The first step to breaking the cycle of sinus headaches is to clear up and control your sinus problems. At this point, you might see your headaches disappear or improve significantly. Some of my patients have also found relief by eliminating caffeine, chocolate, and other stimulants from their diet.
in the face of only mild sinus symptoms, patients will still complain of terrible sinus headaches. These patients may even have a negative computed tomography (CT) scan (a CT scan that appears normal), but the endoscopic examination will show a narrowing of the passageways, or more often, very reactive membranes (membranes that
might look normal but swell significantly when exposed to particles that you may be sensitive to). Unfortunately, because these patients often have a normal CT scan, they usually end up seeing many different physicians before they are correctly diagnosed. This is a very difficult diagnosis to make because patients may appear normal in between bouts or even during the later part of the headache when the swelling resolves. Furthermore, these patients are most often treated successfully with medicines; surgery may be required, but rarely. When surgery is required, patients typically find great relief
For example, Claire was a 28-year-old woman who came to me complaining of bad sinus headaches that occurred in her forehead, cheeks, and teeth. She had been suffering from these headaches for years, probably since the time she began to menstruate when she was a teenager. Claire had been to many different physicians, each of whom could not find anything wrong with her because her CT scans were normal. Allergy testing showed that she had mild allergies, but nothing significant enough to produce these types of reactions. Claire told me that she has always been sensitive to cigarette smoke, car exhaust, and perfumes. She realized that when she was around these odors, her headaches flared.
I first examined her sinuses, and they appeared to look fairly normal. But when I was able to examine Claire immediately after she was exposed to one of her known irritants, she instantly began to flare. I noticed that even touching the inside of her nose with an endoscope caused a reaction. I knew that it was her reactive nature that brought on her headaches and congestion.
For treatment, I put Claire on a topical nasal steroid spray as well as a decongestant and antihistamine for her allergies. These medications brought some resolution to her other CAID symptoms, but her headaches did not go away. Together, we decided that I should perform functional endoscopic sinus surgery (FESS). Today, Claire is headache-free.