Consider this diagnosis in any patient with fever and a severe headache. Intensity may vary, lasting a few minutes to hours. Fever, nausea, and vomiting may mask real problem. Severe headache is usually present for hours or days, localized in the frontal or vertex regions, with tenderness over the involved sinus. Acute sinusitis may spread to intracranial structures, including the cerebrospinal fluid, causing brain damage if not treated promptly.
Patients are usually febrile and appear very ill.
Headaches from chronic sinusitis may occur regularly upon waking or in midmorning and are characteristically worsened by stooping, bending, and atmospheric pressure changes. Pain, at site of temporal artery and behind eye, tends to be focal and unvarying in location. Elevated sedimentation rate is one of the most important findings. Sudden blindness may occur without warning. Usually present in women over age 50.