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A headache in the face, cheeks, forehead, or around the eyes that comes on during a “cold,” or when the nose is congested and runny or filled with mucus, is probably a “sinus headache”: one caused by sinus infection. Another kind of sinus headache is the one that occurs in the sinus areas during descent (landing) in an airplane, especially if you have a cold or active allergy (this is called a vacuum headache).

Unfortunately there are many other causes of headaches that can be confused with sinusitis. For example, migraine and other forms of vascular or “tension” headaches also give pain in the forehead and around the eyes, and they may even cause a slight stuffy-runny nose. But they are more likely to come and go away in a day or so without a physician’s treatment, whereas sinusitis usually gives a headache that lasts for days or weeks until it is treated with antibiotics. Furthermore, intermittent headaches that cause nausea and vomiting are more typical of a migraine-type headache than sinusitis. Severe, frequent, or prolonged headaches deserve a visit to a physician for diagnosis and treatment.

What will a doctor do for my sinuses?

Your physician will ask you questions about your breathing, the nature of your nasal mucus, and the circumstances (time of day or seasons) that give you symptoms. Be prepared to explain your headaches: When and how often they occur, how long they last, and if they are associated with nausea, vomiting, vision changes, or nasal congestion. An otolaryngologist-head and neck surgeon is the kind of physician who will especially examine your ears, nose, mouth, teeth, and throat with particular attention to the appearance of your nasal membranes and secretions. He/she will check for deformities of your nose that impair breathing and for tenderness over your sinuses. X-rays of your sinuses might be needed.

Treatment will depend on the diagnosis that your physician establishes, Infections may require either antibiotics or surgery or sometimes both. Acute sinusitis most likely will improve on medication, but chronic sinusitis more often requires surgery. If your symptoms are due to allergy, migraine, or some other disease that mimics sinusitis, your doctor will have alternative treatment plans.

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The following measures may help you avoid a cluster attack:

* Stick to a regular sleep schedule. Cluster periods often begin when there are changes in your normal sleep schedule. During a cluster period, follow your usual routine.
* Avoid afternoon naps. Once a cluster period has started, taking an afternoon nap brings on a headache for many people.
* Avoid alcohol. Alcohol, including beer and wine, almost always triggers a headache during a cluster period. This can happen quickly, even before you finish the first drink.
* Limit exposure to volatile substances. Prolonged exposure to substances such as solvents, gasoline and oil-based paints may trigger an attack.
* Be cautious in high altitudes. During a cluster period, the reduced oxygen at altitudes over 5,000 feet may trigger a headache. There may be drug interactions between medications for cluster headache and medications for mountain sickness.
* Avoid tobacco products. Nicotine may occasionally trigger a headache during a cluster period. If you’re prone to cluster headache, it’s best to stop smoking and avoid other tobacco products.
* Avoid glare and bright lights. For some people, excessive glare and bright lights can bring on a headache.

Coping skills

Living with cluster headache can be difficult. In addition to the physical symptoms, the chronic pain that often accompanies cluster headache attacks can make you anxious or depressed. Ultimately, it may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

You may find that talking to a counselor or therapist can help you cope with the effects of cluster headache. Or you may find encouragement and understanding in a headache support group. Although support groups aren’t for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you’re interested, your doctor may be able to recommend a group in your area.

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There’s no cure for cluster headaches. The goal of treatment is to help decrease the severity of pain and shorten the headache period.

Acute medication

The purpose of acute treatment is to stop or reduce pain after a cluster headache starts. Because the headache peaks quickly, acute medications must be fast-acting and delivered quickly, using an injection or inhaler rather than oral tablets. You must be ready to take the medication as soon as an attack starts. And you may want to teach family members about your medications so that they’ll be able to help you when you have an attack.

Because the pain of a cluster headache comes on suddenly and may subside within a short time, over-the-counter pain relievers such as aspirin or ibuprofen (Advil, Motrin, others) aren’t effective. The headache is usually gone before the drug starts working. Fortunately, other types of acute medication can provide some pain relief. Treatment of cluster headache is focused more on prevention, with more medication options available to choose from.

Acute treatments include:

* Oxygen. Briefly inhaling 100 percent oxygen through a mask at a rate of 6 to 8 liters a minute provides dramatic relief for most who use it. Occasionally, a higher flow rate may be more effective. The effects of this safe, inexpensive procedure can be felt within 15 minutes. The major drawback of oxygen is the need to carry an oxygen cylinder and regulator with you, which can make the treatment inconvenient and inaccessible at times. Small, portable units are available, but some people still find them impractical. Sometimes, oxygen may only delay rather than stop the attack, and pain may return.
* Sumatriptan. The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, is also an effective acute treatment for cluster headache. Some people may benefit from using sumatriptan in nasal spray form, but for most this is not as effective as an injection. Sumatriptan isn’t recommended for people with uncontrolled high blood pressure or ischemic heart disease.

Another triptan medication can be taken orally for relief of cluster headache. Although oral meds isn’t as effective as injectable sumatriptan, it may be an option for people who can’t tolerate other forms of acute treatment.

* Dihydroergotamine. This ergot derivative is available in intravenous, injectable and inhaler forms. Dihydroergotamine (D.H.E. 45, Migranal) is an effective pain reliever for some people with cluster headache. When administered intravenously, the drug requires you to go to a hospital or doctor’s office to have an intravenous (IV) line placed. The inhaler form of the drug works more slowly. The dosage must be limited to avoid side effects, especially nausea.
* Octreotide (Sandostatin, Sandostatin LAR). This drug, a synthetic version of the brain hormone somatostatin, has traditionally been used to control severe diarrhea. However, some studies have shown that the injectable form is an effective treatment for cluster headache and is safe for people with high blood pressure and ischemic heart disease.
* Local anesthetics. The numbing effect of local anesthetics may be effective against cluster headache pain when used in the form of nasal drops.

Surgery

Rarely, surgery is recommended for people with chronic cluster headache who don’t respond well to aggressive treatment or who can’t tolerate the medications or their side effects. Candidates for surgery must have headaches only on one side of the head because the surgery can be performed only once. People with headaches that alternate sides of the head risk the chance that the procedure will be unsuccessful.

Several types of surgery have been used to treat cluster headache. These procedures attempt to damage the nerve pathways thought to be responsible for pain. However, residual muscle weakness in your jaw or sensory loss in certain areas of your face and head may result. The most common procedures are directed at the trigeminal nerve. They include:

* Conventional surgery. Using a conventional invasive procedure, your surgeon cuts part of the trigeminal nerve with a scalpel or uses small burns to destroy part of the nerve. This form of surgery provides relief for most people with chronic cluster headache.
* Radiosurgery. In a procedure called radiosurgery, a focused beam of radiation is used to destroy part of the trigeminal nerve. Radiosurgery is a noninvasive procedure that may have fewer side effects than does conventional surgery, but some studies have questioned the effectiveness and permanency of the results.

Potential treatments

As scientists learn more about the causes of cluster headache, they’re able to develop more selective treatments for the condition. One development that shows promise is the use of a device to stimulate the occipital nerve, which influences the trigeminal nerve. To treat people with frequent cluster headaches, researchers are testing a stimulator — a pacemaker-sized device that sends impulses via electrodes — that is implanted over the occipital nerve. A Mayo Clinic study of implanted occipital nerve stimulators found that the devices reduced chronic headache pain by an average of about half.

Similar research is under way using an implanted stimulator in the hypothalamus, the area of the brain associated with the timing of cluster periods. Stimulation of the hypothalamus in a small number of people with severe, chronic cluster headaches has produced complete and long-term pain relief with no significant side effects.

In addition, researchers are studying new medications for use in treating and preventing cluster headache.

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