By Bethanne Black, HealthAtoZ contributing writer
Millions of people who suffer from migraine and sinus headache pain say they wouldn't wish it on their worst enemy. Headaches are miserable. These beasts come in all shapes and sizes--dull persistent throbbing, sharp stabbing pain, achy head or sinus pressure.
Sometimes, confusing symptoms can make it difficult to tell one type from another. What you once thought was a sinus headache because of a cold, weather changes or seasonal allergies, could possibly be a full-blown migraine. Although there are many effective treatments available to relieve headaches, many people don't see their doctors about headache pain and end up missing the correct diagnosis and helpful treatment.
"In their lifetime, almost 90 percent of people will have a memorable headache, and about one in four have recurrent episodes of headaches," says Dr. Roger Cady, director of the Headache Care Center in Springfield, MO, and a frequent spokesman for the National Headache Foundation. About 12 percent of the American population suffers from chronic migraines, with women being affected three times as often as men, Cady says.
"It's very prevalent and is one of the leading causes of work absenteeism, with a lot of lost productivity at work and home. In very many ways, it interferes with people's lives."
Sinus headaches are even more prevalent. A nationwide study conducted found that four out of 10 adults in the United States reported having them. Of the sufferers, 40 percent said they'd do anything, including giving up a trip to the Super Bowl, if it meant they could get rid of the pain.
Migraines and sinus headaches are often confused. In a presentation to the American Academy of Neurology, Cady and his associates discussed a study where they asked for people who thought they believed they had sinus headaches and had never seen a doctor for them.
"On a careful history-taking, we found enough symptoms for a diagnosis of migraine, but they (the patients) had pain in the face area, nasal congestion and discharge from the nose, fullness and pressure in the sinuses, and it was precipitated by a weather change," Cady says. "On a pain and disability score, they were suffering to the degree of people with migraines."
Treated with migraine-specific medication, the patients had the same results as migraine sufferers and many were pain-free within two hours.
"Our new thinking is that many people who think they have sinus headaches have a clinical variant of migraines, what I call a sinus migraine," Cady says.
Sinus headaches
Sinus headaches can be the result of a sinus infection or allergies. Often following a cold or flu, sinus headaches are caused by inflammation of the sinus passages, air cavities located in the bones behind and above your nose. As the sinuses become clogged or infected, the increase pressure causes your head to ache. The pain is usually severe and ongoing, beginning in the morning and becoming worse if you bend over. Doctors are becoming increasingly cautious about prescribing antibiotics for the treatment of sinus headaches because repeated use can cause resistance to the drugs.
"A lot of sinus headache probably doesn't have an infection base," Cady says. "If they're having several of these every month, the odds of it being infectious are slim."
Common sinus headache symptoms:
- Pain and pressure around the eyes, across the cheeks and the forehead
- Achy feeling in the upper teeth
- Fever and chills
- Facial swelling
Both heat and ice are commonly used to relieve the facial pain of sinus headaches. Dr. David Hewitt, a migraine expert and an assistant professor of neurology at Emory University School of Medicine in Atlanta, recommends hot compresses, a steamy shower or hot drinks, such as herbal teas or broth, to help reduce the swelling and pressure. A cool-mist humidifier can also help to keep the sinuses moist. If the sinus headache is caused by allergies, a condition known as allergic rhinitis, medications may be necessary to control the pain. Classes of medications used to treat sinus headache from an ear infection include antihistamines, decongestants and inhaled nasal steroids. Sinus headaches are commonly caused by blockage of the osteomeatal complex - a small drainage hole in the maxillary sinus. A combination of the same medicines can usually relieve the inflammation of the osteomeatal complex, allowing the sinuses to drain and relieve the pressure. Occasionally, sinus surgery is necessary to allow the sinuses to drain properly.
Migraine headaches
There are two classifications of migraines - with and without aura. It's the patients who have migraines with aura who most often seek treatment because the experience can be unsettling. "Usually, the aura precedes the headache," Hewitt says. "It's most commonly a visual aura, such as zigzagging lines, slashing lines or dots. It can be pretty scary."
Common migraine symptoms:
- Pain preceded by visual changes
- Mild-to-severe throbbing pain on one side of the head
- Nausea or vomiting
- Sensitivity to light and noise
Migraines can be triggered by any number of factors, which vary from person to person. Some people react to certain foods such as wine, chocolate, aged cheese, processed meats, Chinese food and caffeine are commonly mentioned. Use of caffeine and alcohol can also trigger headaches.
Other triggers include flashing lights, loud noises, menstruation, intense exercise, weather changes, exposure to smoke or perfumes, lack of sleep, stress, sex or stress let-down. What is stress let-down? "The deadline is past, and boom, you're in bed with a headache two days later," Cady explains.
Some medications such as birth control pills and estrogen replacement therapy can also trigger migraines. A headache diary can help identify the activities or exposures that are triggers.
Once a migraine starts, self-help includes an ice pack on the back of the neck or the side of the head and resting in a dark room. Regular exercise - 30 minutes several times a week - is highly recommended as a way to prevent migraine headaches. Plus, it's important to get adequate sleep and not skip meals, especially breakfast.
Some people have good results from taking the herbal treatment valerian, Hewitt says. The American Council for Headache Education also suggests relaxation and stress management training, acupuncture, acupressure and massage therapy, although these may not yet be proven to work for everyone.
"It's just like Grandma says," Hewitt says. "You need to eat well, sleep well and get exercise. I also recommend yoga and biofeedback. A lot of people have what I've coined MLS - miserable life syndrome. They're very unhappy people. That can lead to chronic pain."
Usually headaches are temporary and will go away on their own. However, don't be shy about contacting your doctor if the pain is bothersome. A physician should check out any headache that is severe, recurring or accompanied by a fever.
Most people don't know exactly which kind of headache they have and that there are effective treatments available to bring relief. Perhaps you are treating sinus headaches when what you really have are migraines. If you have frequent or severe headaches, talk to your doctor to find out more. Headaches don't have to be a way of life.
This article was reviewed and updated June 2007.
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