OK, first off, this is a daunting topic. There are many different causes of headaches, and to make matters more complicated, there are combination headaches of several types. Let’s start by saying that many headaches, such as migraines, tension headaches and temporal mandibular joint syndrome, are not of ear, nose and throat origin, and thus a neurologist or an oral surgeon may need to be consulted. It is important to stress, however, that some of these non-ENT headaches may still be triggered by ear, nose and throat problems, such as chronic sinusitis, a deviated nasal septum or allergic rhinitis. Therefore, we do sometimes have cause to treat these headaches in the ENT world.
From here on out, we will discuss headaches of ear, nose and throat origin. The natural starting point of this discussion is the sinus headache. This complaint has been experienced by nearly everyone at some point in his or her life. It is characterized by mid-facial pain, usually associated with nasal congestion and sometimes with a runny nose. Cold and flu viruses can cause sinus headaches by blocking the sinuses or by causing an acute sinus infection. Allergies can do the same thing, but they usually occur multiple times a year, during multiple seasons, not just the cold weather months. The deviated nasal septum is a structural problem inside the nose that blocks the airway and can also block the sinuses, causing headaches. A bone spur from the septum can stick into the side of the nasal airway, causing contact pain.
Over-the-counter medications for headaches include aspirin and other non-steroidal anti-inflammatory agents. They relieve pain, but they do not open blocked sinuses. Antihistamines can be used for allergies, but they also do not open blocked sinuses. Oral decongestants can be used to open sinuses, but they cannot be used with high blood pressure. Decongestant nasal sprays will open sinuses quickly, but they cannot be used for more than five days in a row. Nasal steroid sprays will open sinuses more slowly, but if used daily, they will have a much longer effect.
An ear, nose and throat exam will identify most causes of nasal and sinus headaches. Acute sinus infections can also be identified and treated with antibiotics. Usually, a simple nasal endoscopy, using a telescope, is done in the office with no pain. Sometimes, a CT scan of the sinuses is necessary to see blockages not visible on endoscopy. Oral steroids are very effective at treating blocked sinuses, but they cannot be used with diabetes. Allergy testing and allergy shots are quite effective at treating the allergies that often cause sinus headaches. In cases of chronic sinusitis found on a CT scan, outpatient endoscopic sinus surgery or in-office balloon sinuplasty will usually alleviate the headaches.
If a patient has combination headaches, then treating the sinus blockage, the deviated septum or the allergies can frequently improve migraines and tension headaches. If symptoms persist, then an MRI of the brain may be necessary to rule out neurological conditions. If jaw pain or popping occurs, then dental referral for a possible night guard can be arranged. Don’t mess around with headaches. See your doctor if symptoms are prolonged.