There are times when a headache is not just a headache. It’s a face ache. A feeling of pressure or discomfort in the cheeks, around the eyes and in the forehead may be chalked up to sinus congestion and inflammation, although that is not always the true cause.

“Common sinus symptoms include facial pressure and pain, headaches, nasal congestion and drainage, trouble with the sense of smell, and sometimes fevers with acute sinusitis,” says Dr. Nick Debnath, an ear, nose and throat specialist with Washington University Physicians. “Not everyone gets all of the above, and some people do have facial pain that feels like either a dull pain in the cheekbone and cheek sinuses or in the forehead, between the eyes, sometimes even in the back of the head or the top of the head. Infection or blockage or sinus problems can cause pressure and pain symptoms, but the body doesn’t always follow the rules.”

Most people who self-diagnose with sinus pain or headache actually have something else, he adds. “There’s a laundry list of things that can cause headaches. We think of the sinuses being the source of the problem because the pain and pressure is in the region of the sinuses, but it’s actually common for people to have a migraine and feel like they have a sinus headache.”

Classic migraines are typified by pain on one side of the head, sometimes accompanied by sensitivity to light and nausea. However, Debnath notes that migraines can take other forms, and over-the-counter decongestants can help reduce migraine pain by constricting blood vessels.

When sorting out the cause of facial pain and pressure, Debnath begins by examining the patient for sinus infection. If the patient has a history of sinusitis, then sinus infection is a likely cause. Yet some patients have no evidence of sinus problems to peg as the cause of pain. “Some headaches get better when the blood vessels constrict, and decongestants work in the nose by constricting blood vessels so that limits blood flow to the nose, the lining of the nose shrinks down, and you can breathe better,” Debnath explains.

Dr. Barry Feinberg, an anesthesiologist and board-certified pain management specialist with Injury Specialists, notes that some instances of face and head pain are actually referred pain from the cervical spine. “The vast majority would be from the neck and muscle tension,” he says. “Migraines and vascular headaches present differently, but there’s a little bit of overlap. And then there’s all the weird stuff.” Feinberg is referring to the very rare instances when tumors or other disease processes contribute to head pain.

Feinberg notes that many people have postural issues due to their desk jobs or repetitive movements at work. Improper ergonomics, such as computer screens below eye level that require the individual to tilt the chin down while working, can lead to chronic pain. These issues are best dealt with through a combination of approaches that includes physical therapy, ergonomic adjustments and medication to help reduce acute pain.

“People need to know there are resources out there for help, and you don’t have to be living on Tylenol and aspirin,” Feinberg says. “Pain management for treatment of headaches and neck problems exists and is available in our community.”

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