Headaches: Sinus Care vs. Neck Care

If you suffer from headaches, it is important to try to work out the reasons for underlying factors that generate your headache. If you cannot work out what is happening, doctors often don’t tend to help you. Commonly headaches are due to sinus problems or neck problems.

Dr Xxxxx : The two most common forms of headaches are sinus headaches and neck headaches.

Migraines, although everyone thinks they have them, actually only comprise about 10% and probably less of most headaches.

Most people use the word migraine to be synonymous with the word headache- especially a bad headache. However migraines have a specific cause, with specific types of pain and with specific associations. (Vascular spasm inside the brain blood vasculature seems to be  the cause. They are usually a unique uni-lateral (one sided) thumping type of pain. Generally associated with nausea and or visual disturbances such as flickers/flashes/missing patches of vision).

Dr Xxxxx : Sinus headaches are by far the most common sort of headache. They occur because the sinus openings in the structure of people's faces are small enough or spaced in such a way that they block easily with the slightest amount of inflammation of the nasal linings. Nasal infections such as upper respiratory tract infections or colds are common causes of inflammation of the nasal linings. Allergy can be a common cause of inflammation of the nasal linings.

Facial locations of different sinus headaches.

Irritation (as distinct from allergy) can also be a common cause of inflammation of the nasal linings.

Dr Xxxxx : When the openings to the sinuses block, the body removes air from within the structure of the sinus, generating low pressure within the sinus. This low pressure causes stretching of the linings inside the face and hence pain. If the pressure drops significantly enough, fluid from the blood vessels of the mucosal linings of the sinus is sucked into the space - filling it. This can then become infected. In short a "sinus attack" develops.

Dr Xxxxx : Sinus headaches generally give you a constant ache in the face exacerbated by bending forward and associated with a sensitive or tender area overlying the affected sinuses. The main affected sinuses are the frontal sinuses, the ethmoidal sinuses and the maxillary sinuses. These can all be variably affected by obstruction.

So in treating this condition, it is important to understand why you have developed sinus problems. The treatment of an infection is slightly different to the treatment of an allergy and this again is slightly different to the treatment of an irritation.

Some basic treatments such as decongestants are common to all of the treatments for all the causes of sinus congestion or infection.

Dr Axxxx : Sinuses begin to ache when they become congested, inflamed, infected or when pressure changes develop.

Dr Xxxxx : Infection does not always need to be present when sinuses are hurting. In fact, congestion is far more common than infection.

An x-ray of an infected sinus will show that the sinus cavity does in fact contain air. It is only when the site is completely filled with fluid and becomes infected that an opacified sinus can be seen on an x-ray.

Most doctors look for opacification and fail to look for thickened mucosa in the sinuses. Often small degrees of congestion are also not reported if it affects the smaller sinuses such as the ethmoidals.

Often doctors don't look at the sinus x-rays or sinus a CT scans at all. It takes too much time. For doctors, the interface is becoming software not plates of film, therefore becoming much more time-consuming to initiate.

Passwords to access the software interface are time consuming to use. Often on many corporate systems, it can be in effect impossible to access the information except as a report in any case.  You cannot get a look at the real X-ray even if you would want to.

Dr Xxxxx : Decongestant oral medications can be used along with decongestant nasal sprays in an attempt to remove sinus obstruction caused by nasal lining swelling. Oral medication such as phenylephrine oral tablets or pseudoephedrine tablets have very widespread effects but are not terribly potent. Decongestant nasal sprays have an extreme local effect but only treat where they can touch when they are sprayed.

So there is some benefit to using both forms of decongestants.

Oral medications reach the sinuses which cannot be contacted by decongestant sprays. In short, more cavities can be reached and treated more effectively if both forms of medication are used.

Headaches cripple people's lives.

Dr Axxxx : Some of my medical friends have some concerns that high dose decongestants can cause a reduction of blood flow in the middle ear mechanism causing damage to hearing. Older people seem to be especially more susceptible to this type of injury. My friend relates that he sees a stepwise deterioration in hearing associated with bursts of decongestants used to treat coughs/colds or allergies affecting the facial sinuses. This truth may take research some time to confirm - or disprove.

Dr Xxxxx : Another treatment basic to all forms of sinus problems is the use of Saline nasal sprays. Saline is simply a solution of sodium chloride (salt). However when produced commercially it is usually isotonic (having equal osmotic pressure to the blood - approximately 300 mOsm) and is usually pH neutral to the bloodstream. (pH 7.4).

Erasmus : My friend advises his patients to purchase a commercially available saline nasal spray with a top that can be screwed off. Saline nasal spray is effectively more expensive than many medications. The bottles are also relatively small as well. However, if the top can be screwed off, these spray bottles can be refilled using eye saline at a fraction of the cost.

Do not make up your own saline. Home salt usually contains magnesium chloride as well as sodium chloride, is not pH balanced for the human body, contains fine white sand as an agent to stop the salt from sticking together in crystals and is difficult to mix up unless very accurate weight and volume measuring scientific equipment is available.

Kinkajou : 500 ml to 1000 bottles of eye saline generally cost around $10 Australian. Buying this to refill your spray bottle gives you a high quality product at a very low price and a very good delivery system. You can get 15 refills out of a 500ml bottle of eye saline, for the same price as a single bottle of saline nasal spray. But getting the gadget to use to spray the sinus cavities is worth the initial cost.

Dr Xxxxx : Saline spray should be used especially at night time for all patients. They remove irritants from the nasal lining. They remove allergens such as pollens or fungal spores or dust from the nasal linings. They may well help to rinse a little bit of virus or bacteria off the nasal linings in cases of infection. It is important to especially remove irritants and allergens from the nasal linings at night, because this gives you an entire night with reduced levels of irritants and allergens. The sinus obstruction can be significantly reduced by morning simply by reducing the load of irritants and allergens stuck on the mucus on the nasal linings.

Dr Xxxxx : Now here is where things become different. Antihistamine pills, antihistamine sprays and steroid sprays are useful only for allergic rhinitis - where you are allergic to microscopic agents, typically dust mite (in dust) or pollen or fungal spores.

Antihistamines are generally of little use where irritants (e.g. smoke, chemical vapours, petrol fumes) are the cause of the nasal inflammation. Steroids, typically steroid sprays, can be of some use but are generally less effective in the short term cases of allergic rhinitis. They take time to work (days).

Antihistamines are of little use in coughs and colds. Steroids actively make nasal infections much much worse and should be avoided at all times. Often in the early phase of the nasal infection, people begin to sneeze a lot. So it can be difficult in the early stages to know whether you're dealing with an infection or with an allergy.

However the progression of symptoms of infection definitely differentiates allergy / irritative sinusitis from allergy sinusitis. You may have started sneezing, itching your nose and having a runny nose; but things progress to heavy obstruction, thicker mucus and much more often- the development of yellow purulent mucous discharge from the nose.

Neck Headache: cervicogenic pain
Dr Xxxxx : Neck headaches arise due to irritation of the small joints of the cervical spine (neck). Typically the patient is a little bit older and has developed small growths of bone is on the sides of their joints in their neck. The neck joints fit together quite well at rest.

But when the joints are rotated (i.e. as in looking around), they no longer fit together smoothly due to the extra bone growths present. The joints catch as they grind in rotation. This causes micro-catches and pinches - causing inflammation at these points.

This is particularly worse if the person is carrying weights, in the form of - often children, shopping bags or laundry. The neck muscles contract to help carry the weight especially the trapezius muscles - spreading the weight across the torso, but also significantly contracting the neck muscles. When these joints rotate they now catch under pressure - causing much more injury and damage.

Erasmus : A doctor friend of mine relates that the most important thing to do to avoid neck headaches is simply never to turn the head when you are carrying weight. If you keep your neck absolutely still, the weight transmits through the joints fairly well in their normal resting position. Few catch points are activated or traumatised. Pain and inflammation is avoided.

Dr Xxxxx : Most people, who learn this simple lesson, develop very little pain and very few neck headaches in future.