and tenderness reveal the site of infection. Headache with catarrh or chronic sinusitis-especially frontal-is more difficult to evaluate; in children with allergic rhinitis many turn out to be of the muscle tension type".