When most people think of migraine, they imagine throbbing pain on one side of the head, perhaps accompanied by nausea or sensitivity to light. However, not all migraine follows this classic pattern. Midface migraine, a type of migraine that causes pain in the center of the face, can easily be confused with headache attributed to rhinosinusitis which is colloquially termed a 'sinus headache'. This confusion can delay appropriate treatment and leave people suffering longer than necessary.
What Is a Midface Migraine?
A midface migraine presents with pain in the center of the face, particularly around the eyes, cheeks, and nose. Unlike a traditional migraine that often affects the sides or back of the head, midface migraine can be associated with sinus pain, leading many people to believe they are experiencing a headache attributed to rhinosinusitis.
It's important to note that midface migraine is not necessarily the same as atypical facial pain, which is a term used to describe facial pain that doesn’t fit into typical diagnostic patterns. Atypical facial pain often involves constant, dull discomfort that may be poorly localized, and it might not respond to standard migraine treatments.
Why Midface Migraine Is Mistaken for Headache Attributed to Rhinosinusitis
Many people are familiar with the symptoms of sinus congestion—pressure in the face, fullness in the cheeks, and pain around the eyes. These sensations are strikingly similar to what you might feel during a midface migraine. However, the key difference lies in what’s happening behind the scenes.
A headache attributed to rhinosinusitis is caused by inflammation of the sinus cavities, often due to infection or some sort of structural abnormality of the sinuses. Midface migraine, on the other hand, has no link to sinus disease. Instead, the pain is caused by changes in the trigeminal nerve, which is responsible for sensations in the face. When the trigeminal nerve becomes irritated or inflamed during a migraine, it can produce pain that feels like sinus pressure but isn’t related to congestion or infection. What is even more confusing is that midface migraine may even be accompanied by nasal congestion, ear fullness, eye tearing and eye redness, symptoms also associated with sinus disease.
Key Differences Between Headache Attributed to Rhinosinusitis and Midface Migraine
It’s crucial to distinguish between a headache attributed to rhinosinusitis and a midface migraine to receive the right treatment. While both may cause facial pain, here are some key differences:
Associated symptoms
Headaches attributed to rhinosinusitis are typically accompanied by symptoms of an infection, such as a runny or stuffy nose, fever, or postnasal drip. Midface migraine is not associated with fever, and although it may be associated with nasal congestion and a runny nose, the discharge is often clear instead of thick, green mucus. Midface migraine may also be associated with other migraine symptoms like nausea, sensitivity to light and sound, and aura (visual disturbances). Additionally, midface migraine may occur more commonly with seasonal changes or weather changes. For example, individuals suffering from midface migraine may complain that they get 'sinus headaches' whenever it rains or more commonly in the fall and spring. Interestingly, rhinosinusitis is rarely associated with facial pain alone.
Responses to treatment
Getting the Right Diagnosis
If you’ve been struggling with sinus headaches and have not experienced relief from previous treatments to address sinus disease, you may be dealing with a midface migraine rather than sinus disease. Consulting an orofacial pain specialist can help make the correct diagnosis.
Your doctor may ask you to track your symptoms. They may also rule out sinus infections or other causes of your facial pain. Imaging studies, such as an MRI or CT scan, may be ordered if needed, though most of the time, a careful history and clinical exam are enough to differentiate between sinus pain and migraine.
Treatment for Midface Migraine
Treatment for midface migraine typically follows the same guidelines as for other types of migraine. Acute medications can help stop the migraine once it starts, while preventive medications or lifestyle changes can help reduce the frequency and severity of the attacks.
Some approaches include:
Acute treatments: There are multiple medications available for acute treatment of migraine including triptans, NSAIDs, gepants, ditans or combination medications to stop migraine pain.
Preventive treatments: Multiple preventative medications are available including antidepressants, anticonvulsants, beta-blockers, CGRP monoclonal antibodies, gepants, botox, neutraceutals and neuromodulation devices.
Lifestyle adjustments: Managing stress, improving sleep, and avoiding known migraine triggers can help prevent midface migraine.
Conclusion
Midface migraine is often mistaken for headache attributed to rhinosinusitis due to the location of the pain. However, understanding the difference between the two is key to finding relief. If you suspect your facial pain is due to migraine rather than sinus issues, consulting with a healthcare provider who specializes in headache disorders can help get you on the right track to effective treatment.
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