The Link Between Migraine, Headache, and Sinusitis
Updated: Aug 24, 2020
There seems to be a link between migraine, tension headaches and sinusitis. This link has not been tested in double blind trials but most Otolarynogologists or ENT/sinus doctors, when asked, do admit to the fact that sinus surgery or in office balloon sinuplasty seem to benefit 50% or more of the patients that have migraine to headache with sinus disease and sometimes even those without sinus disease.
Unfortunately, there is no rigorous data on this, therefore neurologists or primary care physicians may not know of the link between these conditions. My own observational data after over 15 years of sinus surgery and balloon sinuplasty, showed that greater than 50% of the patients had improvement to elimination of migraines following sinus surgery. In some patients, this migraine relief extended beyond 5 years with no need for any medication, ibuprofen, Maxalt, triptans or Tylenol. However, given that this is anecdotal personal experience, it truly does not qualify as a randomized trial.
I also see improvement in tension headaches following sinus surgery. Now as a scientist, I can argue that the improvement in migraines or headaches occurred as a placebo effect, that is they improved because the patient “thought” or “knew” they would improve following surgery. So, there is this aspect of autosuggestion. Yet we see patients that sometimes do not improve in sinus headaches following sinus surgery so clearly autosuggestion is not operative in many patients and that there is a clear benefit. Without doing a randomized trial in migraine or tension headache patients, it would be difficult to definitely answer this question.
Nonetheless, observational data suggests benefit from sinus surgery or balloon sinuplasty and I will counsel my patients that there is perhaps a greater than 50% chance that the migraines may improve after sinus surgery in a patient that has met the criteria for balloon sinuplasty. I have also found anecdotally, that patients who may not have sinus disease but have migraine that does not respond to medications, sometimes benefit from balloon sinuplasty.
SO, WHAT IS MIGRAINE?
There are many types or forms of migraine but typically half or all of the head hurts with sensitivity to light with or without nausea or vomiting and occasionally accompanied by flashes of light, blinding spots or even stroke-like symptoms. This usually lasts
for 2-24 hours and the individual usually prefers to sleep it off in a dark room. Migraines
generally get worse with menstruation, changes in atmospheric pressure or may even be
triggered by certain foods such as chocolate, cheese or wine. Migraines are also more common in women. Sinus infection and allergy may trigger migraines as well.
Migraines may occur as frequently as every day or sometimes once in 3-6 months. Some migraines may be associated with ringing in the ears or dizziness/spinning sensation called vertigo. This is called a vestibular migraine and may be confused with Meniere’s disease or inner ear infection. Occasional migraines can be treated with pain medications such as Tylenol or ibuprofen. When migraines are more frequent, Maxalt, or other triptans are recommended. These can be injections, oral tablets or sublingual application or intranasal spray. A sumitriptan spray or Imitrex spray is also available for use during an episode of migraine. Anti-CGRP medications are also of benefit. Propranolol has used for preventing episodes of migraines. Avoiding cheese, wine or alcohol, chocolate is recommended for migraines.
From a sinus and allergy point of view, if there are sinus symptoms and allergy symptoms, it is advisable to get a sinus or allergy workup. Your primary care doctor or neurologist may advise you to get a MRI scan of the brain with contrast to rule out a brain tumor or pathology and a sinus specialist such as me will likely get a CT scan of the sinuses or allergy test if these symptoms are associated with migraines or tension headaches. If sinus symptoms are recurrent along with your migraines or if persistent and not improved with medication, and if the CT scan suggests sinus disease, a balloon sinuplasty may be recommended and or allergy drops or immunotherapy for allergies. Obviously avoiding the triggers of migraine such as stress, certain foods, chemicals, allergens, etc is important. Please call us at Texas Sinus, Allergy, Snoring and Sleep institute to have a through discussion with us regarding the link between migraine, headaches and sinus disease and when balloon sinuplasty or sinus surgery may benefit.
UMANG KHETARPAL, M.D.
Dr. Umang Khetarpal finished his medical school at the young age of 22 and is trained in Otolaryngology-Head and Neck and Facial Plastic Surgery. He completed his internship and specialty residency training in Syracuse, New York. He also has extensive research experience and additional clinical experience through fellowships at Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School in Boston. He has co-authored book chapters and many publications in peer reviewed journals within the specialty. He has presented at major specialty society meetings and at academic institutions. Topics of his research included hearing loss and balance disorders, sinus problems and sleep apnea. His recent research efforts have been entirely focused on sinusitis, especially recurrent acute rhinosinusitis, allergies and in office balloon sinuplasty and in office sinus surgery. He has recently presented five papers at the International meeting of Rhinology in CHicago, June 2019. He discovered and was the first to describe a novel ear disease in families that resulted in balance and hearing problems. His most innovative research was in the cutting-edge field of genetics in Otolaryngology where he was involved in finding the genetic defects for several different diseases. In addition, he has taken time to observe the surgical techniques of some of the world’s most renowned surgeons in plastics surgery. He had been featured 3 times over the years in newspapers in the Rio Grande Valley for introducing latest treatments in thyroid cancer, sleep apnea and sinus surgery locally. His current interest is in molecular genetics of allergic rhinitis and chronic sinusitis with and without polyps and in finding better cures for these conditions. He now calls Houston his home and is starting his practice in the Woodlands.