If you have an annoying headache but no sinus symptoms like nasal congestion or an aching or runny nose, can this solitary symptom be caused by sphenoid sinusitis?
“Headache can be the only symptom of sphenoid sinusitis,” says Dr. Stacey Silvers, MD, of Madison ENT & Facial Plastic Surgery in NYC, who is board certified in otolaryngology.
There are four sinus groups: sphenoid, ethmoid, frontal and maxillary. They are hollow cavities within the skull and can become infected or inflamed, causing a headache.
What is the function of the sinuses? Dr. Silvers explains that they produce a liter of mucous a day, “which helps us warm, filter, moisten the air and help digest our food.”
The next function is that they “aerate the skull (imagine if sinuses were solid bone or full of soft tissue). The head would weigh more and be exhausting to carry around.”
Finally, says Dr. Silvers, “They act as airbags to the brain: If an unfortunate trauma occurs to the face, the sinuses collapse, protecting the posterior vital structures.”
Headaches arising from specific sinus groups can have distinguishing characteristics, such as location.
A headache can definitely be the only symptom of this common condition that can go undiagnosed for a period of time before finally being correctly identified.
Dr. Silvers continues, “This (sphenoid) can occasionally be the only sinus involved. Patients may have no fever, congestion, or cough. The headache will present on the top of the head.”
Sometimes the sphenoid headache is felt in the upper back of the head, or between the top and the upper back.
“As it is not a classic location for sinus headaches, the sinuses may be overlooked as a cause,” says Dr. Silvers.
“A primary care physician does not have the tools to look into the back of the nose. Even an ENT (ear, nose and throat doctor) can have some trouble visualizing the sphenoid sinus opening depending on variations in patient’s nasal anatomy.”
So what would be a clue, then? Dr. Silvers explains, “Suspicion should arise based on the location of the patient’s pain which is typically on the top of the head.
“If a physical exam does not reveal the cause, then a CT scan of the sinus may be justified. With a sphenoid sinus infection the CT scan will show an air fluid level in one or both of the sphenoid sinuses.
“This may be found with or without congestion and swelling in the other sinuses.
“A proper treatment plan with decongestants, sinus washes, antibiotics and occasionally a steroid taper will quickly relieve the patient’s symptoms.”
How would the physical exam be conducted? A physician uses a lighted viewer to peer inside the nose, where swelling can be visible.
The doctor will also tap or press on the patient’s face to see if this brings on pain.
If you’re concerned about the radiation from a CT scan, ask your doctor about testing via MRI, endoscopy or sinus cultures to test for the presence of an infection or inflammation.
An NYC expert in ear, nose and throat care, Dr. Silvers has been named among America’s Top Physicians and Surgeons in facial plastic surgery and otolaryngology numerous times since 2003.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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