Sinus Headache: Say NO to Antibiotics!

There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics.  Why?

First of all, a number of studies have suggested that many – perhaps most – perhaps even 80%-90% – of these patients actually have migraine.

So chances are you should be taking migraine meds instead of sinus meds.

A study published in Neurology in 2002 (Lipton et al) looked at patients with migraine who also supposedly had sinus headaches.  Patients were given analgesics, antihistamines, and/or decongestants for their headaches.  About half were dissatisfied with these treatments.

These patients then took migraine medication for two of their "sinus headaches" – in this case, sumatriptan.  Surprise surprise, 73% had pain relief within 2 hours.  45% were pain free within two hours!

Antihistamines, decongestants, antibiotics – all big business.  But what if most were being given to the wrong people?

The misdiagnosis likely has to do with the high prevalence of congestion and other sinus headache symptoms in migraine.  Many people don’t realize that congestion is common in a migraine attack, or even nasal discharge.  And many doctors are confused as well.

But what if you’ve had a proper work-up, and you believe you do have a sinus infection?  (More on how to differentiate between a migraine attack and sinus headache here)  Chances are you should still say NO to antibiotics.

Most often, sinus headaches from an infection are due to a virus infection – and a virus infection will not be helped by antibiotics.

A recent study in the Journal of the American Medical Association confirms this in real life.  85 adults with uncomplicated acute sinusitis were given an antibiotic, and 81 were given a placebo.  (see Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile)

At 3 days, there was no difference between the groups in quality of life or symptom relief.  At 10 days, there was no difference between the groups in quality of life or symptom relief.  No difference!

In the USA, 1 in 5 antibiotic treatments is given to someone with sinusitis.  That’s a HUGE number of people in one country alone getting a medication they don’t need, that won’t help them!

And those were patients who most likely really had sinusitis.



So let’s take the millions who are diagnosed with, or believe they have, sinus headache.  Subtract most of them – they actually are having a migraine attack.

Now take the few that remain – should we give them antibiotics?  Most likely not.

That’s millions of people with so-called sinus headache – almost all of whom should should NOT be taking antibiotics (or antihistamines, or decongestants…).  And that probably means you, sinus headache sufferer.

In a world where we’re more and more concerned about the personal and worldwide impact of overuse of antibiotics, it’s time we cut those millions of prescriptions.  If you’re not sure, do some research and be sure that you not only have a sinus infection, but an actual bacterial infection (not viral), AND that it’s worth it to take the antibiotics.

Unless you’re in that tiny minority, do yourself and us a favour – get a proper diagnosis, and if you need to take something that will actually help you.

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  • Dr. Michael Zitney Mar 13, 2012

    Great topic, James.
    Very challenging, even for most doctors.
    So many of our patients first come to our clinic reporting they get recurrent sinusitis; many even have a standing prescription from their family doctor. They go and fill it themselves, and within a day or two of starting antibiotics, their “sinus infection” is gone. Now they are even more convinced that’s what they’ve had! The problem is they may get this every month or two!
    You have clearly explained above that most of the time these are migraine attacks and a triptan would be more successful without the risks and side effects of antibiotics.
    The tricky part is (and I haven’t seen this written in any journal, but I’ve seen it so often in my practice) that this seems to happen to people who have really had a sinus infection or two, or even sinus surgery in the past.
    There seems to be a rewiring of the pain pathway back out to the front of the face when you’ve had sinus problems, that makes it easier for the pain signals from other causes (like migraines, neck damage, etc.) to follow the established pattern. The head and neck are particularly prone to “referred pain”; this is when a pain caused in one area is felt in another. The best example is when a heart attack causes pain down your left arm. There is nothing wrong with your left arm, you just feel it there. When you have pain in your head, face or neck, it may be caused by problems elsewhere.
    So when should you assume you have a sinus infection? If you have a fever, congestion, heavy green/yellow nasal discharge and feel like you have a cold or flu, you should talk to a doctor. As James wisely points out, this doesn’t mean you need antibiotics, but it likely means you do have a sinus infection and should be seen.

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