A great deal of confusion exists among patients and their physicians regarding the source of symptoms of facial pressure . While facial pressure is indeed a cardinal symptom of “ true ” sinusitis , up to 45 % of migraine patients report attack-related “ sinus ” symptoms , including tearing , runny nose , and nasal congestion . In migraine , these symptoms may be caused by a release of peptides by the trigeminal nerve branches going to the mucous membranes in the nasal cavity and sinuses . These symptoms may last only a few minutes or hours during the migraine episode . Sinus symptoms caused by colds or sinus infections tend to last for days .
Sinus pain , which feels like pressure , is also commonly associated with migraine , and may be the only “ headache ” experienced in a migraine . In migraine , symptoms tend to last minutes to hours rather than for days , as in sinus infections . Fifty percent of migraine patients report that their headaches are influenced by weather .
Treatment Guidelines for Physicians
For treatment we first encourage a strict migraine control diet , eliminating common migraine culprits including chocolate , wines , caffeine , certain cheeses , monosodium glutamate ( MSG ) as well as less frequently recognized problem foods containing yeast ( yoghurt , sourdough , freshly made bread ), nuts , and nut products . Glutamate can occur in foods not only through the addition of MSG , but also by hydrolyzing ( breaking down ) proteins . So labels that include “ hydrolyzed casein ,” “ hydrolyzed yeast extract ,” etc ., are likely to include glutamate .
We also encourage a regular sleep schedule and aerobic exercise program . Patients are also counseled to avoid vasoconstrictive medications such as psuedoephedrine , and to minimize the use of triptans , which may cause rebound symptoms .
When patients follow these guidelines and still have migraine-associated symptoms , we emphasize prophylactic medications in preference to the “ quick fix ” agents such as fiorinal , triptans , narcotics , or steroids . Effective prophylactic medications are chosen based on the patient ’ s other medical problems and tolerance of side effects . Some suggested regimens follow :
Calcium channel blockers : Diltiazem CD 120 mg / d increasing as tolerated to 240- 480 mg total / d , often in two divided doses . Constipation and hypotension are the most common side effects , but this is often the best-tolerated regimen .
Antidepressants : Nortriptyline starting at LOW doses ( 10 mg / d ) and slowly increasing to 50- 100 mg at night . Higher doses ( 100-200 mg ) may occasionally be needed . Levels can help guide therapy . Dry mouth , weight gain , and sedation are the most common side effects . Patients with poor sleep often benefit the most from these agents .