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Do you have Sinus Headaches?
Many patients are bothered by
pain above the nose and between the eyes, where
the sinuses are located. If there is a severe
nasal inflammation, this may respond to papain/
bromelain enzyme tablets such as
Clear·Ease, dissolved in the mouth between the
cheek and gums. This is especially useful if the
pain follows flying or scuba diving. Clear·Ease is
a blend of pineapple and papaya enzymes designed
especially for sinus and other inflammation,
rather than for the digestive tract. The enzyme
activity one million units of bromelain from
pineapple and a half million units of papain from
papaya. Some chewable papaya enzyme tablets don't
list the enzyme activity.
If the sinus is infected, this
requires an antibiotic and a decongestant such as
Zephrex. Over-the-counter Sudafed is helpful.
Avoid getting chilled, drink lots of liquids. If
there is drainage, Pulsatile Saline Irrigation is
an excellent way to remove pus and stimulate
natural nasal function. But real sinus pain is
rare, even when the patient is blowing yellow
mucous out the nose. However, in many cases the
"sinus headache" is really "referred" pain from
the neck. Feel the back of your neck. Does the
pain travel to the front of your forehead? This is
because of the hookup of the nerves; painful
stimuli radiates to the front area above the eyes.
For neck treatment see Cervical Pain
Pain
Pain in the sinus comes from
pressure on the membranes. Often the most severe
pain comes when a vacuum is formed. For example,
flying at high altitude your nose may clog because
of the dryness in the cabin and your failure to
drink adequate fluids, such as hot tea. The nose
closes and almost immediately the body starts to
absorb the oxygen in the sinus which is now
plugged. On landing, the sinus is now at a low
pressure whereas the atmosphere outside is at a
higher pressure 15 psi (100 kN / square m)- the
pain is like having a 5 pound weight (~ 2 kg mass)
on your eyeball. A similar thing can happen in
scuba diving.
Treatment consists of opening
the sinus passages so the air pressure can
equalize. Spray the nose with a nasal
decongestant. The doctor may give you cortisone by
injection or pill to get the passages open. Take
enzyme tablets such as Clear·Ease, dissolved
in the mouth between the cheek and gums. Taking a
decongestant like Sudafed or Zephrex LA is good.
In my office we spray the nose well and put
pledgets (small wads) of cotton with nose drops at
the sinus openings. Sometimes the patient breathes
helium which easily goes into narrow openings.
This is a painful condition and we do give pain
medicine as needed. The nasal irrigator is
recommended if there is phlegm or drainage that
should be removed at home.
Pain from bacterial sinus
infections is surprisingly rare, even when the
x-rays show significant disease. Drainage of the
pus is done in the office, especially local
shrinking and suction, and daily at home using the
nasal irrigator . Antibiotics are also used, plus
decongestant and enzyme tablets as above. Apply
hot compresses over the sinus area, and drink hot
tea, about 8 glasses a day, to help restore
movement to the microscopic cilia of the nose and
sinuses. Sometimes nasal pain is due to extreme
swelling of the membranes against a deviated nasal
septum or nerve area.
If someone has pain in cold air,
while skiing for example, we consider that they
may have a wide nose so that the bones don't come
together, where the roof of the nose is open,
allowing cold air to strike the membranes
directly.
The trigeminal nerve is in 3
parts to transmit pain sensations from the face.
The nerve can be irritated by a viral infection
and cause a neuralgia. We diagnose this by the
distribution of the nerve. Trigeminal neuralgia is
a nerve irritation that is quite painful and
requires good care, but can be helped. This type
of pain is not helped by relaxation or exercises .
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