Sinus Headaches May Acutally Be Migraine

Throbbing and tenderness in your nose, cheeks and/or eyebrows seem to be clear indicators of a sinus headache. Most likely they aren’t. 90% of what patients think are sinus headaches are actually untreated migraines.

[Headache specialist Eric] Eross and colleagues advertised a free evaluation to people suffering
from “sinus headaches.” They signed up the first 100 people, and gave
them a rigorous 1.5-hour evaluation. It turned out 90 of the 100
patients were really suffering from migraines.

Sinus headaches do exist, but they are much rarer than people believe.

If you have an active sinus infection, your head hurts. Typical symptoms include fever, swollen lymph nodes, and a green or yellow nasal discharge. But most people who think they have sinus headaches don’t have these symptoms — just pain high in their cheeks. They likely have migraines, Eross says.

Following the study, about half the participants who thought they had sinus headaches became Dr. Eross’s patients. Most of them improved dramatically with migraine treatment.

Sinus headache was one of my early self-diagnoses. I can’t tell you how many allergists, ENTs and ENT surgeons I saw. I underwent numerous tests and scans and tried meds and allergy shots, but nothing showed that I had sinus headaches. That didn’t stop me from having nasal surgery for my headaches, which was completely ineffective.

My migraines don’t fit the symptoms of what most people think of as migraine: I didn’t have a visual aura, one-sided pain, nausea or sensitivity to light. Turns out that this describes “classic migraine” (or migraine with aura) which about 40% of people with migraine have symptoms of. Much more common is migraine without aura, often called “common migraine.”

Because of this, getting the right diagnosis was difficult for me. My experience makes me want to tell everyone who has “sinus headaches” that they could have another kind of headache disorder. Since this is my blog, I will. Please consider that your headaches aren’t sinus-related.

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National Headache Foundation Answers Frequently Asked Questions

In one comprehensive page, the National Headache Foundation responds to common questions about migraine as well as tension-type, cluster, sinus, rebound headaches. The short answers include links to comprehensive information. Questions include:

  • Does weather affect migraines?
  • What are the triptans?
  • What alternative therapies are used to treat migraine?
  • What is biofeedback?
  • Are headaches hereditary?
  • What type of doctor should I see to diagnose and treat my headache?

Lyrica, Sleep and Chronic Pain

In studies of Lyrica’s effectiveness for fibromyalgia and shingles pain, participants have reported sleeping better while taking Lyrica.

On his RevolutionHealth blog, sleep specialist Steve Poceta wrote:

Lyrica has been shown to improve sleep in certain patients who have pain, such as fibromyalgia and shingles pain. However, it is also important to assess the effect of a drug on the sleep of normal sleepers, because the sleep of patient groups is by definition already abnormal.

Dr. Poceta also describes the stages of sleep and how different drugs target different areas. Although I had trouble summarizing his points, the explanation isn’t hard to read or understand. I recommend reading it.

For anecdotal evidence, a reader told me that since starting Lyrica in January, her migraines have gone from 3 or 4 times a week to about once a month. Her insurance won’t cover it, even after having her doctor appeal the first decision.

She spends $100 a month on the drug, although she just found a pharmacy that carries it for $72. Proof that shopping around is valuable!

Guilt Comorbid With Headaches

“Comorbidity refers to the greater than coincidental association of separate conditions in the same individuals. Historically, a number of conditions have been noted to be comorbid with migraine, notably psychiatric disorders (anxiety, depression, panic disorder), epilepsy, asthma, and some congenital heart defects.”

This quote is from an abstract of an article from the June 2005 issue of Current Opinions in Neurology. A comorbidity never included on the list is guilt. OK, so guilt isn’t exactly a illness, but you have to admit there is a “greater than conicidental association” of guilt in people with headache.

We feel guilty because we think we’ve done something to contribute to the pain. Maybe it was getting too worked up over that deadline, eating a trigger food, staying up too late with friends, not drinking enough water, oversleeping. We lie in pain, berating ourselves for whatever we did that caused this headache.

We feel guilty because our partners, parents, kids or friends take care of us when we’re sick. Not only that, they have to pick up the slack of the of chores, errands and responsibilities that we couldn’t take care of.

We feel guilty because we call in sick to work, cancel plans with friends, sleep too much, tell everyone around us to be quiet, have dust bunnies under our beds and in the corners and even in the middle of the dining room table.

We feel guilty because we don’t go to our kids’ soccer games, return phone calls, stop to chat with neighbors, enjoy the sunshine/snow/rain, take the dog for a walk, cook dinner.

While our heads pound, we rage against ourselves for demanding to be the center of attention, not doing our duties, spoiling plans, being unsociable. Our guilt entraps us not just because we let other people down, but because we let ourselves down. Every day. We know we could do more or be better or care for others if we weren’t so weak or lazy or crazy.

We tell ourselves this isn’t true. We may even know it academically. But it’s hard to believe when we’re laid up, cooped up, fed up.

Paul of A ClusterHead’s Life is intimate with guilt these days.

Explaining What Chronic Daily Headache and Migraine Are Like

Explaining to my family, friends and employers that my migraines are debilitating has been challenging. There are many misconceptions about headache disorders and migraine, so people don’t understand the difference between an occasional headache and CDH or migraine.

The best way I’ve found to let those around me know the seriousness of this illness is to let them see me in the throes of a migraine (which is not an easy feat). If the people in your life are willing to talk about your pain, there are many good resources to explain the severity of the illness.

The best resource I have found is a book called Chronic Pain and the Family, which I reviewed on Blogcritics. (If you decide to buy the book, I’d appreciate it if you went to Amazon through the link from my blog rather than Blogcritics — it helps pay for The Daily Headache.)

There are other good resources that won’t cost you anything, like these significant facts about migraine:

  • Between 28 million and 35 million (depending on which estimate you look at) Americans have migraines
  • Of these migraine sufferers, 91 percent aren’t able to function normally during a migraine
  • An estimated $17 billion in health care and lost labor costs result annually from adults suffering from migraines

The National Headache Foundation has terrific information on how headache affects a sufferer’s life. This fact sheet
(PDF) describes migraine and its suspected mechanics. It even
recommends a children’s book that explains the disease to kids. ACHE also has good information.

Children & Headaches

Nearly every child has a headache at some point. Like in adults, an occasional headache is normal. Although headaches are typically benign, they could signal something serious. If kids have headaches frequently or the headache seems different than usual, it’s time to see a doctor.

Contact a doctor if your child’s headaches:

  • Occur at least once a month
  • Keep him or her out of school
  • Follow an injury, such as a blow to the head
  • Awaken him or her from sleep
  • Feature persistent vomiting or visual changes
  • Are accompanied by fever, along with neck pain or stiffness

Causes of headaches in children include a genetic predisposition (especially to migraine), head trauma, illness and infection, environmental factors, emotional factors, and certain foods and beverages. See the Mayo Clinic article in the above link for details about these causes.

Information comes from the Mayo Clinic. See Headaches in Children: Common, But Sometimes Serious to learn about causes, types of headaches, diagnosis and treatment. The National Headache Foundation also has a guide to children’s headaches, which even has a section for kids to explore.

Your child having headaches isn’t a reason to panic, but it isn’t something to ignore.

Must-Read Time Article on Headache

A 2002 Time cover article on headache describes current migraine research — and the heretofore lack of said research — and what it means for people with headache. As the article says, “What [the research] all adds up is a revolutionary view of extreme headaches that treats them as serious, biologically based disorders on a par with epilepsy or Alzheimer’s disease.”

It’s a hopeful piece that shares the fascinating biology of headache as well as what headache sufferers actually go through. Although the article is three years old, it’s a step toward educating others that Tylenol doesn’t trounce migraines, chronic daily headaches and cluster headaches.

Now articles need to use this quote from the book Migraine and Other Headaches:

“In general, headache sufferers are worse off than people who have arthritis, roughly similar to those who have congestive heart failure severe enough to interfere with walking up and down stairs and only slightly better than people with AIDS.” (from All in My Head, by Paula Kamen, page 282)

The Time article is a must-read for people with headache and their loved ones. And it includes an awesome graphic of the path of a headache (you’ll find it under the graphics section of the sidebar).