Sinus headache is commonly diagnosed when patients have facial pain and pressure accompanying their headache. However, it is not as common as believed; the headache must accompany acute rhinosinusitis, a diagnosis that is based both on clinical and radiologic evidence. Many patients who are diagnosed with sinus headache and treated with antibiotics have a primary headache, usually migraine. In 2013, the International Headache Society revised the criteria for headache caused by rhinosinusitis. However, these criteria may not be valid for sphenoid sinusitis. Dr. Chen of Taipei Veterans General Hospital in Taipei, Taiwan, explains the key points for diagnosis of rhinosinus-related headache and updates pertinent advances in this headache disorder.
• Many patients with a primary diagnosis of "sinus headache" have migraine or tension-type headache; the differential diagnosis depends on the patient's history.
• Uncomplicated sinusitis, other than sphenoid sinusitis, should be treated with a broad-spectrum oral antibiotic for 10 to14 days.
• Sphenoid sinusitis may be associated with major complications (bacterial meningitis, cavernous sinus thrombosis, etc.) and should be managed with high-dose intravenous antibiotics.
• Treatment failure and recurrent sinusitis are indications for neuroimaging and endoscopy to search for a source of obstruction in the sinus ostia and ostiomeatal complex.