What Is Sinusitis
Sinusitis is the inflammation of the paranasal sinuses, which may or may not be as a result of fungel, infection, from bacterial, fungal, viral, allergic or autoimmune issues. Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).
Factors which may predispose to developing sinusitis include: allergies; structural problems such as a deviated septum or small sinus ostia; smoking; nasal polyps; carrying the cystic fibrosis gene (research is still tentative); prior bouts of sinusitis as each instance may result in increased inflammation of the nasal or sinus mucosa and potentially further narrow the openings.
Recent studies on sinusitis and migraine
Headache is the most common symptom of sinusitis and "sinus headache" however, rarely but can be a misdiagnosis of a migraine. Acute sinusitis can cause pressure within the sinus cavities of the head, but this typically has associated pain to palpation of the sinus area and purulent greenish discharge from the nose. The use of the term sinus headache therefore is often misleading and results in underdiagnosis of migraine.
Most studies tells that up to 90% of "sinus headaches" are migraine. This confusion occurs in part because migraine involves activation of the trigeminal nerves which innervate both the sinus region but also the meninges which surround the brain. As a result, direct determination of the site of pain origination can be confused on a cortical level. Additionally, nasal congestion is not an uncommon result of migraine headaches, further confusing the issue.
Few studies further demonstrated that most patients with "sinus headache" respond to triptan migraine medications, and state dissatisfaction with their treatment when they are treated with decongestants or antibiotics.The subtlety is that while most patients with sinusitis have some sort of facial pain, pressure, or headache, not all patients who attribute the symptom of headache to their sinuses may have legitimate diseases of the sinus. Acute and chronic sinusitis can cause pressure within the sinus cavities of the head, but this is associated with pain on palpation of the sinus area.
Treatments
There are over the counter medicines that can relieve some of the symptoms associated with sinusitis, such as headaches, pressure, fatigue and pain. Usually these are a combination of some kind of antihistamine along with decongestant or pain reliever. Seeing a doctor will usually result in a prescription for antibiotics and a recommendation for rest.
Therapeutic measures range from the medicinal to the traditional and may include nasal irrigation or jala neti using a warm saline solution, hot drinks including tea and chicken soup, over-the-counter decongestants and nasal sprays, and getting plenty of rest. Analgesics (such as aspirin, paracetamol (acetaminophen) or ibuprofen) can be used, but caution must be employed to make sure the patient does not suffer from aspirin-exacerbated respiratory disease (AERD) as this could lead to anaphylaxis.
If sinusitis doesn't improve within 48 hours, or is causing significant pain, a doctor may prescribe antibiotics (Amoxicillin usually being the most common) with amoxicillin or clavulanate (Augmentin/Co-Amoxiclav) being indicated for patients who fail amoxicillin alone. Fluoroquinolones and less frequently Doxycycline are used in patients who are allergic to penicillins.
A recent British study has found that for most cases of acute sinusitis, antibiotics and nasal corticosteroids work no better than a placebo.