Rose Marie Mathew, DO

Seasonal allergies and sinus infections are often to blame for those who deal with chronic recurring headaches. Though it may be difficult to initially determine the exact cause of headaches, a good history and physical from your physician may be needed to help diagnose the cause of your pain. Headaches are debilitating and can adversely affect a person’s quality of life. As headache symptoms are often confusing, the key to successful headache management is accurately diagnosing the type of headache.  The most common primary headaches include: 

  1. 1. Tension-type headache.
  2. 2. Cluster headache. 
  3. 3. Migraines 

All of these types of headaches typically occur episodically. Sinus headaches are a secondary and a less common cause than primary headache disorders.

Migraine is the most common type of primary headache. This type of headache is usually one-sided (or may be bilateral) and can be a throbbing or pulsating type of pain. It can be moderate to severe in intensity and associated with nausea, vomiting, and light or sound sensitivity. Attacks may last for several hours to days and may occur with or without an aura.  An aura typically precedes the headache and most often consists of flashing lights, wavy lines or bright dots.  Migraine sufferers often have a first-degree relative with migraines. Occular migraines are visual disturbances whose underlying mechanisms are similar to migraines but without the development of a headache. Common migraine triggers include:

  1. 1. Stress.
  2. 2. Red wine.
  3. 3. Dairy products (especially aged cheeses).
  4. 4. Lack of sleep.
  5. 5. MSG.
  6. 6. Weather changes.
  7. 7. Menses in women.

Treatment for migraine is individualized and is based on the frequency and severity of episodes. Individuals are counseled on behavioral strategies including stress reduction, avoidance of specific triggers, improved sleep hygiene and diet modification. Triptan medications (Imitrex) have revolutionalized migraine treatment as they bind to a specific migraine receptor in the brain.  There are several different triptan medications, which may be taken orally, intranasally or via injection to abort a migraine attack. Individuals who experience frequent migraines may be placed on a daily, prophylactic medication. Prophylactic medications include anti-convulsants, anti-depressants and anti-hypertensive agents. 

Tension-type headaches are usually bilateral and described as a mild to moderate band like pain or a dull pressure. Episodic tension-type headaches often respond well to over the counter medications and behavioral strategies, including exercise and stress management.  

Cluster headaches are characterized by excruciating, debilitating eye pain lasting for minutes to hours, often with tearing, nasal congestion, reddened eye, small pupil, or facial sweating. Males are more commonly affected and headaches tend to be seasonal.  Inhaled oxygen, triptans, and indomethacin may be used as abortive treatment. Prophylactic medications are similar to migraine treatment and refractory cases may be treated with lithium or with specialized surgery.  

Acute sinusitis is a relatively uncommon cause of headache. This is usually characterized by purulent nasal discharge and a pain location determined by the site of infection. Treatment includes antibiotics, nasal decongestants and/or cortisone-based nasal sprays.  Patients with frequent “sinus” headache often are really manifesting migraine type headaches.  

Patients who develop new onset headaches should undergo a medical evaluation by a neurologist or other headache specialist.  The development of a sudden and “worst headache of your life” or if the headache is associated with fever and stiff neck, you should seek immediate medical attention.  Workup for any headache disorder consists of a thorough history and physical examination as well as appropriate brain imaging.

Author: Richard Terrana