Headache is one of the top health complaints of Americans. We're bombarded with advertisements and we pay many millions of dollars for pain relievers. Headache also is one of the most common reasons people see physicians.
Three types of headaches may possibly be related to allergic disease - "sinus headaches" (facial pain), migraines and cluster headaches.
What is the connection between allergies and headaches?
Years of published data and clinical experience suggest that food allergy may be a trigger of recurrent, persistent migraine headaches in a few, but by no means all patients. In such cases, only a few foods trigger migraines and, by limiting or avoiding them, you can experience complete or marked relief without medication. If you have a firm diagnosis of migraine made by a physician expert in the diganosis and treatment of migraine headaches, you may want to keep a diary of foods eaten and their relation to your headaches, and then request consultation with an allergist for evaluation and possible allergy testing. On a nonallergic basis, some migraines are provoked by food additives or naturally occurring food chemicals such as monosodium glutamate (often added to oriental food and packaged foods), tyramine (found in many cheeses), phenylethylamine (found in chocolate) or alcohol. The artificial sweetener aspartame has also been reported as a trigger migraine in some people.
Everybody gets headaches. How do you know when you should see your doctor about them?
Because each of us is different in how we handle pain, you must decide yourself. However, here are some conditions that might call for a visit with your physician:
- The recent onset of frequent, moderate to severe headaches, associated with other symptoms such as nausea or vomiting.
- Headaches that occur on a daily or weekly basis.
- Headaches that make it impossible for you to think, do your work, go to school or enjoy life.
- Headaches that respond only to a great deal of over-the-counter pain-relief medication.
- Headaches with fever that last more than a day or two.
How are headaches diagnosed?
Your doctor will ask you to describe how severe your pain is, where it's strongest, how you obtain relief, if other symptoms accompany your headaches and if you've found that some things make your headache worse. A physical examination will reveal the causes of some headaches. If necessary, your doctor will order laboratory tests, x-rays and brain-wave tests. Often these tests are ordered after consultation with a neurologist, a physician who specializes in nerve and brain problems.
Some types of headaches have an allergic basis, but most do not. Before you see an allergist-immunologist for evaluation and treatment of your headaches, you should first visit your primary care physician first to rule out the other more common causes of your headaches.
In some cases, a careful evaluation allergy evaluation may pinpoint the allergen (allergy-causing substance) causing a headache.
What are the symptoms of "sinus headache"?
The four groups of sinus cavities in the head are hollow air spaces with openings into the nose for exchange of air and mucus. They're 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 cheeks is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Other sinuses can cause pain on the top of your head, or elsewhere. Sinus pain can be dull to intense, often begins in the morning and becomes less intense after you move from a lying down to an upright position.
Similar pain can also be caused by severe nasal congestion, particularly if you have a septal deviation or septal "spur" from a previous nasal injury. Such "headaches" or facial pain can involve one side only.
Oral or nasal spray decongestants often help relieve symptoms of facial pain headache due to nasal or sinus blockage. Antihistamines are generally less helpful. Obstructed sinuses can get infected, requiring more intensive treatment, including antibiotics.
One hint that allergy might play a role in your sinus headaches or facial pain is if you have other upper airway symptoms such as the itching, sneezing and runny nose of seasonal allergic rhinitis (hay fever). Allergy is not usually a direct cause of these types of headaches when the other allergic rhinitis symptoms are not present. Allergic reactions to things like airborne pollens, dust, animal dander, molds, as well as foods, can lead to sinus obstruction. Treatment of the underlying allergic cause of sinus pain can result in long-term relief. Medications used to treat allergies include antihistamines, decongestants, intranasal steroids and cromolyn. In some cases, allergen immunotherapy (allergy shots), may be recommended. When possible, of course, avoid the allergen if an avoidable substance causes your allergy.
What are migraines?
Migraine headaches vary from very intense and disabling to mild. Migraines tend to be throbbing, usually one-sided headaches, that often are aggravated by sunlight and are frequently accompanied by nausea. Migraine headaches can run in families. There are two general types of migraine: classic and common (plus many variations). If you are having these types of headaches, you should schedule an appointment with your doctor for evaluation, because certain new medications are very effective in preventing and stopping migraines in their tracks.
Classic migraine attacks tend to be severe and of long duration. They are preceded by aura, a sensation that signals the start of a headache. The aura may be a funny smell, partial vision loss or a strange sound.
Common migraine is more prevalent than classic migraine. Attacks are generally milder and shorter. There is no aura. However, because the attacks may occur more frequently, common migraine also can be quite disabling.
If you have more questions about allergies and headaches, your allergist-immunologist will be happy to answer them.
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