Nasal and paranasal sinuses are known to cause headache pain.

Although there are many causes of headache, nasal and paranasal disease is frequently blamed. Acute nasal and perinasal sinus problems (less than three months) tend to cause pain over the sinus areas which include the forehead, eye socket or midface; whereas chronic disease (over three months) tends to cause the dull, vague aching type of headaches all over the skull, not just over the sinus location.

Symptoms can be worse in the morning because of accumulated mucopurulent (snot) material within the nose and sinuses during sleeping. Also, barometric weather changes can make it worse.

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Other triggers include forceful blowing of the nose and situations where pressure changes can occur, such as flying in an airplane or diving underwater.

The physiologic cause, a.k.a. the process and development of a paranasal sinus headache, is inflammation and irritation of nerve fibers located in the nasal anatomy. There is a large nerve called the trigeminal nerve that is generally the nerve that is involved with patient’s symptoms.

Since symptoms can vary, headaches associated with paranasal sinus disease can be confused with headaches that are result of irritation of the temporal mandibular joint (jaw joint), trigeminal neuralgia (inflammation that causes shooting and stabbing pain along the nerve root), migraines and very rarely, if ever, diseases such as meningitis, which are usually associated with neck stiffening.

Sometimes acute problems resolve themselves. Other times antibiotics, if appropriately selected, also help. For patients that have chronic and/or recurrent issues, nasal sinus surgery can produce some good results. Research and recent studies suggest that over 80% of patients who underwent functional nasal sinus surgery had partial or greater relief with their headaches.

Surgery is frequently used to correct a deviated nasal septum that could be pinching the nerve. Swollen tissues in the lining of the nose and other structures in the nose called turbinates can be surgically corrected and reduced to avoid pressure irritation that could trigger a headache.

More recent studies suggest approximately 50% of people who reported headaches noted relief after surgery. Approximately 40% saw improvement of the severity or the frequency. Fewer than 20% reported no change.

I understand patients do not relish the idea of undergoing surgery but if the pain is bad enough and no results or answers have been obtained from other physicians there are tests that can be done in the office called nerve blocks. These nerve blocks can be done with and without needles depending on the location that is to be blocked.

If temporary relief is noted with this testing method, it suggests that the patient might be a good candidate for long-term results with nasal sinus surgery.

Denis W. Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit

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