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You ask . We answer . you said it 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
TOO MUCH OF A GOOD THING
How do you recommend treating tension-type headache without causing rebound headaches ? — Lwellen H .
Rebound headaches , or medication overuse headaches , are the result of taking a medication that makes problems worse . The analogy I use for patients is over-fertilizing your plants . At a certain level , fertilizer is good . For example , for a certain amount of tensiontype headache , ibuprofen is good ; but remember the old rule of thumb that too much of a good thing becomes a bad thing . For people with headache , that translates to a situation where pain relievers feed or perpetuate headache , escalating the problem and increasing the frequency of headache episodes . This often presents as a gradual increase in headache frequency over weeks or months .
To avoid this situation , first use medications that work effectively for tension-type headache . Such options might include NSAIDs , aspirin and acetaminophen . Then limit use of those medications strictly to 10 to 12 days per month . Medications that contain caffeine likely carry a higher rebound potential , so I recommend limiting use of medications combined with caffeine to eight days per month . If you require more frequent treatment ( e . g ., if you are having 15 or more headaches per month ), then it ’ s time to do more to prevent the headaches . This might include taking a daily medication such as amitriptyline . At a certain point , you need to stop treating the symptoms and start addressing the core condition .
Rebound headache is a tremendous problem with opioid or narcotic agents ( see page 35 ) because the ceiling can be as low as three days a month before the medication-overuse effect appears . I strongly recommend avoiding narcotics . Not only are they not indicated for the treatment of tension-type headache , but they also carry a high risk of rebound headache .
— Robert G . Kaniecki , MD , University of Pittsburgh , Pittsburgh
Do you have a question for the NHF experts ? Send it to info @ headaches . org , and it could appear in our next issue .
The Sick Headache “ I recently discovered a copy of your magazine , and I am moved to write about my own experiences regarding migraines . I am a 74-year-old man , born in a small market town into a working class family in England , and have suffered with migraine as long as I can remember . When I was a child , such attacks were known as “ sick headaches .” They would start with an odd odor in the nose , and then I would start to see vibrating semicircles that completely blurred my vision . Then one side of my face , usually the right side , would start to tingle and go numb . This feeling would move into the mouth and tongue , at which point I would invariably vomit , hence the “ sick ” part of the diagnosis . The numbness would then move into my arm and leg , by which time I would be lying down in a dark room , and my head would start to ache . The only treatment considered at that time was aspirin , which did no good . The symptoms would persist for up to three days , and I had very little sympathy from my family , siblings or parents , and certainly never a visit to a doctor . Even if my parents had known the word “ migraine ,” which they clearly didn ’ t , it would have been associated at that time with upper-class ladies , who in the romantic novels of the time were always retiring to their bedchambers with a migraine .
“ As I grew up , I learned to cope with these attacks , which happened at least once a month , and I would go and lie down in a dark room until it passed . As I got older , I realized what it was I suffered from and tried all the suggested remedies I read about . Finally I found the only one that worked , an over-the-counter tablet called Migraleve™ . Taken at the start of the symptoms , the attack would be reduced to only two to three hours , after which I would be able to return to work , though still feeling fairly groggy for maybe a day or two .
“ When I was in my early 20s , I started keeping a food diary . I soon realized that a meal containing cheese would invariably be followed within 24 hours by a severe migraine , which was unfortunate as cheese had always been a big part of my diet . I gave up eating cheese , and sure enough the frequency of attacks diminished to only three to four a year . These I could often trace to exposure to the smell of cheese . Also , sometimes an attack would be triggered after drinking red wine , and I discovered that a severe headache would follow a meal or snack containing chocolate . I later discovered that it was only cheese made from cows ’ milk that caused the problem , so I could substitute goat cheese or cheese made from sheep ’ s milk . Unfortunately , having recently moved to South Carolina , I find it quite difficult to source those cheeses , and they tend to be very expensive . It is also difficult , when eating out , to find food on menus that don ’ t include cheese . Now at 74 , when I do get a migraine attack it is very mild and usually over in less than an hour .” — TERENCE A .
HW : Thank you for sharing your story with us ! We ’ re glad to hear your migraines have waned . Readers , if you would like to share your headache story , visit www . headwisemag . org / WiseWords .
If you have comments or suggestions about Head Wise , send them to info @ headaches . org or post them on the NHF Facebook page .
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