ENT health

Headache, Sinusitis, and Migraine - an Approach to Diagnosis

Written by
Dr. Abid Khan
and medically reviewed by Dr. Sneha Kannan

15 Jul 2019  -  1 min read



One of the most common complaints of patients in general and ENT practice is a headache. And in chronic cases, it might be due to sinusitis, termed as sinus headache or trigeminal migraines. Symptoms of "sinus headache" include persistent pain or pressure over the cheeks and around or behind the eyes. Other symptoms include nasal congestion, nasal blockage, and it occurs for more extended periods. Sometimes, patients with headache do not have sinusitis, and it turns out to be a trigeminal migraine.

Headache, Sinusitis, and Migraine - an Approach to Diagnosis

It is believed by physicians and patients as well that when symptoms of pressure or pain is present over the cheeks and around the eyes, then it is a sinus headache. It makes sense as well, but surprisingly, most of the patients (around 60 to 70 %) that land in ENT clinic as "sinus headache," turn out to be trigeminal migraines.

What Is Trigeminal Migraine?

Criteria for migraine, according to the International Society of Headache are:

  • Episodic, recurrent headache lasting 4-72 hours with any two of these pain qualities - Unilateral pain or Throbbing pain.
  • Pain worsens on movement.
  • Moderate to severe pain.

In addition to any of these associated symptoms:

  • Nausea
  • Vomiting.
  • Light and sound sensitivity.

Trigeminal migraines are different than other migraine headaches, as the trigeminal nerve supplies forehead, cheeks, ear, and around the eyes. As trigeminal nerve also supplies the mucous glands in the nasociliary lining, and ear as well, the symptoms of runny nose, congestion, etc. are also experienced in trigeminal headaches. Ear symptoms include blockage of the ear and tinnitus.

How Is Trigeminal Migraine Treated?

Once the diagnosis of trigeminal migraine is confirmed, antibiotics have no role in the management of trigeminal migraine. Medications to relieve migraines are:

  1. Propranolol.
  2. Metoprolol.
  3. Amitriptyline.
  4. Botox.
  5. Timolol.
  6. Divalproex.
  7. Valproate.
  8. Topiramate.

Foods to avoid during migraine headaches:

  1. Alcohol.
  2. Yeast products.
  3. Caffeine.
  4. Chocolates.
  5. Nitrate preservatives.

Non-food triggers to avoid are:

  1. Anxiety.
  2. Too little or too much sleep.
  3. Hunger.
  4. Exercise.
  5. Travel.
  6. Dehydration.

Frequently Asked Questions


How To Treat Balanitis?

Depending on the type of balanitis, anti-itch cream, steroid ointment, and antifungal or antibiotic cream are used. Along with medicines, proper penile hygiene has to be maintained.


What is Circinate Balanitis?

Circinate balanitis or balanitis circinata is a common type of dermatitis seen in people suffering from reactive arthritis. It results in ring-shaped lesions on the glans penis.


What is Balanitis Xerotica Obliterans?

Balanitis xerotica obliterans is a skin disease that results in whitish lesions on the penis. If this affects any other part of the body, it is called lichen sclerosus (LS). It causes itching, redness, and pain during sex.


What is Zoon's Balanitis?

Zoon’s balanitis is a type of inflammation of the glans penis, which is commonly seen in middle-aged men, that results in a single well-defined erythematous lesion. It is not a sexually transmitted disease.


What are the home remedies for Balanitis?

Some home remedies are as follows:
Do not use scented and harsh soaps.
Properly clean the head of the penis after retracting your foreskin.
Use warm water to wash your genitals.
Dry the area properly after washing.


Is Balanitis A STD?

Some types of balanitis that result from fungal or bacterial infection can be transmitted sexually.


What Is The Fastest Way To Cure Balanitis?

Balanitis can be treated by maintaining good genital hygiene and by applying prescribed creams or lotions properly.


What Antibiotics Treat Balanitis?

If the doctor suspects the cause to be bacterial, then he or she might prescribe antibiotics. The commonly prescribed antibiotics are Amoxicillin, Erythromycin, and Clarithromycin.


Can Balanitis Be Cured?

Some types of balanitis might be difficult to cure if they are resistant to treatment. Consult a doctor if you have recurrent episodes of balanitis.


Is Balanitis Fungal Or Bacterial?

Balanitis can be either fungal or bacterial.


How Do You Test For Balanitis?

Your doctor can diagnose the condition by looking at the lesions. But to confirm and to know the type of balanitis, your doctor can ask you for a swab test, urine test, blood test, or a biopsy.

Last reviewed at:
15 Jul 2019  -  1 min read



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