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Sinus vs. Migraine Headaches

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Sinus and Migraine Headaches: Introduction

Persistent headaches are a common problem for many people who continue to suffer despite long-term and aggressive headache remedies. Allergies and sinuses are significant contributors to headaches problems, making it difficult for patients to distinguish between sinus headaches and migraine headaches.

After extensive research,  I created a patient education program to empower headache sufferers to understand, manage, and minimize the occurrence and severity of their headaches. While there is often no quick fix for chronic sinus headaches or migraines,  I am confident that we can work together to help you take control of your headache symptoms.


II. Myth of the Sinus Headache

Most patients (and doctors) assume that pain or pressure over the forehead and cheekbones is caused by a sinus or allergy problem. However, in 2004, leading headache researchers published the results of a landmark study concluding that almost 90% of patients who experienced “sinus” headaches were actually suffering from migraine headaches.

Not all migraine headaches are severe. Migraine headaches can vary from one instance to the next, and some migraine sufferers achieve some relief with sinus and allergy treatments. There’s no wonder that the confusion between allergies, sinuses, and migraines is vast.

Location, Location, Location

Despite the prevalence of pain and pressure in the cheekbone and forehead, allergies and sinuses are rarely the primary causes of headaches. However, sinus problems and allergic rhinitis (hay fever) can certainly be contributing factors to headache severity and frequency.

Let me explain...
The trigeminal nerve enables sensation in the face, including the forehead, cheekbones, and neck. It is also responsible for the pain and pressure most headache sufferers experience, including those with tension headaches, migraine headaches, and cluster headaches.

But when your headache is accompanied by pain in these areas you are actually experiencing referred pain, not sinus pain. Referred pain is caused by impulses that originate in one area of the body but are felt in another area. The best example of this is when a person having a heart attack feels pain in their jaw or left arm. While there is nothing wrong with the arm or jaw, the nerves damaged during the heart attack cause “referred” pain to these areas.

For patients with chronic or recurrent headaches, pain impulses start in the headache region of the brain and are transmitted to areas of the face, head, neck, eye area, and even teeth because of the reach of the trigeminal nerve. While sinus and allergy problems can cause facial pressure, it is more likely the result of a migraine headache.

III. Migraine headaches/ Allergy/ Sinus connection

It is important to understand that many people with allergies never (or rarely) experience headaches. Likewise, many people that experience headaches do not suffer from allergies. In reality, both are so common that simultaneous suffering is very likely.


When a patient has both allergy symptoms and frequent headaches they are likely suffering from two different, but connected problems. Despite their differences, allergy symptoms and migraine headaches can also worsen at the same time.

IV. Allergy and migraine commonalities

Allergy sufferers and migraine headache suffers experience some of the same triggers:

  • Sensitivity to environmental triggers such strong odors and alcohol
  • Seasonal weather changes in Spring and Fall
  • Histamine (the chemical released in the body that causes allergy symptoms)

Also, allergies often act as headache triggers in migraine patients.

V. Do you have a sinus headache or a migraine headache?

Headaches and allergies, while connected in some ways, are separate disorders. For some patients with allergies and migraine headaches, treating the allergy symptoms may go a long way towards reducing the frequency and severity of the migraines. For others, allergy and sinus treatments are insufficient migraine remedies.
  • Have you ever experienced a severe or disabling headache?
  • Do certain triggers worsen your headaches, such as strong odors, alcohol, stress, menstrual cycle, or lack of sleep?
If you answered yes to both questions, you likely are experiencing migraine headaches in addition to your allergies. Specialized allergy testing can determine which allergens contribute to your allergy symptoms and whether or not allergies are affecting your headaches.


VI. The Headache Threshold

Understanding the concept of the headache threshold is the key to understanding why migraine patients experience more frequent and severe headaches. Everyone has the ability to experience a headache and, in fact, it can be an important warning sign for many disorders. Your body’s headache threshold is the point at which certain conditions in your body initiate headache symptoms. Migraine patients have a much lower threshold than those who do not experience frequent headaches.

Consider this bathtub analogy:

The top of the bathtub represents your headache threshold. When water reaches the top of the tub, it begins to overflow, symbolizing your threshold being crossed. Migraine patients have a much smaller bathtub and are more likely to experience headaches from events or physical changes that would not cause a headache in others.

Now picture the bathtub with many faucets emptying into it at varying and alternating rates. For migraine patients, these faucets represent headache triggers. The faucet that causes the overflow can vary from one day to the next, just as the migraine trigger to breach your headache threshold varies. The strength and sum of these triggers determines the frequency and severity of your migraine headache.

The goal of migraine headaches treatment, then, is to turn off as many faucets as possible. Some are easy, such as avoiding hunger and dehydration, reducing stress, and limiting alcohol. Others, such as those in the environment, may be more difficult to avoid.

Patients can also start to identify periods in their life when they are more vulnerable to headache triggers. Recognizing your pre-headache phase gives you time to implement behavior modification techniques or therapies to derail the headache severity. Keeping a headache journal can help you identify periods of vulnerability and how multiple factors come together to trigger your migraines.

VII. The Big Picture

Looking at your migraines as a whole can be much more effective that focusing on just one or two triggers, and can help you better stave off debilitating migraine symptoms. I look forward to helping you make sense of your headaches and gain control over your environment and wellbeing.


Sinus and Migraine Headaches Chicago

Dr. Rotskoff specializes in sinus and migraine headaches diagnosis and treatment in the Chicago-land area. His patient education program helps headache sufferers to understand, manage, and minimize the occurrence and severity of their migraines. In addition to serving the Chicago area, Clarity Allergy Center has an office in Arlington Heights and conveniently serves the following surrounding areas: Morton Grove, Skokie, Lincolnwood, Glenview, Evanston, Des Plaines, Park Ridge, Niles, Kenilworth, Wilmette, Mount Prospect, Palatine, Elk Grove, Buffalo Grove, Bartlett, Lake Zurich, Schaumburg, and Elgin. 


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