What is a Sinus Headache?
Many patients (and their physicians) mistakenly believe that their headaches are coming from problems with their sinuses. In actuality - according to a group of otolaryngologists, neurologists, and allergists - sinus headaches are probably quite rare, and usually only associated with acute sinus infections. A true sinus infection comes with nasal congestion, discharge, focal pain, and even fever. It will not improve without drainage and antibiotics. Thus, an intermittent headache on the face that gets better with pain relievers or decongestants is probably not at all due to the sinuses.

Most often, people with “sinus” headaches have normal or nearly normal CT scans of their sinuses, confirming that their pain is due to some other type of headache. Even chronic sinus problems are not thought to be a common cause of intermittent headaches. Over 90% of patients who think they are having sinus headaches are actually experiencing another type of headache.

What is Occipital Neuralgia?
Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead.  Irritation of one these nerves anywhere along their course can cause a shooting, stabbing, or tingling pain with symptoms often located on one side of the head. Sometimes the pain can also seem to shoot forward (“radiate”) toward one eye. In some patients the scalp becomes extremely sensitive to even the lightest touch, making washing the hair or lying on a pillow nearly impossible. In other patients there may be numbness in the affected area. The region where the nerves enter the scalp may be extremely tender.

What causes Occipital Neuralgia?
Occipital Neuralgia usually occurs when there is a loss of cervical curvature and the occiput (base of the skull) becomes hyper-extended in relation to the first cervical vertebrae.  This leads to inflammation of the atlanto-occipital joint, muscle spasm, nerve irritation and intense pain

What is a Migraine Headache?
Migraine Headaches are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck, and face – or all over. At their worst, they are typically associated with sensitivity to light, noise, and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers. Migraine pain can be felt in the face, where it may be mistaken for sinus headache or the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus-like” symptoms, including watering eyes, nasal congestion, and a sense of facial pressure.  In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances (flashing lights, zig-zags, blind spots), many people experience numbness, confusion, trouble speaking, vertigo (spinning dizziness), and other stroke-like neurological symptoms. Some patients may experience their auras without headaches.

What causes Migraine Headaches?
Most migraine headaches are caused by meningeal irritation (the outer covering of the brain and spinal cord).   In some cases the first cervical vertebrae has shifted forward collapsing the spinal sheath decreasing the flow of cerebral spinal fluid about the brain.  In other cases we have found dietary issues including dehydration, toxic food additives and food allergies.  Migraines can be complicated and require thorough evaluation.

Tension Headaches
Tension headaches are often described as a band or vice like pain in the head.  They usually start in the upper back or neck and migrate forward.

What causes Tension Headaches?
Anxiety and stress cause us to raise our shoulders and shift our heads forward.  This greatly increases the force on the cervical musculature.  Chronic muscle spasm can lead to the production of lactic acid, a muscular irritant, and tension headaches.  Anxiety and stress can also cause both vaso constriction and short shallow breathing.  Depriving the brain of oxygen will most assuredly result in a headache.