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Headache, Sinusitis, and Migraine - an Approach to Diagnosis

Published on Jul 15, 2019 and last reviewed on Oct 10, 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:

In addition to any of these associated symptoms:

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.

Last reviewed at:
10 Oct 2019  -  1 min read




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