The Link Between Your Sinuses and Your Headache
Have you been experiencing the following symptoms in your head, face or nose?
- Sensitivity to light and sound
- “fuzzy headedness”?
The combination of the aforementioned can be referred to as cognitive dysfunction. They can be caused by a phenomenon called “sinus migraine” and they may or may not point to problems in the sinuses themselves.
First I want to tell you a little bit about headache: Prior to the 1990’s, doctors were taught that there were many different kinds of headache and that is was important to distinguish between them based on symptoms. Much was made of distinguishing a vascular headache from a sinus headache from a tension headache.
Modern headache research using functional MRI imaging shows that the brain behavior that generates these various headaches can be the same. In other words, most headaches, regardless of how they feel and where they are, are just the same bad guy wearing different disguises. There are some exceptions, including sinus pain from acute infection, joint or muscular pain from the TMJ area, and nerve pain from pinched nerves in the neck. But if your head pressure/ pain—regardless of its intensity, duration, or position– is accompanied by some of these other symptoms (nausea, dizziness, light sensitivity, fuzzy-headedness), it is likely being generated by your brain itself, and is really a “headache.”
All Headaches Are Migraine Variants
All these headaches, in terms of what your brain is doing, are similar to the classically described migraine headache. This means that almost all headaches, even if they are mild, lack aura or vomiting, or have a different distribution, can be thought of as migraine variants, and can be treated successfully as such. There are many “triggers” for headache. In sinus and allergy patients, a notable trigger can be a sinus infection or an allergy attack. This is why these sinus headaches are more common when you are sick with a sinus problem. Daily or frequent headaches, whether in your head or face, can be a sign of an ongoing sinus problem. But be warned! Many a patient has come to me with facial pain, pressure and congestion and has been found to have perfectly normal sinus function. A sinus migraine can mimic a sinus infection in many ways, and it can be hard to tell the difference without a CT scan. Endoscopy in the ENT office can be helpful in finding signs of sinus disease, including swelling of the outflow tracts, nasal inflammation, and abnormal mucous. But if the exam and CT are normal, you may be experiencing a recurring sinus headache, or “sinus migraine,” without any actual sinus problem at all.
This being said, most of my sinus migraine patients also have some sinus or nasal disease. It is of critical importance to help the nose and sinuses to be as healthy as possible to reduce the incidence of facial pain and other symptoms. But we must take into account the other triggers for headaches, and try to reduce these as well:
- Release from stress, i.e., the Saturday morning headache
- Lack of sleep
- Skipping meals
- Hormonal changes, i.e., before or after menses and during perimenopause
- Alcohol (especially wine)
- Certain foods, i.e., aged cheeses and meats, nuts, chocolate
- TMJ problems, i.e., tooth clenching or grinding
- Lack of sunlight
- Caffeine withdrawal
- Intense smells
- Weather changes, i.e., especially a dropping barometer before it rains
Also, while we are evaluating and treating your sinus or nasal problem, we can also seek a more effective control of your symptoms by treating the headache itself. A combination of hydration, sugar, a non-steroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen or naproxen, and caffeine can be a very effective over-the-counter (OTC) remedy. Sudafed or other nasal decongestants are also often helpful in the treatment of headache, because they restrict the dilated blood vessels in the brain that create the pain or pressure. Tylenol can be a helpful addition also and can be taken in addition to an NSAID if necessary. (How many headache patients have I seen that were convinced that they had a sinus problem because “Tylenol Cold and Sinus” offered them the best relief!) You can find these combinations in many OTC headache and sinus remedies. Or you can create your own combination. My favorite home remedy is Advil and Mountain Dew. It can be amazing to realize that one or two Aleve, perhaps with a cup of coffee or tea, can clear away your sinus pressure, nausea and brain fog. For more severe pain and other symptoms, we rely on prescription headache medicine such as Imitrex, which can be taken with the above therapy, and can stop migraine it its tracks for many people.
If the sinus migraines are once a week or less, the above approach is recommended. Unfortunately, a sinus migraine can be transformed into a daily experience by persistent use of medication to control the symptoms. This is called “chronic daily headache” or “transformed migraine.” This situation is quite a conundrum, because it is caused by the very things we rely upon for relief! The recommendation for daily headaches is to stop all previous daily treatments and allow the headache to “burn itself out;” sometimes a physician can help you accomplish this by giving you a tapering dose of oral steroid (such as prednisone) and starting a prescription headache prevention medication. Headache prevention medication is usually recommended if headaches are twice a week or more.
A note about OTC medications: some OTC meds may not be appropriate for you. You should not take any medication (or a close relative of it) if you are allergic to it. You should not take nasal decongestants like Sudafed if you have high blood pressure. You should not take NSAIDs if you have a bleeding problem, are on blood thinners, or have gastritis. Ask your doctor or pharmacist if you have questions about which OTC meds may be OK for you to take.
Marta T. Becker, M.D.
Alan S. Berger, M.D.