DEAR DOCTOR K:
I’m a woman in my 30s who has suffered from sinus headaches for years. Allergy medications haven’t helped. What else can I try?
Seasonal allergies can cause sinus congestion, sneezing and a runny nose. But when you experience pain and pressure in your head, it may be time to consider other causes. That’s because sinus problems do not usually cause headaches. At least, they don’t cause what most people refer to when they use the term “headache.” Most people with sinus congestion refer to “head congestion,” not headache.
I spoke to my Harvard Medical School colleague Dr. William Kormos. He said that if you’re regularly experiencing headaches with nasal congestion, you may have migraine headaches. That’s because migraines can cause sinus pressure and clear discharge, just as they can cause the eyes to get red and teary.
People with migraine headaches are often misdiagnosed with sinus problems. That may be because many people don’t associate sinus pain and pressure with migraine headaches. In fact, more than 80 percent of migraine sufferers report sinus pain and pressure. Half also experience nasal congestion or a runny nose. To add to the confusion, weather changes are common migraine triggers. So your migraines might follow a pattern you associate with — and mistake for — seasonal allergies.
A doctor should be able to diagnose the type of headaches you are experiencing. He or she will make the diagnosis based on an accurate, detailed description of your symptoms. For example, nausea, vomiting or sensitivity to light or sound are clues that your pain is related to migraines.
Migraine headaches should be treated as soon as symptoms begin, as any delay can make the headache harder to treat. The mainstay of migraine treatment is a group of drugs called triptans.
Another crucial part of migraine management is prevention. Certain activities, foods and other factors can trigger migraines. Identifying and avoiding your headache triggers may help reduce how often you have migraines and how badly they hurt. Common triggers include:
- Caffeine (either too much or less than usual)
- Certain foods and drinks, including those that contain tyramine (aged cheeses and meats, fermented drinks); sulfites (preserved foods, wines); and monosodium glutamate (MSG)
- Stress, or (more often) relaxing following a stressful day
- Hormone levels (which may be affected by menstrual cycles or hormone-containing medication)
- Lack of sleep
- Changes in weather or altitude
- Overuse of pain medications
Also ask your doctor about preventive medications. These are prescription drugs taken every day to reduce the number and the severity of migraines. The drugs, also all used to treat other conditions, include beta blockers, calcium channel blockers, ACE inhibitors, anti-seizure drugs and some drugs used for depression.
(This column ran originally in October 2014.)