Sinus Headaches for 2006?

There are many reasons for a headache during the holidays, but mine was due to sinusitis. Like many other folks, for as long as I can remember, I've had hay fever, also called allergic rhinitis. A couple of times a year, I get sinusitis, which usually causes a toothache, apparently located at the base of an upper incisor. I also get a feeling of pressure at my cheeks, and a sinus headache.

I've learned that sinusitis is caused by rhinitis, specifically swelling of the nasal mucosa at the areas deep in the nose where the sinuses normally drain. The fancy term for this area is the osteo-meatal complex, or OMC for short. Your doctor would need a fiberoptic scope to view this area, a $1000 instrument that only ENT docs have in their office. However, the symptoms of rhinosinusitis are distinct enough that viewing the OMCs is not necessary to confirm this very common disease before treating it.

When I've got an exacerbation of my allergic rhinosinusitis, I use Sinus Rinse twice-a-day, followed by a nasal decongestant, then a nasal corticosteroid spray. Washing out the nasal passages with salt water is a treatment used successfully for hundreds of years.

If you like metaphysics and alternative medicine, you can dribble a cup of salt water into each nostril from a $20 ceramic Neti pot. If you are rich, you can put the salt water in a $120 nebulizer and spend ten minutes sitting while it produces a salt water mist. All pharmacies carry a $15 bottle of saline nasal spray with preservatives, but it only has 4 ounces of salt water, not even enough to rinse out one side of your nose once. I've tried all of these over the years, but have happily settled on a plastic squeeze bottle that holds a cup of warm water. This Sinus Rinse bottle costs less than ten dollars, lasts for a year or more, and comes with packets of salt, the size of fake sugar packets.

I simply tear open a salt packet and pour it into the bottle. I then fill the bottle from the warm shower or the bathroom sink and shake it. Sometimes I've filled it with cold water and nuked it for 30 seconds in the microwave. I then lean over the sink and push the smooth black tip of the bottle against one nostril, then gently squeeze the bottle, sending the salt water through one side of my nose and out of the other side, washing away the gunk. I then repeat the squeeze on the other side.

If I was really poor, I would just buy the bottle and measure out a teaspoon of salt from a shaker or container of salt, but the Sinus Rinse packets don't cost much and are very convenient, especially since I travel a lot. If you don't mix the correct amount of salt with the water, it will sting your nose. If the water is too cold or too hot, it's also uncomfortable. The correct temperature and salt concentration makes the nasal lavage (rinse or douche) soothing, although the sight of snot is not appetizing. Just remember, if you don't wash this icky material -- mucus, pollens, smoke particles, and pus cells (neutrophils and eosinophils) out of your nose, you will unknowingly swallow it, up to a quart every day. (The concentrated hydrochloric acid in your stomach digests it quickly.)

I wait for more than 15 minutes after the Sinus Rinse (enough for the remainder of the salt water to drain away), and then use a long-acting nasal decongestant spray (like Afrin). The exact technique of using a nasal spray is very important, since the usual technique doesn't get the medication around the sinus drainage openings, where it is needed the most. If you haven't used the spray for more than 24 hours, check the level of fluid in the bottle and prime it by spraying it once into the room air. Ensure that it produced a nice plume of mist.

Stand next to your bed (or someone else's bed!). Look downwards. Insert the tip of the bottle about a half an inch into your nostril and then tilt it so that it is pointed towards the back of your neck (NOT towards your eyebrows). Squeeze it. Don't inhale while you are squeezing the bottle. Do the same for the other nostril. Now quickly lie down on your back with your head extending over the edge of the bed, and stay there for 3 minutes! This strange maneuver causes the solution to drain downwards to bathe your sinus openings (the OMC areas), which have become closed due to inflammation of the nasal mucus membranes.

If your doctor has also prescribed for you a nasal corticosteroid spray (like Flonase, Rhinocort, or many others), administer that spray a few minutes after the nasal decongestant spray, using the same technique.

The decongestant nasal spray will begin to work within a few minutes, but the corticosteroid spray takes several days of daily use to fully suppress your nasal inflammation (rhinitis).

Use the Sinus Rinse first because that removes all of the mucus in the nose, which would prevent the medications from getting to where they are needed (the OMC areas). Use the nasal decongestant spray before the nasal corticosteroid spray because the decongestant will quickly shrink the nasal passages, allowing better distribution of the corticosteroid solution thoughout the nasal cavity.

I'm aware of the old worry that the use of nasal decongestant sprays for more than 3 days may cause rebound nasal congestion (rhinitis medicamentosa or Afrin Addiction), so, I try not to use it for more than a week. By then, the nasal corticosteroid spray has reduced my nasal inflammation, preventing the rebound nasal congestion, and the original cause of the rhinosinusitis exacerbation is gone.

I noticed that a company is now selling online a new $30 "system" for Afrin Addiction. It works by slowly tapering (diluting) the daily dose of nasal decongestant. I prefer to use a nasal decongestant instead of an oral decongestant (like Sudafed), because of the many side-effects of oral decongestants (such as nervous system stimulation and increased blood pressure).

Related Topics: Headache, Nasal Sprays: More Than Meets the Nose?

Tags: sinusitis,headache,webmd