Which clinical history findings are characteristic of pediatric sinus headaches?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Answer

The diagnosis of headache due to sinusitis is suggested by a history of persistent upper respiratory infection (URI) symptoms lasting longer than 10 days. Nasal discharge, congestion, and cough lasting more than 10 days are usually present; fever may be present as well.

Recurrent headaches occur in approximately 15% of children with sinusitis. These patients complain of a throbbing headache that is worse in the morning or that occurs at the same time each day. The pain may vary with changes in head position.

With ethmoid disease, pain may be referred to behind the ipsilateral eye. With frontal sinusitis, pain may occur just above the inner canthi of both eyes.

Acute bacterial sinusitis may present with the following [41] :

  • Persistent symptoms of nasal congestion/discharge and cough lasting more than 10 days without clinical improvement

  • Abrupt onset of severe symptoms/signs of high fever (>39° C), purulent nasal discharge, and facial pain lasting for 3-4 consecutive days

  • Onset of worsening symptoms and signs, such as a new fever, headache, or increased nasal discharge 5-6 days after the onset of a typical viral upper respiratory infection


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