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There are many causes of so-called “sinus” pain and headaches

Blocked sinuses - often the complaint is one of pressure over the face, cheeks or forehead, worse when people lean forward. They will often (not always) complain of more typical blocked or runny nose, suggesting allergy or infection as well. Usually the severity of pain correlates with the nose; bad blocked nose-bad pain; clear nose, less/no pain. And if chronic ongoing infection is present, usually the sense of smell deteriorates too.

Tooth grinding/bruxism - many people grind or clench their teeth at night or during the day. Sometimes it is due to tension/stress. This can result in pain over the cheeks and over the angle of the jaw and lower half of the face, often worse in the morning. And it you crack a tooth due to grinding, it can be very expensive to repair. So see you dentist to be checked out and maybe have a splint made if needed to wear at night to protect the teeth.

Tension headaches - these often occur at the end of the day, over the top of the head, when people are tired.

Neck and shoulder pain - this can sometimes radiate from the neck.

Migraine headaches - very commonly mistaken for “sinus” trouble. Symptoms are independent of the nose, can go behind one eye and be associated with nausea/sickness in the stomach, dislike of bright lights or noises, the need to lie in a dark room and radiate behind one eye. There are many causes of migraine, but dehydration is a very common one. If a specific anti-migraine tablet like Imigran or Zomig help, that points to migraine as the cause as these tablets have no pain killing properties.

Middle turbinate syndrome - this is a complex condition. Essentially, a structure called the “turbinate” inside the nose presses on the nasal septum, and one gets a nerve-derived pain. It is often worse when the nose is more blocked as a swollen nose usually means a more swollen turbinate that is more likely to press on the septum. It is often better with a decongestant/unblocking nose spray temporarily, or if one squirts local anaesthetic up the nose to numb it. Treatment options include surgery to trim and remove some turbinate tissue.

What to do?

See if some of these possibilities sound familiar, think about what makes the pain worse or better, see if you think there is a relationship between your pain and nose blockage and then discuss them with your doctor. I have seen many people where their doctor has taken them at face value when they complain of “sinus” and treated them with antibiotics and done an xray, when in fact they had typical migraine headaches and might have been better off seeing a neurologist.

Last reviewed  19 June 2020

Summary
The complaint of having “sinus pain” is common, but blocked sinuses are not always the cause. It sometimes pays to think laterally, because not all “sinus pain” is due to sinus disease.