How can you tell if you have sinus pain or migraine? In general terms, with migraines you have a long history, a history of repeated headaches, an aura before the headache starts and a sore neck when it ends. A migraine is a specific kind of headache. Generally, a migraine comes from the blood vessels becoming twitchy or spastic. Migraines start with an aura of flashing lights, feeling light-headed, a need to urinate, or knowing that the headache is coming.
This is called the “prodromata.” The aura comes when the blood vessels constrict. Then the blood vessels slam open, often causing leakage through the blood vessel walls. This is the cause of the headache pain, and it is described as throbbing. The pain is more severe than a tension headache, and the patient feels better lying down in a dark room with a cold compress. The cold compress helps to constrict the swollen vessels.. Some patients awaken in the middle of the night with this headache. This is usually diagnostic of migraine. Headaches are usually on one side of the head.
There is a hormonal relationship in headaches of a migraine nature. In families where one sister started birth control pills and got migraine, other sisters get, migraine when they start birth control pills. But the condition is highly variable. Migraines may stop or increase in pregnancy or menopause Children can get this, too. Throughout history many persons became addicted to drugs because of their migraine. Napoleon is said to have had a migraine attack during the battle of Waterloo.
Migraine is often one sided. It can be brought on by weather changes and by certain foods, particularly red wine and smelly cheeses. Although any alcohol may bring on the migraine, some patients are able to take vodka without getting a headache. Migraine is usually a pounding headache, often the vision is distorted. The author of Alice in Wonderland, Lewis Carroll, actually “saw” the giant rabbit and the other characters during his migraine attacks..
In sinus pain, the headache is usually fairly well localized to a sinus area. If it is in the cheek and the teeth ache too, it is due to the maxillary sinus. If it’s on both sides of the nose, between the eyes with a stuffy nose and colored nasal discharge and it hurts to wear glasses, that is the ethmoid sinuses. Sinus headache is associated with nasal congestion and colored discharge from the nose. With sinus pain, one feels sick most of the time; with migraine the patient feels Okay before the headache and afterward.
Frontal sinus headache is diagnosed by pain at the roof of the orbit of the eye. Pressing on the roof of the eye, which is the floor of the frontal sinus is painful. The sphenoid sinus is difficult to diagnose. This sinus is in back of the nose above and behind the throat. Pain can be referred almost anywhere.
In sinus inflammation, despite infection and drainage of pus, this type of pain is often not very severe- Motrin or Aleve may relieve the pain. In migraine it is always quite severe and is not relieved by an aspirin.
There are other types of sinus headaches that can be confused with migraine. One is due to the nasal septum being crooked and pressing on a nerve. Another is due to the sinus being blocked and a vacuum forming inside the sinus. Here the X ray may be normal and the nose may not be congested. You may get this upon landing from a flight.
Comparison of Migraine and Sinus Pain:
Nature of the pain: Migraine is pounding. Sinus pain is steady. Pressure on the sinus makes it worse.
Nausea: Present in migraine, not present in sinusitis.
Family history: In migraine there is usually a family history.
Aura: Migraine has an aura, sinus pain does not.
For my patients with migraine, I have them focus a hot shower stream to the back of the neck for several minutes, while slowly rotating the head from side to side, gently. This may train the blood vessels not to be so “twitchy.”
Most sinus pain involves failure of nasal cilia to beat to remove toxins and bacteria. Use of Hydro Pulse Nasal/Sinus pulsatile irrigation to restore cilia movement is indicated. Sometimes the mucus thickens and impairs cilia action. Use of the pulsatile irrigator to remove this mucus is therapeutic. Persons who have recurrent sinus headaches do so because inflammation remains in the sinus cavity. They may have taken the correct antibiotic treatment, but because the nasal cilia still are not moving bacteria out of the nose, they get another infection. When you use pulsatile irrigation the bacteria, phlegm and inflammatory factors are removed, and cilia function is restored. With fewer bacteria in the nose and sinus, then the body can heal by natural means without antibiotics.
Sinus pain may be present in the Frontal Sinus area due to referred pain from the cervical or neck area. Usually this is on both right and left side frontal areas about the eyes. Pressing on the Frontal sinus is not painful, but pressing on the posterior neck gives you pain in the Frontal Sinus. Sinus pain can also be referred from the TMJ., the eye itself, and the teeth. The nerve that goes to the upper teeth also goes to the maxillary sinus so it may be difficult to tell which is causing the pain- checking the teeth and an X Ray of the sinus may be needed.
With sinus pain, the membranes are swollen which is painful. Or the sinuses are blocked, with a vacuum which causes the pain. Anti inflammatory products such as Aleve or Prednisone work. Proteolytic enzymes such as papain or bromelain reduce swelling and thin the mucus, which improves cilia movement. The product, “Clear.ease” is a lozonge that melts in the mouth between the cheek and the gums. It contains papain and bromelain, but melts in the mouth so it is not inactivated by stomach acid.
Summary of Sinus Pain:
If your sinus pain comes on with red wine it is migraine.
If your pain wakes you up in the middle of the night, with throbbing it is migraine.
If one Tylenol stops your sinus pain it is NOT migraine
If your sinus pain has other symptoms such as local tenderness, stuffy nose, yellow discharge it is from the sinus.
There is no fever with migraine.
Sinus pain can hang on for many days; migraine usually is shorter.