Can a deviated septum cause headaches?

Short answer: A deviated septum can contribute to headaches in some people, either by blocking sinus drainage and causing recurrent sinus pressure, or through a contact point where a septal spur presses on the side wall of the nose. However, migraine and tension headaches are far more common and often mimic sinus pain, so a careful evaluation is important before treatment.

Key takeaways

• A deviated septum may contribute to headaches through blocked sinus drainage or a contact point.
• Migraine and tension headaches are much more common and often feel like 'sinus' pain.
• An ENT can look for contact points and sinus disease with nasal endoscopy and, if needed, a CT scan.
• Surgery is considered only when there is good evidence the nose is the source of pain.

Dr. Prashanth's perspective

A significant deviation with sharp spurs touching the side wall may irritate nerves such as the anterior ethmoidal nerve and cause headaches; some patients also describe neck or shoulder discomfort. I advise endoscopic correction only when the symptoms match the findings.

— Dr. Prashanth R. Reddy, ENT Surgeon, ENTHealth360

How could a bent septum lead to headaches?

A bent septum may lead to headaches in two main ways, although neither happens in everyone with a deviation.

Blocked sinus drainage. The sinuses are air-filled spaces around the nose that drain through small openings. A significant septal bend can crowd these openings. Mucus may then collect, and recurrent sinusitis can cause pressure around the cheeks, forehead or between the eyes.

Contact point. A septal spur, a sharp ridge of bone or cartilage, may press against a turbinate, the curved shelf on the side wall of the nose. Some researchers believe this contact can trigger localised pain behind the eye or around the nose. The evidence is mixed, so it is considered carefully.

How can you tell a nasal headache from migraine or tension headache?

Nasal and sinus headaches usually come with nasal symptoms; migraine and tension headaches often do not.

• Sinus-related: facial pressure with blockage, thick discoloured discharge, reduced smell, sometimes fever. Often follows a cold.
• Contact-point pain: localised pain near the nose or eye, sometimes worse when the nose swells, with no other cause found.
• Migraine: throbbing, often one-sided, with sensitivity to light or sound, nausea, and sometimes a watery or stuffy nose. Can be mistaken for sinus.
• Tension headache: a tight band around the head, linked to stress, screen time or poor posture.

Many people labelled with 'sinus headaches' turn out to have migraine. A headache diary helps sort this out.

What can you do at home to ease headaches linked to the nose?

Home measures that keep the nose clear may help sinus-related pressure, while general headache habits help other types.

• Use saline rinses to support sinus drainage.
• Treat allergy triggers such as dust mites and pollen.
• Stay hydrated and keep regular meals.
• Keep a headache diary: time, triggers, nasal symptoms, sleep.
• Limit painkiller use to a few days a week, since frequent use can cause medication-overuse headache.
• Avoid long-term decongestant sprays. If you have used one for more than a week, speak to an ENT about a safe way to stop.
• Take screen breaks during long workdays in AC offices.

How are breathing, sleep and energy connected here?

Headaches, nasal blockage and poor sleep often reinforce one another.

A blocked nose may push you to mouth-breathe at night, which can fragment sleep. Poor sleep is a recognised trigger for both migraine and tension headaches, and it may lower your tolerance for pain.

Waking with a headache, feeling unrefreshed and losing focus by afternoon is a pattern I often see in clinic. Improving nasal breathing may help sleep for many people, but headaches with other causes need their own treatment.

How does nose breathing support energy and BMR?

Your basal metabolic rate (BMR) is the energy your body burns at rest to keep the heart beating, the brain working and cells repairing. Your cells make that energy using oxygen, so how well you breathe matters.

Nose breathing helps in two ways:

• Warm, moist, filtered air. The nose warms, humidifies and filters each breath before it reaches the lungs. Conditioned air is gentler on the airway lining, which matters in Bangalore's air-conditioned offices and traffic dust. Mouth breathing skips this step and can leave the throat and airways dry.
• Nitric oxide from the sinuses. The paranasal sinuses continuously make nitric oxide (NO), a natural gas. When you breathe in through your nose, small amounts of this NO travel to the lungs, where studies suggest it may help widen tiny blood vessels and improve oxygen uptake. Mouth breathing largely bypasses it.

Nose breathing does not "boost" your BMR. That is set mainly by muscle mass, age, body size and hormones such as thyroid. But comfortable nasal breathing by day, and undisturbed breathing at night, support efficient oxygen supply and deeper sleep, which your body needs to use energy well and recover.

A simple check: sit quietly and breathe through your nose with your mouth closed for two minutes. If that feels difficult, or one side is always blocked, it is worth having your nose examined.

When should you see an ENT?

See an ENT if headaches come with nasal blockage, discharge or reduced smell, or keep returning despite treatment.

• Facial pressure with blockage lasting more than a few weeks
• Repeated sinus infections
• Localised pain near the nose or eye with a known septal deviation

Seek urgent medical care for:

• A sudden, severe 'worst-ever' headache
• Headache with fever, stiff neck, confusion or drowsiness
• Swelling around the eye, double vision or reduced vision
• Headache with weakness, numbness, slurred speech or fits
• A new headache after a head injury

How an ENT evaluates and treats it

An ENT will take a detailed headache history and look carefully for nasal and sinus causes.

A nasal endoscopy, a thin camera passed gently into the nose, shows any septal spur touching the side wall, swelling, polyps or pus. A CT scan of the sinuses may be advised to look for sinus disease or contact points. Sometimes a numbing spray is placed on a suspected contact point to see if the pain eases. If a nasal cause is unlikely, referral to a neurologist may be suggested.

Treatment depends on findings. Sinus inflammation is often treated first with saline, steroid sprays and, when appropriate, other medicines. If clear evidence shows a septal spur or sinus blockage is causing pain and medical treatment has not helped, septoplasty or endoscopic sinus surgery may be discussed. The right option depends on the cause.

Frequently asked questions

Does nose breathing give me more energy? It does not add energy by itself, but it delivers warm, humidified air and sinus nitric oxide to the lungs, which may help oxygen uptake. Together with better sleep, that supports the energy your body uses at rest (BMR) and during activity.

Will septoplasty stop my headaches? Only if the headaches are clearly caused by the septum or sinus blockage, and even then results vary. That is why careful evaluation comes first.

Is it a sinus headache or migraine? Sinus headaches usually come with blockage and discharge. Throbbing pain with light sensitivity or nausea is more typical of migraine.

Can a blocked nose cause morning headaches? Poor sleep from nasal blockage may contribute to morning headaches. Snoring with morning headaches can also suggest sleep apnoea and is worth checking.

References

• Lundberg JO, Farkas-Szallasi T, Weitzberg E, et al. High nitric oxide production in human paranasal sinuses. Nature Medicine. 1995;1(4):370-373.
• Lundberg JO, Settergren G, Gelinder S, et al. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica. 1996;158(4):343-347.
• Keck T, Leiacker R, Heinrich A, Kühnemann S, Rettinger G. Humidity and temperature profile in the nasal cavity. Rhinology. 2000;38(4):167-171.

About the author

Dr. Prashanth R Reddy is an ENT surgeon at ENTHealth360, Bangalore (MS ENT; MBA, IIM Bangalore; Seoul Rhinoplasty Fellowship), seeing patients at Sakra World Hospital, Marathahalli and in Koramangala. His practice focuses on how breathing affects sleep, energy and everyday performance.

Related reading: Why do I get nose blocks and headaches in AC? · Why does my sinus keep coming back every few months?

For educational purposes only. Not a substitute for medical advice. Please consult a qualified ENT specialist.