Q. I occasionally get pressure around my eyes and forehead that causes sleepiness with only mild migraine. I have non-allergic rhinitis. Are these symptoms common, and do I treat with nasal steroids or just the usual ibuprofen? At other times I have regular migraines. I also have a deviated septum. Would repairing that help with my migraines? – Colleen B.
A. The way I look at migraine is that there are three main components: There is the migraine pain, which is really severe; then there’s the tension pain where the headaches don’t reach migraine proportion and there isn’t any sensitivity to light or noise; and at the lowest level, there is the pressure sensation you get. What?we have found in some studies is that if you have migraine or tension-type headache and you have pressure, your headaches tend to be more frequent and more disabling. It looks like the pressure sensation is a predictor for more severe migraine. About 80 percent of migraineurs report pressure over their sinuses.
What may be causing this? A migraineur has a hypersensitive nervous system that probably picks up all sorts of changes in your head, since nerves go to your sinuses. Anytime the sinuses get clogged or you have nasal congestion, the brain perceives that as pressure. I would suspect that pressure sensations are occurring from this phenomenon where the sinus gets blocked, causing negative pressure on the membranes in the sinuses.
I believe that sinus pressure is going to be best treated with some sort of decongestant or a nasal steroid; the steroid would work over days, whereas?the nasal decongestant would work much quicker, particularly if it is in a nasal spray. However, you don’t want to use a nasal spray decongestant for more than two or three days at a time because you can form a dependence on the medication, and every time you don’t use it, your nose just swells completely shut. If you want long-term improvement from the pressure, you could use nasal steroids or a nasal antihistamine. Anti-inflammatories are very effective for treating pain originating from the sinuses. It’s very possible that you could treat the after-effects of the sinus problem on the nerves by treating with the anti-inflammatories.
Vincent Martin, MD, University of Cincinnati College of Medicine, Cincinnati
