Unilateral headache sudden onset with nasal discharge worse by bending over. inflammation of frontal sinus is most common. Upper respiratory tract infections, malaria, typhoid can also cause headache.
Patient Complaints (P/C):
- If patient come and complain about headache we will try to differential Diagnosis,
Differential Diagnosis:
- Migraine: Mostly in females. Unilateral headache. History of previous episodes. Pain duration: 3 hours to 3 days.
- Sinusitis: Early morning headache.
- Tension-type headache: Continuous, band-like pain. More severe in the evening.
- Cluster headache: Mostly in males. Associated with red eyes and congested nose with lacrimation.
If patient lye on right side his left sinus will drain but right will not cause pain, bending over will increase the pain and will not allow to touch that area of head.
Rhino-sinusitis both can occur simultaneously(running nose, headache, sneezing).
If patient has used cetirizine because it will decrease running nose and cause congestion lead to sinusitis.
Examination (O/E):
- Nose examination – Deviated Nasal Septum (DNS).
- Tenderness over sinuses suggests acute sinusitis.
- X-ray Paranasal Sinuses (PNS) to confirm sinus involvement.
- X ray will show which sinus is involved.
Treatment of Sinusitis for Adults
| Category | Medication Name | Generic Name | Dosage | Pregnancy Safety |
|---|---|---|---|---|
| Antibiotics | Tab. Leflox | Levofloxacin | 250 mg BD | NO |
| Cap. Cefspan | Cefixime | 400 mg OD | Yes | |
| NSAIDs | Tab. Panadol | Paracetamol | 1g TDS | Yes |
| Tab. Aninac Forte | Ibuprofen + Paracetamol | 200/60 mg TDS | No (Ibuprofen in 3rd trimester) | |
| Antihistamines | Tab. Fexet | Fexofenadine | 60 mg BD | Yes |
| Tab. Jardin | Loratidine | 10 mg OD | Yes | |
| Decongestants | Tab. Sinutab | Pseudoephedrine | 60/120 mg BD | No |
| Nebulization | Normal Saline | 0.9% NaCl | TDS | Yes |
Additional Notes:
- Sinus headache typically presents in early morning and worsens if drainage is blocked.
- Tenderness over sinuses differentiates sinusitis from other headaches.
- Rhinosinusitis is associated with runny nose, headache, and sneezing.
- Cetrizine may be prescribed for allergic sinusitis.
Pediatric Sinusitis Treatment Table
| Category | Medication Name | Generic Name | 1 Year Dosage | 2-5 Years Dosage | 5+ Years Dosage | Safe in Children |
|---|---|---|---|---|---|---|
| Antibiotics | Syp. Amoxil | Amoxicillin | ½ tsp (2.5 ml) BD | 1 tsp (5 ml) BD | 2 tsp (10 ml) BD | Yes (above 3 months) |
| Syp. Augmentin | Amoxicillin + Clavulanic Acid | ½ tsp (2.5 ml) BD | 1 tsp (5 ml) BD | 2 tsp (10 ml) BD | Yes (above 3 months) | |
| Syp. Zithromax | Azithromycin | ½ tsp (2.5 ml) OD (3 days) | 1 tsp (5 ml) OD (3 days) | 2 tsp (10 ml) OD (3 days) | Yes (above 6 months) | |
| Syp. Suprax | Cefixime | ½ tsp (2.5 ml) BD | 1 tsp (5 ml) BD | 2 tsp (10 ml) BD | Yes (above 6 months) | |
| NSAIDs (Pain Relief) | Syp. Panadol | Paracetamol | ½ tsp (2.5 ml) TDS | 1 tsp (5 ml) TDS | 2 tsp (10 ml) TDS | Yes (all ages) |
| Syp. Brufen | Ibuprofen | ½ tsp (2.5 ml) TDS | 1 tsp (5 ml) TDS | 2 tsp (10 ml) TDS | Yes (above 6 months, avoid in dehydration) | |
| Antihistamines | Syp. Telfast | Fexofenadine | ½ tsp (2.5 ml) BD | 1 tsp (5 ml) BD | 2 tsp (10 ml) BD | Yes (above 6 months) |
| Syp. Zyrtec | Cetirizine | ½ tsp (2.5 ml) OD | 1 tsp (5 ml) OD | 2 tsp (10 ml) OD | Yes (above 6 months) | |
| Syp. Claritin | Loratadine | ½ tsp (2.5 ml) OD | 1 tsp (5 ml) OD | 2 tsp (10 ml) OD | Yes (above 2 years) | |
| Decongestants | Syp. Sinarest | Pseudoephedrine + Chlorpheniramine | Avoid | ½ tsp (2.5 ml) BD | ½ tsp (2.5 ml) BD | Use with caution (above 2 years) |
| Nebulization | Normal Saline | 0.9% NaCl | 2-3 times daily | 2-3 times daily | 2-3 times daily | Yes (all ages) |