Intended for healthcare professionals

Rapid response to:

Primary Care 10-minute consultation


BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:346

Rapid Response:

Sinusitis causes headache

We read with interest addressed to general practitioners article by S. K. Bal et al. “Headache” (BMJ 2005;330:346).

In our opinion presented list of serious causes of secondary headache should also contain sinusitis.

Red flag signs for sinusitis depend on location of inflammatory process and comprise: for maxillary sinusitis – acute pain of the central part of the faces, sensitivity to tapping over the cheek, increasing by bending and biting, especially in the morning and before noon; for frontal sinusitis – severe pain in the forehead and head, sensitivity to pressure or tapping on the forehead and on the sites of exit of the supraorbital nerve, increasing by bending; for sphenoid sinusitis – pain within the skull irradiating to the occiput or the temple or deep pain in the eyes. In ethmoid sinusitis marked pain is unusual.

Sinusitis is a disease that may lead to serious orbital (periostitis, subperiosteal abscess, orbital phlegmon) and intracranial (epidural, subdural and brain abscess, sinus thrombosis, meningitis) complications as well as bony complications like osteomyelitis of the flat bones of the skull1,2,3.

Headache caused by sinusitis is relatively common cause for visit by GP and often requires further otorhinolaryngological treatment.


1. Bambakidis N, Cohen A. Intracranial complications of frontal sinusitis in children: Pott’s puffy tumor revisited. Pediatr Neurosurg 2001; 35:82-89.

2. Lang E.E, Curran A.J, Patil N, Walsh R.M, Rawluk D, Walsh M.A. Intracranial complications of acute frontal sinusitis. Clin Otolaryngol 2001; 26:452-457.

3. May MLA. Severe consequences of sinusitis. J Paediatr Child Health 2004; 40:311-314.

Competing interests: None declared

Competing interests: No competing interests

11 February 2005
Waldemar Narozny
Ass. professor
Jerzy Kuczkowski, Boguslaw Mikaszewski
Department of Otolaryngology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland