Two serious Headache disorders that may mimic sinusitis

There are several usual headache disorders, or conditions that cause headaches, that don’t occur very often. They are rare. But they can mimic sinusitis with respect to the pain. That is, they can cause pain that is felt “over the sinuses”. Two conditions that are rare, very rare, but conditions that can be serious include:    Temporal Arteritis and Wegeners disease

Temporal Arteritis

Temporal arteritis, also known as Giant cell Arteritis, is a disease caused by inflammation of the medium to large arteries, and usually occurs in arteries in the head and neck, most commonly in the temporal artery.  The temporal artery, by the way, can be felt pulsing just in front of the ear, and it courses up towards the top of the head, where it branches forwards and backwards a bit.

Temporal arteritis is generally a disease of people older than 50 years of age.  Its not a common disease at all.  It occurs in about 1 in 3,000 people under the age of 70, and about 1 in 1000 people over 80.  Temporal arteritis can cause profound headache that can definitely mimic sinusitis, but the other symptoms associated with temporal arteritis also mimic sinusitis, at least some of them.   Temporal arteritis causes great concern among physicians and patients because the incidence of visual impairment from the disease is large (26%) and blindness, even with therapy, occurs in 15% of patients.   So, thought it is rare, I thought it would be best to mention it in this book.

Temporal arteritis is associated with several other symptoms.  Dr. Hayreh at the University of Iowa studied  patients with known history of temporal arteritis and found that (in addition to the visual problems noted above) patients have the following symptoms:

Headache in 56%
Anorexia/weight loss in 52%,
Jaw claudication (that is, the jaw hurts whenever they eat) in 48%,
Malaise in 38%,
Myalgia in 29%,
Fever in 26%,
Abnormal temporal artery in 20%,
Scalp tenderness in 18%
Neck pain in 16%
Anemia in 13%

Symptoms of “darkening vision” or the sense that a “curtain” was coming down over ones vision was a particularly ominous symptom, as it predicted a poor outcome, blindness.

Patients over the age of 50 with chronic headache and any of the above symptoms should discuss it with their doctor as soon as possible.  Often a doctor can find other indications of this disease by history, physical exam, or blood testing.   If there is a suspicion of this disease, a biopsy of the temporal artery can be relatively easily performed to look for signs of the inflamed vessels.  Treatment typically requires steroids to suppress the inflammation / immune response.

Next up in the blog:   Wegeners disease.

Jeffrey E. Terrell, MD

Michigan Sinus Center

University of Michigan Health System


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