December 27, 2006
The idea of referred pain explains allergic headaches. For most of our internal organs, we don’t have specific feeling. We feel the pain of our insides somewhere on the surface of our body. One common example is heart pain. Commonly our patients feel their pain in the left arm or can. We call the heart pain referred to the arm or hand. Swelling or pressure on the inside of the nose refers its pain to the face. The advertising industry has brain-washed us into calling these ‘sinus headaches’. The pain is described as pressure sensation around the eyes and between the eyes. Pain from the back part of the nose can also be experienced in the eye. Such pain sometimes get quite intense! How susceptible we are to getting nasal headache depends on the shape of our noses. Those of us with the tall narrow noses have the most trouble. Anything causing swelling in the narrow nose can cause the nose to pinch itself. If the wall dividing our nose(septum) is buckled, one side will be more troublesome than the other.
How do you tell if your headaches are allergic? They occur in a specific time and place. Secondly their associated with a sensation of stuffiness of the nose. When you blow your nose the secretions will be clear. The headaches usually are accompanied by itchy eyes or itchy roof of the mouth. Specific foods can trigger nasal headaches not only by allergy mechanisms which cause the swelling, but also by triggering blood vessel reflexes creating the same effect.What can you do about them? The best treatment is prevention. If you can identify the environmental trigger for the stuffiness and avoid it you’ll have no further headaches. Often this is not practical. Over-the-counter the decongestants which include pseudoephedrine or phenylpropanolamine are designed to reduce the swelling and maybe successful in reducing the tightness of the pinch. They are often combined with antihistamines both to block the allergic reaction and to counteractive in the agitation which can be a side effect. The final ingredient in many over-the-counter remedies includes a pain killer like aspirin or acetaminophen. Although they’re called sinus pills, they do little to improve sinus function but really are active in the nose.When the responsible factor can’t be identified or avoided, and over-the-counter remedies don’t help, it’s time to see an allergist.
Successful desensitization will mean the end of the problem. Occasionally, allergy is just one factor causing nasal headaches. Correcting the allergy alone may not provide relief because many other influences cause nasal swelling. Other factors can include infection hormonal changes, or reflexes triggered by light or temperature change. In most cases, nasal headaches add to the misery of migraine, which is often accompanied by swelling in the nose on the same side of the headache. In these circumstances, the most direct approach is to change the geometry inside the nose. This is done by changing the shape and consistency of the second, the wall that divides the nose into two sides. In properly selected cases, the surgery has a very high success rate.
Norman J. Harris M.D., F.A.C.S.
100 East Valencia Mesa, Suite 111
Fullerton, California 92635
Tel (714)441-0133, FAX (714)441-1082