Sinus Headache or Migraine?


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Could Your "Sinus Headache" Be a Migraine?

Of course it is possible for the migraine sufferer to develop a sinus infection, especially if you also have seasonal allergies. In fact, many suspected sinus headaches are migraines.

Here's how that works: the sinus cavities are lined by sensitive tissues whose nerves are fed mostly by a branch of the trigeminal nerve. This is the same nerve responsible for migraine headaches. When you have sinus congestion, it can confuse the nerves and cause what is called referred pain, sending pain to distant areas in the face and head, away from the sinuses themselves. So, sinus headaches may cause pain that is not in the sinus region, and migraines can cause pain that is in the sinus region. Just to make things even more confusing, some migraine sufferers experience nasal congestion or watery eyes with their migraine attacks. This is because the trigeminal nerves can release neurotransmitter chemicals that cause blood vessels to dilate, which is why your eyes get red and watery and your nose gets congested.It isn't clear why this happens more to some people and not to others with migraine.

The Sinus, Allergy and Migraine Study investigated 100 subjects self-diagnosed with sinus headaches. They were then evaluated by headache specialists, and 63% were diagnosed with either migraine with aura or migraine without aura, and 23% with probable migraine. Only 3% actually had sinusitis. Interestingly, 62% reported that exposure to allergens was a significant headache trigger. Although the symptoms can overlap, these general guidelines can help somewhat in telling migraine and acute sinus infection apart. Sorting out chronic sinus headache is more difficult, especially if there is also another type of chronic headache present.

SINUS INFECTION

These are the major features of a sinus infection:

Usually bilateral

Fever*

Discharge thick, yellowish-green*

Diminished or absent sense of smell*

Minor factors:

halitosis (bad breath), cough, headache, dental pain, ear pressure, fatigue

Facial pain or pressure—more likely to be non- throbbing

Sinus CT or direct examination positive

MIGRAINE

Features of a migraine headache:

Often (not always!) one-sided*

No fever

Discharge thin, clear if present

Heightened or altered sense of smell or avoidance of odors

Occasional symptom: watery, red eyes Facial pain or pressure—more likely to be throbbing or pulsating*

Diagnosis based on symptoms.

*Major features of each disorder.

Sinusitis occurs in 15% of the population— and that is even higher than migraine, unless we take into consideration the possibility of overdiagnosis of acute sinusitis in the migraine population.

Contact Point Headache

As if this were not confusing enough, there is another headache type called Contact Point headache. This occurs when you have a deviated septum or bone spurs in the nose, and the bone from the center of your nose comes in contact with the sensitive tissue on the other side of your nose. This can cause headaches that can feel very much like a migraine.

What Should You Do About Sinus Pain and Congestion?

If you think you have allergies causing allergic rhinitis, or allergies triggering your migraines, it might be worthwhile to see an allergist. Specific treatment of allergies may reduce your migraine frequency.

If you think you have a sinus problem, it may be worthwhile to see an ear, nose, and throat physician (the technical name is otorhinolaryngologist). Treatment of a mechanical problem like a deviated septum, bone spurs, or other physical sinus problems can be helpful if you truly do have chronic sinusitis.

Gastric reflux can also be a cause of chronic sinusitis.

Be careful about treating yourself with over-the- counter sinus medications, especially if you do so on a frequent basis. This can result in rebound rhinitis, causing more nasal congestion than you might otherwise have had. They can also cause rebound headaches if used frequently. It is always best to see your doctor for examination, particularly since this can be such a confusing diagnostic challenge. One thing is for sure, though—antibiotics are not the best treatment for migraine! So don’t just pick up the phone and ask for a prescription. If there is any doubt, go in and be seen.

Reference:

1. Rozen TD. Intranasal contact point headache. Neurology. 2009;72(12):1107.
2. Behin F, Lipton RB, Bigal M. Migraine and intranasal contact point headache: Is there any connection? Current Science Inc. 2006;10(4):312-315.
3. Behin F, Behin B, Behin D, Baredes S. Surgical management of contact point headaches. Headache. 2005;45(3):204-210.

4. Eross E, Dodick D, Eross M. The Sinus, Allergy and Migraine Study (SAMS). Headache. 2007;47(2):213-224

by Christina Peterson, M.D.

updated June 20, 2011

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