Hi, I’m Doctor Larry Weiss with Weiss ENT. We have offices in Marietta and Woodstock, GA and today, let’s talk about facial pressure and pain. Is it due to a sinus cause or, which is very frequent, a migraine which is atypical?

We all know where our sinuses are and when you have facial pain its logical to place the blame on a sinus issue. But not all facial pain and pressure is a sinus problem. There’s something called migraine variant or atypical migraine, where you don’t have the classic TV symptoms. Like the horrible pain where your head’s going to blow up; the nausea, the vomiting, you want to be in a dark room, or take some serious pain reliever like morphine.

There are times when people have pressure fullness in their head and other symptoms, including nasal congestion and pressure, and it is not due to a sinus cause, but rather what we call atypical migraine or migraine variant. So how do we figure out is the facial pressure the pain due to a real sinus cause or migraine? Well, listening to the individual will often give us the biggest clue. Has it been going on for a long time? Is there yellow green drainage or cough that goes along with the sinus cause? Does the individual have nausea, dizziness, a change in hearing; all these are very good clues.

There’s also a specific physical exam for migraine in which we can tell if the nerves that are involved in migraine are tender or not. When they are, that gives us a great clue that the individual is suffering from migraine. Migraine is a very common problem that affects millions of people. It is a diagnosis of exclusion – ruling out other causes. When we do suspect that somebody is suffering from migraine, it is important that we get an MRI of the brain to make sure that we’re not missing anything.

Once we get the MRI results back and eliminate other possibilities for the cause of the headaches, and we suspect migraine is the issue, then we take a step back and we talk to the individual about what is going on in their life. Many people with migraine have triggers. Stress, physical or psychologic or real triggers for a lot of people also different foods can be triggers for migraine. The more common are alcohol, especially red wine, cheese, peanut, peanut butter, chocolate, MSG and Chinese food, high salt and take different taste substitutes. Lots of stuff that tastes good.

So what’s super important is we ask people in the beginning to keep a log of anything they eat or drink, and hopefully we can figure out triggers. If one had to suffer with migraines, this is a good time in the history of the world because there is a lot that we can do to help people with migraine to really minimize the impact of migraine on the quality of their life. What are those things that we can do to help people with migraine? Hopefully they can figure out triggers and minimize the impact of those triggers on their life.

There are now some new medicines that act specifically on the migraine pathway, which has been recently discovered, and these medicines block that pathway. These are wonderful medicines that don’t have the side effects of the more traditional medicines that have been used for migraine. In addition, Botox, which is often used for cosmetic reasons, is a godsend for a lot of people with migraine. It does involve an injection in the muscles surrounding the nerves involved with migraine, and the Botox relaxes those muscles and prevents them from squeezing the nerve. Which prevents those nurses from sending the impulses to the brain, which triggers the migraine pathway, and it greatly improves the quality of life for many, many people with migraine. If you are a loved one or suffering with chronic facial pressure, pain, congestion, stuffiness, dizziness, you may have migraine. Please give us a call so we can help you figure it out and hopefully improve the quality of your life. Take care.