SINUS HEADACHES

Many patients are bothered by pain above the nose and between the eyes, where the sinuses are located. If there is a severe nasal inflammation, this may respond to papain/ bromelain enzyme tablets such as Clear·Ease®, dissolved in the mouth between the cheek and gums. This is especially useful if the pain follows flying or scuba diving. Clear·Ease® is a blend of pineapple and papaya enzymes designed especially for sinus and other inflammation, rather than for the digestive tract. The enzyme activity one million units of bromelain from pineapple and a half million units of papain from papaya. Some chewable papaya enzyme tablets don't list the enzyme activity.

If the sinus is infected, this requires an antibiotic and a decongestant such as Zephrex. Over-the-counter Sudafed is helpful. Avoid getting chilled, drink lots of liquids. If there is drainage, pulsatile irrigation with the Original Sinus Irrigator or best with the Hydro Pulse® Nasal / Sinus Irirgation System is an excellent way to remove pus and stimulate natural nasal function. But real sinus pain is rare, even when the patient is blowing yellow mucous out the nose. However, in many cases the "sinus headache" is really "referred" pain from the neck. Feel the back of your neck. Does the pain travel to the front of your forehead? This is because of the hookup of the nerves; painful stimuli radiates to the front area above the eyes.

Pain

Pain in the sinus comes from pressure on the membranes. Often the most severe pain comes when a vacuum is formed. For example, flying at high altitude your nose may clog because of the dryness in the cabin and your failure to drink adequate fluids, such as hot tea. The nose closes and almost immediately the body starts to absorb the oxygen in the sinus which is now plugged. On landing, the sinus is now at a low pressure whereas the atmosphere outside is at a higher pressure 15 psi (100 kN / square m)- the pain is like having a 5 pound weight (~ 2 kg mass) on your eyeball. A similar thing can happen in scuba diving.

Treatment consists of opening the sinus passages so the air pressure can equalize. Spray the nose with a nasal decongestant. The doctor may give you cortisone by injection or pill to get the passages open. Take enzyme tablets such as Clear·Ease®, dissolved in the mouth between the cheek and gums. Taking a decongestant like Sudafed or Zephrex LA is good. In my office we spray the nose well and put pledgets (small wads) of cotton with nose drops at the sinus openings. Sometimes the patient breathes helium which easily goes into narrow openings. This is a painful condition and we do give pain medicine as needed. The nasal irrigator is recommended if there is phlegm or drainage that should be removed at home.

Pain from bacterial sinus infections is surprisingly rare, even when the x-rays show significant disease. Drainage of the pus is done in the office, especially local shrinking and suction, and daily at home using the Hydro Pulse® Nasal / Sinus Irrigator. Antibiotics are also used, plus decongestant and enzyme tablets as above. Apply hot compresses over the sinus area, and drink hot tea, about 8 glasses a day, to help restore movement to the microscopic cilia of the nose and sinuses. Sometimes nasal pain is due to extreme swelling of the membranes against a deviated nasal septum or nerve area.

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