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Headache, Sinusitis, and Migraine - an Approach to Diagnosis

Published on Jul 15, 2019 and last reviewed on Jun 06, 2023   -  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. Telemedicine portals can be used to take an online prescription for migraine and also an in-office visit to the doctor can help to get prescription. 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 Is a Sinus Headache Diagnosed?

Sinus headaches are diagnosed by observing the presenting symptoms. The patients have a fever, stuffy nose, thick and colored mucus nasal discharge, fullness in the ear, swollen and puffy face, cheek pain, forehead pain, and pain in the bridge of the nose. The pain worsens when the individual moves the head or while bending forward.


How to Self-Differentiate Between a Sinus Headache and a Migraine?

It is quite easy to confuse a sinus headache and a migraine since both cause facial pain, nasal congestion, and a runny nose. It may be possible to differentiate between both by marked differences in the pigmentation of the nasal discharge. The discharge is usually clear in migraines and is discolored and thick, along with fever in sinus headaches borne from sinus infections.


Is It Possible to Have Both Migraine and Sinus Headaches Simultaneously?

Sinus headaches are basically migraines occurring during a sinus infection. These require dual-phase treatment as the first phase is focused on dealing with cranial and facial pains while the next phase is to clear the sinus infections. Hence, it is possible to have migraines during sinus infections.


How Is a Migraine Diagnosed?

Migraine is preliminarily diagnosed by tracking the events, which is then referred to a specialist to exclude any underlying conditions. CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, blood chemistry, urine analysis, sinus X-rays, EEG (electroencephalogram), ocular exams, and spinal taps can be ordered by the concerned specialists to diagnose any underlying pathology or a migraine.


What Primarily Causes Sinus Headaches?

Sinus headaches are primality borne out of sinus infections. These cause pain and pressure changes within the skull. Rhinovirus infections (common cold) and allergies are the most common reasons for sinus infections and associated pains. Alternatively, sinus headaches can also be migraines with secondary nasal symptoms.


How Does One Feel With a Sinus Migraine?

Sinus migraines are associated with cold, nasal congestion, and discolored-thick nasal discharge. Individuals have to deal with facial and cranial pains and blocked ears. The face might get swollen, and the patients might feel pressure around the eye sockets, cheeks, and forehead.


Is It Possible to Trigger Migraine With Sinusitis?

Sinus congestion due to sinusitis can increase the pressure within the skull and cause facial pain. Sinusitis can also trigger migraines. Usually, nasal symptoms are secondary to migraine headaches and not vice-versa. In such cases, the prime focus is to relieve the pain, as antibiotics do not provide any relief.


How to Determine a Possible Cranial Spread of a Sinus Infection?

Sinuses are one of the easiest highways to the brain. Untreated infections can reach the brain, causing encephalitis. This is seen as headaches, fevers, and fatigue, along with serious symptoms like hallucinations, paralysis, seizures, and loss of consciousness.


What Is the Time Span of a Sinus Migraine?

Sinus migraines may begin hours or days before the actual headache event and last for another few hours to days. Usually, migraines should not last beyond two days. Sinus headaches can last for longer periods based on the severity of the primary sinus infection.


What Can Be Done to Stop Sinus Migraines?

Certain methods can be recruited to deal with sinus migraines, including
- Warm compresses on the face.
- Using decongestants.
- Using saline nasal sprays or drops.
- Using a vaporizer or steam inhalation.
- Using antihistamines.
- Analgesics.
- Steroids to reduce inflammation.
- Specific migraine treatment protocol.


What Is the Best Medication for Sinus Headaches?

The primary treatment for a sinus headache is to reduce and remove the pain caused by intra-sinusoidal pressure build-up, which over-the-counter medications like Acetaminophen and Ibuprofen can do. Other migraine management drugs like Sumatriptan, Ergotamine, and Rizatriptan may also be included with proper medical consultation.


Is It Possible to Have Sinusitis Without a Blocked Nose?

Sinus infections do not tick all the listed symptoms in every individual. So, it is quite possible to have sinusitis without a stuffy or blocked nose. This especially holds true if the individual bears a history of allergies or other sinus problems.


What Is a Neurologist’s Opinion on Migraines?

Migraine is a neurological condition, and a neurologist is the best specialist to confirm the diagnosis. This is done by first tracking the events and associated lifestyle choices. The neurologist might order a range of tests to exclude any underlying pathology before circling over a final migraine diagnosis.


Which Is the Fastest Cure for Migraine?

Each individual has a different way of dealing with a migraine attack or event. For some, dark and silent environments help relieve the pain; some require cold compressions over the neck or face; some might benefit from small caffeine drinks; some find sleep therapeutic; exercise might be analgesic for some, while yet others might need pharmacotherapy. A wide range of activities has been reported as therapeutic and analgesic to migraine, including sex, chocolate, certain foods, or drinks.


What Condition Can Look Like Sinusitis?

Sinusitis shares its presentation with many other conditions, including the common cold, allergies, migraine headaches, chronic daily headaches, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea.

Last reviewed at:
06 Jun 2023  -  1 min read




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