Sinus pressure is a common discomfort, often described as a feeling of fullness or heaviness centered behind the cheekbones, the forehead, or the eyes. This frontal location is typical because the maxillary and frontal sinuses are situated there, making pain in these areas an expected symptom of inflammation. When pressure is felt in the back of the head, it raises questions about whether the sinuses could be the source. The anatomy of the deeper sinuses and the complex network of head and neck nerves confirm that posterior head pain can originate from sinus issues, though it is less common than the frontal pattern.
How Sinus Issues Cause Posterior Head Pain
The reason sinus pain can manifest in the back of the head lies within the deepest pair of paranasal sinuses: the sphenoid sinuses. These sinuses are located centrally within the skull, deep behind the nasal cavity and near the base of the skull. Unlike the frontal or maxillary sinuses, the sphenoid sinuses are positioned close to important structures, including the optic nerve and the brain’s covering.
When inflammation or infection (sphenoid sinusitis) occurs, the resulting pressure buildup can cause a severe, deep-seated headache. This pain is frequently felt in the vertex (top of the head) or the occipital region (back of the head) due to referred pain. The sensory nerves innervating the sphenoid sinus cavity are branches of the trigeminal nerve.
The trigeminal nerve, which handles sensation in the face, converges with nerves from the upper cervical spine (neck) in the brainstem’s trigeminocervical complex. When inflammation irritates the trigeminal nerve branches, the brain misinterprets the signal, perceiving the pain as coming from the neck or the back of the head instead of the sinus. Sphenoid sinusitis pain is often intense and deep, and may be accompanied by neck pain, complicating the diagnosis.
Common Non-Sinus Causes of Pressure
While sinus issues can cause posterior head pressure, the sensation is more frequently attributed to other common headache types. The most prevalent cause that mimics this feeling is the tension headache. This headache is characterized by a mild to moderate, non-throbbing pain that feels like a tight band squeezing the head, often encompassing the back of the head and the neck. Tension headaches are associated with stress, poor posture, and muscle tension, but they are rarely accompanied by nasal congestion or discharge.
Another cause of posterior head pain is a cervicogenic headache, which originates from an issue in the neck’s bony or soft tissues. This pain is considered a secondary headache because it stems from another disorder, such as neck trauma, arthritis, or muscle stiffness. It typically presents as a steady, dull ache that starts in the neck and radiates upward to the back of the head, often affecting only one side. The pain is worsened by specific neck movements or sustained awkward head positions, which helps differentiate it from sinus inflammation pressure.
A third condition causing severe pain in the back of the head is occipital neuralgia, a type of nerve pain. This condition is caused by irritation or injury to the occipital nerves, which run from the upper neck up to the scalp. The pain is described as sharp, piercing, or electric shock-like, often starting at the base of the skull and shooting up over the scalp, usually on one side. Simple movements like brushing one’s hair can trigger this intense, brief pain, which differs markedly from the dull, constant pressure of sinus pain.
Seeking Diagnosis and Relief
If posterior head pressure is persistent, severe, or accompanied by symptoms like high fever, a stiff neck, or sudden vision changes, immediate medical evaluation is necessary. These symptoms are considered “red flags” and may indicate a serious underlying condition. A doctor will perform a physical examination and may order imaging, such as a CT scan, to confirm sinus inflammation or rule out other neurological causes.
For pressure that is not severe, home-based relief strategies can often provide comfort. Hydration is beneficial for thinning mucus, which aids in sinus drainage. Applying moist heat, such as a warm compress or steamy shower, can help relax tensed muscles and promote sinus drainage. Nasal irrigation using a saline solution can wash away irritants and reduce inflammation, offering relief for sinus-related pressure.