Diagnosis

• The headache is recurrent
• It has a significant impact on daily activities
• The headache does not get worse over time

Ruling Out Neuralgia. In some cases, headache that persists after successful treatment of chronic sinusitis may be due to neuralgia (nerve-related pain) in the face. This condition requires specific drugs, such as tricyclic antidepressants or carbamazepine. Trials using such drugs may identify patients with neuralgia and help avoid unnecessary invasive treatments for chronic sinusitis.

Ruling Out Other Conditions. A number of other conditions can mimic sinusitis. They include:

• Dental problems
• A foreign object in the nasal passage
• Temporal arteritis (headache caused by inflamed arteries in the head and neck)
• Persistent upper respiratory tract infections
• Chronic fatigue syndrome (CFS) or fibromyalgia. However, researchers reported in the Archives of Internal Medicine that there may be a link between CFS and sinusitis. In the study, patients with unexplained chronic fatigue were 9 times more likely to suffer sinus problems than those without fatigue.
• Temporomandibular disorders (problems in the joints and muscles of the jaw hinges)
• Vasomotor rhinitis, a condition in which the nasal passages become congested in response to irritants or stress. It often occurs in pregnant women.

Diagnostic Approach to Acute Sinusitis

Medical History. The patient should describe all symptoms such as nasal discharge and specific pain in the face and head, including eye and tooth pain.

After assessing symptoms, the doctor should take a thorough medical history of the patient:

• Any history of allergies or headaches
• Recent upper respiratory infection (colds, flus, infection)
• History of sinusitis episodes that is unresponsive to antibiotic treatment. (In such cases, the doctor will usually diagnose chronic or recurrent acute sinusitis and refer the patient to a specialist for more advanced testing.)
• Exposure to cigarette smoke or other environmental pollutants
• Recent travel
• Recent dental procedures, particularly if there is pain toward the back of the mouth
• Medications being taken (particularly decongestants)
• Any known structural abnormalities in the nose and face
• Injury to the head or face
• History of medical conditions, such as chronic fatigue syndrome or fibromyalgia, which can produce tender areas in the face or sinus regions and nonspecific symptoms of ill health.
• Any family history of allergies, immune disorders, cystic fibrosis, or immotile cilia syndrome
• In small children with sinusitis, whether they attend a day care center or nursery school