Allergy, Nose & Sinus

Causes of Headaches in Forehead Region After Sinus Surgery

February 10, 2020
causes of severe headache after sinus surgery

WARNING: THIS BLOG CONTAINS GRAPHIC SURGICAL IMAGES AND VIDEOS.

Experiencing headache symptoms post-sinus surgery and finding yourself wondering “Is it normal to have bad headaches after sinus surgery?” or “How long do headaches last after sinus surgery?”

Some temporary pain or discomfort can be normal when recovering after sinus surgery due to inflammation, scarring, or blockages. However, experiencing a severe or persistent headache can be concerning. Understanding why these headaches occur and how to manage them can provide relief and reassurance. Let’s explore the potential causes and solutions for headaches following sinus surgery through a case study.

I recently saw a patient, Madam A, who had sinus surgery done by another surgeon for frequent sinus infections (recurrent sinusitis). She used to suffer from 4-5 episodes of sinus infections a year over the last few years. About a month after her sinus surgery, she started getting headaches in her left forehead region, just above her left eyebrow. She never had this pain prior to her sinus surgery. A review of the CT scan of her sinuses (special X-rays of her sinuses) before she underwent surgery showed that her sinus drainage pathways in both her cheek regions (maxillary sinuses) may be congested, predisposing her to frequent sinus infections. However, her forehead sinus (frontal sinus) was not affected.

causes of severe headache after sinus surgery

Caption: A front view of the CT scan of Madam A’s sinuses showing a clear (black part indicating the sinus is filled with air) frontal sinus before her first sinus surgery

 

 

On examination, a nasoendoscopy (scope through the nose) showed that her cheek sinuses (maxillary sinuses) were open and clean. However, there was some scarring close to the drainage pathway of her left frontal sinus region. A repeat CT scan of her sinuses showed a complete blockage of her left frontal sinus, causing her to have constant left frontal headaches. A course of oral antibiotics, nasal wash and nasal steroid sprays did not alleviate her symptoms.

 

 

CT scan

Caption: A repeat CT scan of Madam A’s sinuses showing a blocked left frontal sinus (grey part) after her sinus surgery

 

 

Blocked Left Frontal Sinus

Caption: A CT scan showing the side view of Madam A’s sinuses. The left frontal sinus is completely filled with mucous (grey part)

Madam A underwent revision functional endoscopic sinus surgery (re-do sinus surgery) to unblock her left frontal sinus. The surgery was performed with the Image Guidance System (IGS). IGS allows the surgeon to determine the exact position of the surgical instrument during sinus surgery. The position of the surgical instrument is indicated by a green cross and superimposed on the CT scan images (refer to images below). This is especially useful in revision sinus surgery, where scarring or loss of surgical landmarks caused by previous surgery may make it difficult for the operating surgeon. Another good use of IGS is in patients with complex sinus anatomy (especially in the frontal recess). During Madan A’s sinus surgery, a thick mucous was encountered in the left frontal sinus. The frontal sinus pathway was widened and flushed with normal saline. Post-surgery, Madam A is glad that the headaches in the forehead region have been resolved.

 

 

 

 

Revision Sinus Surgery

Caption: IGS images showing the position of the surgical instrument (suction tube) in the frontal recess where the mucous is suctioned out

 

 

Caption: IGS images showing the tip of the surgical instrument in the left frontal sinus

 

 

The extent of sinus surgery is often determined by a combination of the patient’s symptoms and the severity of the sinus disease on a CT scan. One of the potential complications of sinus surgery is scarring, which can block off previously unaffected sinuses. Although uncommon, it is a potentially serious and debilitating complication like in Madam A’s case. Hence, it is important for the sinus surgeon to be meticulous during sinus surgery to avoid such a complication.

If you’re dealing with pain and wondering how to get rid of severe headaches after sinus surgery, you can consider consulting an Ear Nose Throat (ENT) specialist in Singapore for a medical opinion. The ENT will be able to assess your condition before recommending potential surgical or non-surgical treatments to help alleviate or manage your pain.

 

 

Best wishes,

 

Dr Gan Eng Cern
ENT Specialist Singapore

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

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    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
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    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award

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    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
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