These include causes such as:
- nose allergy
- a bent nasal septum blocking the sinus opening or in contact with the opposite nasal lining
- a narrowed sinus opening/s with a sinus infection and
- an obstructed sinus with a negative sinus pressure
Sometimes possibly all of the above can be present in the same person at the same time. All of these conditions can stimulate and irritate the trigeminal nerve, which then generates the headache that we feel.
Treatment begins with the correct diagnosis. A full external and internal endoscopic examination of the nose should be undertaken. In instances when a sinus-related cause is suspected e.g. facial pains above, behind and below the eyes, and at the top of the head, a CT scan of the sinuses can exclude sinus disease. X-ray of the sinuses are traditionally undertaken but for a more comprehensive picture, CT scans provide a great deal more information as well as serve as the roadmap for sinus surgery should that be required.
Usually common things happen commonly, and by far the commonest nasal cause of a headache is inflammation of allergy or infection. If infection is seen, a simple course of antibiotics can be undertaken. Nasal allergy is easily treated also by avoiding the allergen e.g. house dust or pollen, saline nasal irrigation, topical nasal steroids and/or antihistamines. The reduction in the inflammation desensitizes the nasal lining as well as reduces the possibility of nasal lining contact and sinus obstruction.
Perhaps the next most likely cause for nasal irritation is when two opposing nasal linings touch one another forming a trigger point. This is likely to occur when the nasal septum is bent inside the nose. Often the patient would be aware of the bent septum as they are aware of a blocked nose, more on one side than the other although both may be equally blocked.
Sometimes a frank sinus infection is seen on endoscopy. Then antibiotic treatment with nasal decongestants also, would normally suffice, as sinus surgery is not the usual first line treatment modality. However in situations when the sinus condition becomes chronic without relenting or recurrent, then usually a more permanent solution to re-open the sinus drainage and re-vent the sinuses may be indicated. Nowadays, sinus surgery is extremely high tech, using endoscopes for minimally invasive surgery. Surgery is targeted at re-opening the natural openings of the sinuses.
To make the surgery even less traumatic, when appropriate, the sinus openings can be re-dilated with inflatable balloons; this technique is known as balloon sinuplasty.
So to summarize, nose and sinus-related headaches are not altogether that uncommon especially today in our polluted modern world. It should be differentiated from all the other causes of headaches by its picture. Treatment of these headaches are usually very successful once the correct diagnosis has been established, as there is often a triggering point that fires off the nerve-endings of the trigeminal nerve that gives us these so-called Sluder’s headaches. You can almost imagine Dr. Sluder himself having a bad headache when he first described it too!