Although allergies are thought to cause headaches, the two are different conditions. Allergies can cause sinus congestion, which can then lead to headache pain.Two types of headaches are linked to allergies: sinus headaches and migraines.
Lisa Joseph, M.D., Summit Medical Group internist, shares insight into the link between allergies and headaches, including allergy headache triggers, symptoms, and how to get relief.
Selected Podcast
Do You Suffer From Headaches Due to Allergies?
Featured Speaker:
Lisa Joseph, MD
Lisa V. Joseph, MD, specializes in internal medicine. Dr. Joseph has practiced in northern New Jersey since 1998 and sees patients for physical exams, preventive health screenings and immunizations, hypertension, diabetes, heart disease, women's health and many other adult health issues. Dr. Joseph practices at Summit Medical Group's Randolph location, 477 Route 10 East, College Plaza, Randolph, NJ. Transcription:
Do You Suffer From Headaches Due to Allergies?
Melanie Cole (Host): Although allergies are thought to cause headaches, they are two different conditions. Allergies can cause sinus congestion which can then lead to headache pain. The two types of headaches are linked to allergies, sinus headaches, and migraines. What is this link between allergies and headaches? My guest today is Dr. Lisa Joseph. She’s an internist with Summit Medical Group. Welcome to the show, Dr. Joseph. Let’s talk about that link between allergies and headaches. Do all headaches come from allergies and do all allergies cause headaches?
Dr. Lisa Joseph (Guest): Well, first, I’d like to say thank you, Melanie, for this opportunity. I thought it would be appropriate to speak about allergy and headaches and seasonal allergic rhinitis or hay fever. It’s associated with sinus headaches which is a common complaint especially now in the spring. Although a sinus headache is commonly diagnosed by physicians and even self-diagnosed by patients, acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches. In many cases, presenting with sinus headache turn out to have might migraines. The prominence of sinus symptoms often leads to the misdiagnosis of sinus headaches in patients who meet diagnostic criteria for migraine. In fact, an observational study that enrolled almost 3,000 patients with a history of physician or self-diagnosed sinus headaches and no previous history of migraines reveal that 88 percent of these patients actually had a migraine. In the patients with migraines, sinus pain, pressure, and congestion commonly occurred in association with typical migraine features, such as pulsing head pain and sensitivity to light and activity and sound. Therefore, sinus headache may be difficult to diagnose. Sometimes physicians will give a trial of medication to see if the patient will respond. Actually, systemic history is the single most important factor in establishing a headache diagnosis and determining the future workup and treatment plan. A thorough history also helps focus the physical examination and prevent unnecessary investigations and imaging studies. I often ask patients to keep a headache diary in which they can log such things as frequency, intensity, and duration of headache, number of headache days a month, associated symptoms and abnormalities, any precipitating and relieving factors, any recent change in vision, any recent changes in sleep, exercise, weight, or diet, and in women, any change in her method of birth control and effects of menstrual cycle and hormone therapy.
Melanie: If we suspect that a migraine or a headache is due to one of these seasonal or food allergies, is the first we thing we do we go to see an allergist or our internist or do we start right away figuring out, doing over-the-counter medications, trying Nasacort or things that might clear us up a little? Give us a kind of a working first line of defense, what you want people to do if they start to get these headaches on a regular basis.
Dr. Joseph: Well, I think it’s important to know what some of the triggers are and the symptoms before approaching management. In terms of allergic rhinitis and hay fever, an allergy headache trigger would be nasal or sinus congestion and this can occur from exposure to pollen, trees, grasses. The key for all headaches is to identify the triggers and avoid them, which may not be easy to do. In terms of symptoms of sinus headache, the sinus cavities are hollow air spaces with openings into the nose to allow the exchange of air and mucus. They are located inside each cheekbone, behind the eyes, behind the bridge of the nose, and in the forehead. Secretions from the sinus cavities normally drain into the nose. Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up. Often, the pain is localized over the affected sinus, perhaps causing facial pain rather than a headache. For example, if the maxillary sinus in the check is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Obstruction in other sinuses can cause pain on the top of your head or elsewhere. Sinus pain can be dull to intense. It often begins in the morning and becomes less intense as you move from lying flat to sitting or standing in an upright position. This is kind of a tell-tale sign. Similar pains can also be caused by severe nasal congestion, particularly if you have a deviated septum. Such headaches or facial pain can involve one side only. So in terms of management and treatment, the first thing you should do is see a physician and get the correct diagnosis. The first approach in managing the sinus headache is to avoid the allergens that triggered them. Many of these are air-borne so this may be difficult. In terms of outdoor exposure, patient should stay indoors as much as possible when common triggers such as high pollen count are at their peak, usually during the mid-morning and early evening and when wind is blowing pollens around. They should avoid using window fans that can draw pollens and mold into the house and they should be wearing glasses or sunglasses when outdoors to minimize the amount of pollen getting into their eyes as this can cause sinuses to clear up as well.
Melanie: Dr. Joseph, do you approve of things like air filters to keep the indoor air clean? What do you think of something like nasal lavage to kind of give your sinuses that shower that might help with these headaches?
Dr. Joseph: That would be a great idea actually. Some at-home treatments and conservative management that people can do without even seeing a physician would be to drink plenty of fluids to thin out the mucus, stay well-hydrated, inhale steam two to four times a day, spray the nose with nasal saline several times a day, use a humidifier, use a Neti pot to flush the sinuses, many people do that, and even applying heat to the sinuses, like a warm, moist washcloth to your face several times a day. I also tell patients that when they come in from the outdoors, they’re going to be covered with allergens. One thing they should do is to not only wash their clothes but they should also take a bath so they’re not getting in to bed in the evening with the allergens.
Melanie: Well, that’s very good advice, certainly the not getting in to bed with these allergens on you, and people don’t even really think about that sort of thing. What is your best advice for people that are suffering from these seasonal allergies? They’ve got the sneezing and the itching, watery eyes. What do you think of the various nasal sprays out there? Can some of them make the situation worse if they try some of those over-the-counter nasal sprays?
Dr. Joseph: Well, this is where it’s important to see your physician first to get a recommendation of what over-the-counter medicines you could use. Your doctor may suggest both prescription and non-prescription medications, like antihistamines, decongestants, and corticosteroids. Antihistamines block the effect of histamines which is the chemical produced by the body in response to allergens. Oral and nasal decongestants may be the treatment of choice for nasal congestion that causes a sinus headache. Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissues. Intranasal corticosteroids are also used. These medications can significantly reduce nasal congestion as well as sneezing, itching, and a runny nose. Other treatments and medications include immunotherapy or allergy shots. These may be recommended for people who don’t respond well to treatment with medications, experience side effects from medications, or have allergen exposure that is unavoidable. Nasal cromolyn is also used. Nasal cromolyn is a nasal spray that blocks the body’s release of allergy-causing substances. Nasal cromolyn can help to prevent allergic nasal reaction if taken prior to an allergen exposure, but it doesn’t work in all patients. Then finally, pain relievers. Over-the-counter medications like acetaminophen and ibuprofen may provide some short-term relief for sinus headache pain.
Melanie: Thank you so much, Dr. Joseph. That is great information. You are listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Do You Suffer From Headaches Due to Allergies?
Melanie Cole (Host): Although allergies are thought to cause headaches, they are two different conditions. Allergies can cause sinus congestion which can then lead to headache pain. The two types of headaches are linked to allergies, sinus headaches, and migraines. What is this link between allergies and headaches? My guest today is Dr. Lisa Joseph. She’s an internist with Summit Medical Group. Welcome to the show, Dr. Joseph. Let’s talk about that link between allergies and headaches. Do all headaches come from allergies and do all allergies cause headaches?
Dr. Lisa Joseph (Guest): Well, first, I’d like to say thank you, Melanie, for this opportunity. I thought it would be appropriate to speak about allergy and headaches and seasonal allergic rhinitis or hay fever. It’s associated with sinus headaches which is a common complaint especially now in the spring. Although a sinus headache is commonly diagnosed by physicians and even self-diagnosed by patients, acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches. In many cases, presenting with sinus headache turn out to have might migraines. The prominence of sinus symptoms often leads to the misdiagnosis of sinus headaches in patients who meet diagnostic criteria for migraine. In fact, an observational study that enrolled almost 3,000 patients with a history of physician or self-diagnosed sinus headaches and no previous history of migraines reveal that 88 percent of these patients actually had a migraine. In the patients with migraines, sinus pain, pressure, and congestion commonly occurred in association with typical migraine features, such as pulsing head pain and sensitivity to light and activity and sound. Therefore, sinus headache may be difficult to diagnose. Sometimes physicians will give a trial of medication to see if the patient will respond. Actually, systemic history is the single most important factor in establishing a headache diagnosis and determining the future workup and treatment plan. A thorough history also helps focus the physical examination and prevent unnecessary investigations and imaging studies. I often ask patients to keep a headache diary in which they can log such things as frequency, intensity, and duration of headache, number of headache days a month, associated symptoms and abnormalities, any precipitating and relieving factors, any recent change in vision, any recent changes in sleep, exercise, weight, or diet, and in women, any change in her method of birth control and effects of menstrual cycle and hormone therapy.
Melanie: If we suspect that a migraine or a headache is due to one of these seasonal or food allergies, is the first we thing we do we go to see an allergist or our internist or do we start right away figuring out, doing over-the-counter medications, trying Nasacort or things that might clear us up a little? Give us a kind of a working first line of defense, what you want people to do if they start to get these headaches on a regular basis.
Dr. Joseph: Well, I think it’s important to know what some of the triggers are and the symptoms before approaching management. In terms of allergic rhinitis and hay fever, an allergy headache trigger would be nasal or sinus congestion and this can occur from exposure to pollen, trees, grasses. The key for all headaches is to identify the triggers and avoid them, which may not be easy to do. In terms of symptoms of sinus headache, the sinus cavities are hollow air spaces with openings into the nose to allow the exchange of air and mucus. They are located inside each cheekbone, behind the eyes, behind the bridge of the nose, and in the forehead. Secretions from the sinus cavities normally drain into the nose. Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up. Often, the pain is localized over the affected sinus, perhaps causing facial pain rather than a headache. For example, if the maxillary sinus in the check is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Obstruction in other sinuses can cause pain on the top of your head or elsewhere. Sinus pain can be dull to intense. It often begins in the morning and becomes less intense as you move from lying flat to sitting or standing in an upright position. This is kind of a tell-tale sign. Similar pains can also be caused by severe nasal congestion, particularly if you have a deviated septum. Such headaches or facial pain can involve one side only. So in terms of management and treatment, the first thing you should do is see a physician and get the correct diagnosis. The first approach in managing the sinus headache is to avoid the allergens that triggered them. Many of these are air-borne so this may be difficult. In terms of outdoor exposure, patient should stay indoors as much as possible when common triggers such as high pollen count are at their peak, usually during the mid-morning and early evening and when wind is blowing pollens around. They should avoid using window fans that can draw pollens and mold into the house and they should be wearing glasses or sunglasses when outdoors to minimize the amount of pollen getting into their eyes as this can cause sinuses to clear up as well.
Melanie: Dr. Joseph, do you approve of things like air filters to keep the indoor air clean? What do you think of something like nasal lavage to kind of give your sinuses that shower that might help with these headaches?
Dr. Joseph: That would be a great idea actually. Some at-home treatments and conservative management that people can do without even seeing a physician would be to drink plenty of fluids to thin out the mucus, stay well-hydrated, inhale steam two to four times a day, spray the nose with nasal saline several times a day, use a humidifier, use a Neti pot to flush the sinuses, many people do that, and even applying heat to the sinuses, like a warm, moist washcloth to your face several times a day. I also tell patients that when they come in from the outdoors, they’re going to be covered with allergens. One thing they should do is to not only wash their clothes but they should also take a bath so they’re not getting in to bed in the evening with the allergens.
Melanie: Well, that’s very good advice, certainly the not getting in to bed with these allergens on you, and people don’t even really think about that sort of thing. What is your best advice for people that are suffering from these seasonal allergies? They’ve got the sneezing and the itching, watery eyes. What do you think of the various nasal sprays out there? Can some of them make the situation worse if they try some of those over-the-counter nasal sprays?
Dr. Joseph: Well, this is where it’s important to see your physician first to get a recommendation of what over-the-counter medicines you could use. Your doctor may suggest both prescription and non-prescription medications, like antihistamines, decongestants, and corticosteroids. Antihistamines block the effect of histamines which is the chemical produced by the body in response to allergens. Oral and nasal decongestants may be the treatment of choice for nasal congestion that causes a sinus headache. Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissues. Intranasal corticosteroids are also used. These medications can significantly reduce nasal congestion as well as sneezing, itching, and a runny nose. Other treatments and medications include immunotherapy or allergy shots. These may be recommended for people who don’t respond well to treatment with medications, experience side effects from medications, or have allergen exposure that is unavoidable. Nasal cromolyn is also used. Nasal cromolyn is a nasal spray that blocks the body’s release of allergy-causing substances. Nasal cromolyn can help to prevent allergic nasal reaction if taken prior to an allergen exposure, but it doesn’t work in all patients. Then finally, pain relievers. Over-the-counter medications like acetaminophen and ibuprofen may provide some short-term relief for sinus headache pain.
Melanie: Thank you so much, Dr. Joseph. That is great information. You are listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.